With lots of blood, plenty of gore, and - every now and then - a nail or bone protruding from an arm, the Hamilton County Health Department could have easily doubled as the set of a horror film Wednesday morning.
But as 200 volunteers sat getting elaborate, bloody make-up completed at the Hamilton County Health Department, hospitals throughout the region were being alerted to a scenario far worse than anything in a horror movie: A bomb explosion during a football game at Neyland Stadium in Knoxville that injures thousands.
Soon, the "victims" in the makeup would arrive at emergency rooms in droves.
The scenario, devised by state officials, was one part of what officials called the largest emergency response drills conducted in the state, meant to test the region's ability to respond to a mass-casualty event.
The drill was orchestrated by the East Grand Division Healthcare Coalition and involved 56 hospitals, health departments across the region, hundreds of first responders and about 1,000 actors portraying bomb victims.
"We have never seen anything with quite this magnitude," said Sabrina Novak, emergency response coordinator with the Hamilton County Health Department.
With mass-casualty disasters like the Boston Marathon bombing, state officials have recognized the need for emergency drills to stretch beyond individual hospitals or even cities. If such a bombing were to occur in Knoxville, hospitals from Chattanooga to Johnson City would be needed to help the wounded.
"Anytime you overwhelm a local resource, you need to have backup plans. And we need to be prepared to be on the receiving end of some heavy patient volumes with serious injuries," said Dr. Jim Creel, chief medical officer at Erlanger Health System.
On Wednesday, those included everything from burns to fractures to bloody lacerations and smoke inhalation. Some actors weren't visibly injured, but were having panic attacks and meltdowns in the emergency room. Some were "dead on arrival."
The drill tests a hospital staff's ability to make agonizing decisions in seconds. What if a surge patients flooded the hospital when it was already full? What patients would have be discharged, or moved out of the intensive care units?
"The staff has a method to the madness and they have to make decisions, but this tests that," said Winston Shields, Memorial Health Care System's director of emergency preparedness
The drill also could prepare the region for incidents like large-scale transportation disasters and a natural catastrophes, said Novak.
Hospital officials compared the drill to the actual surge of patients they experienced during the April 27, 2011, tornadoes, which killed 81 people in the tri-state region and injured hundreds.
That day forged a bond between the competing hospitals and other providers in the region, though officials say they already have strong cooperation thanks to monthly meetings where local health care providers and other emergency workers plan for a whole range of potential disasters.
"I consider us sister facilities," said Robin Marsh, director of emergency services at Parkridge Health System.
"We all have to depend on each other and support each other if we went to take care of the community."
Contact staff writer Kate Harrison at firstname.lastname@example.org or 423-757-6673.