All 27 acute care hospitals in Hawaii participated in a tsunami and earthquake disaster exercise Thursday, which organizers said was mostly successful.

Hospitals on six islands joined in the Navy’s 2018 Rim of the Pacific (RIMPAC) training exercise simulating a natural disaster. This is the first time all of the state’s acute care hospitals participated in the exercise.

More than 300 volunteer patients gathered at Ford Island and waited to be treated and transported to local hospitals.

“There were a lot of successes,” said Chris Crabtree, director at Hawaii Healthcare Emergency Management, the program that helped coordinate the disaster exercise. “New things we were trying went well … and we will implement them further.”

The volunteers were made up to look like they had serious injuries.

The floor of a makeup tent on Ford Island was splattered with fake blood as artists turned volunteers into injured patients. Each patient was given a laminated card that described their injuries in detail for medical personnel. Injuries included visible harm such as broken ankles, deep lacerations and objects impaling the skin as well as mental trauma.

Most volunteers heard about the event through one of the 27 hospitals.

“When I got the email, I hurried to add myself,” said Dawnn Villarreal, a first-time volunteer from The Queen’s Medical Center waiting to be airlifted to a nearby hospital. “I’m really excited to try this,” she said.

Volunteer patients were ushered into a triage tent to be organized into one of three tents for treatment: green (minor), yellow (delayed or non-life-threatening) or red (immediate).

Despite some of the cards instructing patients to “scream in pain,” many volunteer patients were smiling while waiting to be treated in medical tents or waiting to be transported by U.S. Army helicopters, U.S. Air Force Reserve Air Ambulances or ambulance buses.

“Everyone has different backgrounds and we learn from each other,” said Diana Bradner, a registered nurse at Kaiser Permanente who also worked as a nurse in the simulation. “This exercise shows us where to improve,” she said.

The RIMPAC disaster training exercise will continue today with 92 post-acute and acute care facilities involved.