Nicole (Mancuso) Castellano ’14 didn’t expect her experience in emergency medical training to be put to the test so soon after graduating from Texas A&M University’s nursing program in 2016. And especially not during such a devastating event: the 2017 mass shooting in Las Vegas.
“My heart was racing. I didn’t know what I was going to walk into,” Castellano recalled. “That was the scariest part, because you had no clue how bad it was going to be, what you were going to see and if it’s going to change you for what you see that night.”
Castellano was on duty the night of the shooting and was the only nurse on the emergency department floor who had received mass casualty training. Due to her experience as an undergraduate nursing student at Texas A&M, and despite having graduated only months before, she was placed in charge of fellow nurses to triage patients as they entered the emergency room. She treated nearly half of the 53 victims of the shooting who were rushed into the hospital that night.
“It was complete chaos — we had people come in from the lobby, along with those brought in by emergency medical services,” she said. “High adrenaline and a sense of duty helped me keep my composure. You have to stay calm in these situations, for the sake of the patient.”
The massacre claimed the lives of nearly 60 people and injured hundreds more. It was the deadliest single-shooter mass shooting in America. First responders flocked to the area to help, with Castellano among them. Despite not knowing what to expect or the extent of the horrors she would see, she was able to draw on her experience at Texas A&M Health’s Disaster Day, the nation’s largest student-led interprofessional emergency response simulation. Hosted every year, the intricate event helps prepare students for emergency response and teaches them vital skills to practice collaboratively upon graduation.
Castellano credits the real-world techniques she learned by participating in the interprofessional simulation with helping her mentally prepare for the experience of the Las Vegas shooting. “If it wasn’t for them, I would not have known what to do, and I don’t think I would have been able to keep my composure and stay calm and figure out who needs help right away.”
Preparing first responders for the worst
Disaster Day, a Texas A&M Health event, was initiated by the Texas A&M College of Nursing in 2008, prompted by the destruction caused by Hurricane Ike and the massive response needed afterward. However, the training day doesn’t just mimic the aftermath of hurricanes — it also prepares students to respond to fires, train derailments, earthquakes and various other mass-casualty events, as well as the aftermath of natural disasters. A different scenario is planned each year and kept secret until the day of, ensuring participants are just as unaware as they would be in the event of a real disaster.
The simulation takes place at the Texas A&M Engineering Extension Service’s (TEEX) Disaster City, which is equipped with full-size collapsible structures, rubble piles and various other features that form a 52-acre training ground that has been struck by some kind of large-scale disaster. Students from various colleges and schools participate, demonstrating the importance of cooperation among responders in a real-life scenario.
Throughout the day, drills are performed in which students act as either survivors, patients, providers, search-and-rescue personnel or family members of those impacted. Victims — outfitted with ripped clothing and fake wounds — cry out for help from their locations and are brought to makeshift field hospitals to be assessed and treated. Students’ responsibilities are based on their individual degree paths. Pharmacy students determine necessary medications, psychology students provide mental health assessments, veterinary students tend to the animals involved, nursing and medical students treat patients, and public health students deploy resources. Instructors and others observe each exercise and provide students with feedback on both their clinical skills and collaboration with one another in their responses.
The entire event is organized throughout the year by a group of over 50 Texas A&M Health students, with help from faculty and staff in health-related departments, as well as TEEX/Disaster City staff and members of the Texas Division of Emergency Management.
Translational skills in action
One skill that health science students, in particular, are able to hone is the ability to triage effectively — that is, sort incoming patients by the level of their injuries and urgency with which they need care, creating a more efficient and organized system for delivering care. Castellano recalled that having learned this method during Disaster Day was especially helpful in the chaos she entered on the night of the shooting.
“The simulation taught me how to appropriately triage in cases of mass casualties and how to treat patients properly,” she said. “Having the knowledge of triaging really helped to know who needs more time from me and who is OK in comparison. What I learned at the college built my initial skills to become an ER nurse.”
The tragic events of the Las Vegas mass shooting in 2017 brought Castellano’s training into sharp focus. Her ability to remain composed amid the mayhem that night and effectively triage and treat so many patients was a profound testament to the power of preparation.
Since then, Castellano has continued to follow the path of serving others by advancing her nursing education and applying the experience she has gained as a health care provider to stand as a force for good. After earning her Master of Science in Nursing-Family Nurse Practitioner degree in 2020, Castellano began working as a family nurse practitioner in Nevada before moving to Manvel, Texas, where she helped build a small primary care clinic into a successful practice.
Recently, she moved to Idaho Falls, Idaho, where she will begin offering whole body care through a primary care and mental health practice. Her husband, Chris, also serves in the medical field as a registered nurse at the Idaho Falls Community Hospital emergency department, and the two will soon welcome their second daughter.
Castellano’s experience vividly illustrates that events like Texas A&M Health’s Disaster Day are not mere academic exercises. By providing realistic, high-stakes exposure to mass-casualty scenarios, the program instills critical skills and turns theoretical knowledge into the muscle memory needed to respond when real-life horror strikes.
Ultimately, the training forged in the rubble and simulated crisis of Disaster City translated directly into life-saving action on one of the deadliest nights in U.S. history, underscoring the vital role such specialized, intensive preparation plays in fortifying the nation’s next generation of first responders.
