From evacuation helicopters taking victims to the nearest hospital to dog rescues and on-site decontamination procedures, the training has to be as real as possible.
More than 5,700 people participated in this year's Vibrant Response near Indiana's Camp Atterbury, the nation's largest exercise in mass-casualty response to catastrophic events on U.S. soil.
This exercise is one of many conducted around the country each year led by the Fort Sam 5th Army Command.
Lt. Col Michael Brough of Army North spoke about the latest training at the Command Operation Information Center at Fort Sam and said they go to great lengths to keep soldiers ready for anything.
He said the people behind the scenes have been designing these scenarios for months before the exercise takes place and troops don’t know ahead of time what kind of scenarios come up in the script.
"To give you an example, we had a simulated warehouse fire and it burned a lot of medical supplies. And so here in our operations center we bring the surgeons, along with the people who are the logisticians, and we say, 'What do we know about this?' And then we say, "How can we fix this?'" Brough said.
Army North officials were pleased with the results of the training and issued this statement:
"By all accounts, the Department of Defense Chemical, Biological, Radiological or Nuclear Response Enterprise is better today than it was 20 days before. Soldiers enhanced their ability to respond to emergencies, save lives, alleviate suffering and help the American people get back to a state of normalcy after a disaster."
Listen to what it's like at one of these live events, a simulated nuclear detonation in a rural community immediately followed by a hurricane in Fort Polk, La.: