Will You Be Prepared When Disaster Strikes?

On May 26, more than 70 people were injured after a car ploughed into crowds celebrating their club’s Premier League title in central Liverpool, England. Days later, in early June, another car crashed into pedestrians in the German city of Passau, injuring five.

Emergency responders routinely prepare for this kind of incident in simulations. When two racing cars recently smashed into a tent full of partygoers in northern Belgium, killing and injuring dozens — it was only a drill. The event was part of a mass casualty simulation held at Campus Vesta, a former military base turned emergency training site, involving more than 400 participants.

Marc Sabbe, MD, PhD, emergency physician at University Hospitals Leuven in Leuven, Belgium, and professor of emergency medicine and disaster management, organized the drill for postgraduate students. “There’s an increased need for simulations, specifically because the risks we are seeing are either increasing in number or in severity,” he said.

Training for the Worst

Countries across Europe are ramping up large-scale training simulations to prepare health and emergency workers for future crises — from terrorist attacks and industrial accidents to pandemics and climate-driven disasters. These exercises not only build skills but also test whether response protocols work under real pressure.

In Belgium, medical education is being overhauled to embed disaster preparedness into training. “There’s now a real movement to prepare our healthcare workers for a different time,” said Sabbe, who coordinates the disaster management postgraduate program at KU Leuven, Leuven, Belgium. He has been involved in discussions about introducing disaster management into the curricula of Flemish medical schools,  which is expected to launch in February next year.

This autumn, the UK will run its largest ever pandemic simulation, Operation Pegasus, designed to test national capabilities and response mechanisms over several months.

Meanwhile, the EU’s MODEX program continues to support complex multinational drills, such as a simulated chemical, biological, radiological, and nuclear event in Latvia and an earthquake scenario in Austria.

Simulations range from localized drills to immersive, hyperrealistic events involving hundreds of participants, complete with smoke, fire, debris, and mock victims. Airports and train stations sometimes lend facilities for such scenarios, which often include live press briefings and coordination centers.

From Makeup to Manikins: The Art of Simulation

To give simulations an authentic feel, organizations like Casualties Union train volunteers to play injured victims, using realistic makeup and role-play to react to treatment. “If they give us pain relief, we relax. If they don’t, we become more and more agitated,” explained Darren Bartlett, a paramedic from the UK’s South East Coast Ambulance Service and training adviser to the union.

Hospitals, too, are stepping up. Senior hospital leaders at University Hospitals Leuven take part in tabletop decision-making simulations, while nurses and emergency staff participate in targeted drills. Every 2 years, the emergency department conducts larger simulations, such as a recent mock mass shooting coordinated by disaster preparedness lead Dimitri De Fré, MA.

Healthcare professionals need to train for scenarios that can overwhelm their hospital’s capacity, De Fré explained, noting how cascading failures — such as an IT system outage — can disable lifesaving machinery, communications, and access to patient data and digital protocols.

Still, large-scale drills can drain already stretched teams and come at a high cost. The current Magnitude full-scale earthquake response exercise running across Germany, Switzerland, and France carries a price tag of nearly €1 million.

Simulate Often, Simulate Smart

Smaller-scale “functional exercises” can deliver many of the same benefits and be held more regularly, said Sara Waring, PhD, a senior lecturer in investigative and forensic psychology at the University of Liverpool, Liverpool, England. “The more complex the skill, the faster it’s going to degrade without any form of repetition.”

But simulation alone isn’t enough; lessons must be learned. Exercise Alice, a 2016 UK tabletop drill modeling a MERS-CoV outbreak, flagged major gaps in personal protective equipment supply and contact tracing protocols. The recommendations, however, were not acted upon before COVID-19 struck.

Multiagency learning is another weak point. Too often, debriefs happen in silos, explained Waring, warning that fragmented follow-ups undermine joint preparedness.

Looking ahead, new technologies — such as high-fidelity manikins, immersive simulation suites, and virtual reality platforms — are expanding access and reducing costs. But Waring cautioned that tech should not replace full-scale immersive simulations. Healthcare professionals still need to be put under stress and work with multiple colleagues in a chaotic environment. “You don’t want a challenging emergency to be the first time they’ve ever been exposed to this to think through how they should respond,” she said.

Waring, Bartlett, De Fré, and Sabbe reported having no relevant financial relationships.

Tatum Anderson has been a global health and medical journalist for more than 20 years, with publications in the Bulletin of the World Health Organization, The Lancet, BMJ, BBC News, and The Economist, among others.