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A chorus of groans, wails and cries for help greeted the small group of firefighters and paramedics as they entered the Montgomery County Fire and Rescue Service training facility's gymnasium Thursday morning.

"Please help," called 27-year-old Gaithersburg resident Megan Ellis as she crouched over her mother, Suzanne Ellis, who lay unmoving on the wood floor; dark red blood smearing both women's faces, and a grisly scar disfiguring Megan's left jaw line. "Mom? Wake up, mom ... Help!"

The paramedics got to work quickly, running from body to body, stopping just long enough to assess each victim's condition: Are they conscious? Who can stand and who has lost too much blood? Who needs immediate help? Even though the "victims" in this case are a group of 27 volunteers sporting fake injuries and spattered in blood mixed from corn syrup, the medics and firefighters were deadly serious about their response to the mass casualty exercise Thursday, said MCFRS Lt. Ben Cosme.

In the scenario, terrorists have bombed multiple targets in Washington, D.C., and Montgomery County officials and hospitals must somehow accommodate those injured in the attack as District hospitals are full to capacity or have been jeopardized in the attacks. So while the blood may be fake, the real-world lessons learned from conducting such exercises cannot be overlooked, Cosme said.

"Sometimes there's a disconnect between how you plan things and how it actually comes out," he said, explaining that, even in mock events, errors can be identified and corrected before someone's life is on the line. "When it does happen, you know it might not run perfectly, but at least you have an idea of some of the shortcomings the system has and how to overcome them quickly."

MCFRS Assistant Chief Scott Graham agreed with Cosme. He said on top of allowing rescue officials to practice valuable skills, the exercise also tests the relationships between different area agencies, such as emergency medical crews in Montgomery and Prince George's counties and the U.S. Department of Defense, which organized and ran the two-day exercise along with the University of Maryland's Center for Health and Homeland Security.

"With as many jurisdictions as we have in the national capital region the last thing we need at the time of an incident is for folks not to know what one another are doing," Graham said. "So one of the purposes of this evaluation is to make certain that all of our personnel have the appropriate amount of equipment, training, and that they're all ready to respond."

Graham said that as horrible as it may be to contemplate such an attack, a terrorist strike against targets in the Washington area is within the realm of possibility for first responders and medical personnel.

"Outside of the normal 911 call load, this is something that is always on our plate," he said, explaining that at least a dozen such exercises have been conducted in concert with the DOD and local hospitals over the last six years. "We have to be right 365 days a year, 24 hours a day; somebody who wants to cause harm to our region only has to be right once."

At Suburban Hospital in Bethesda, the makeshift outdoor emergency room was a flurry of nurses in HAZMAT suits testing patients for radiation, intake technicians taking each patient's photo and assigning them a tracking number, and doctors working to remove the faux rubble from arms, chests and legs.

Brendan Carmody, an emergency room doctor from Potomac, said the hospital has put an increased focus on disaster preparedness since Sept. 11. Even without acts of terrorism, the hospital's proximity to D.C. means they are often helping out with incidents that would cause a sudden flood of patients.

"If it were real, I think we'd be even better prepared," he said. "The unreality of it makes it difficult. I'm not good at faking, but I am good at being an ER doctor. The simple fact that this is our second time [practicing this same drill] means—God forbid—we're 110 percent prepared for it. When you're dealing with something so rare as a terrorist attack, as a dirty bomb, this just makes sure you're that much more prepared."

Suburban used the drill as an opportunity to test new research that matches patient photos with descriptions sent by family members who report missing persons. Another research project put tracking devices on emergency room staff to map their locations.

And while the focus at the hospital seemed to be on logistics — how to set up an emergency room outdoors to prevent contaminating other patients with radioactivity, better ways to alert family members of where their loved ones are hospitalized and how best to separate patients based on severity of injuries — the volunteer patients didn't mind having a little fun with it.

Several volunteers Thursday were busy hefting camera phones and posing for new Facebook pictures featuring their gruesome make up and fictional compound fractures. Rockville resident Seth Sweger, 24, joked with a nurse about whether he'd have a ready-made Halloween costume based on the giant screw protruding out of a puddle of fake blood on his chest.

Tiffany Nelson, 19, dramatically limped into the staging area with her sweatpants pulled up to reveal exposed bones. Her right forearm had a closed fracture, and a slash adorned her face as she tried not to smile. Nelson was put in the Red Zone, meaning her injuries were life threatening.

Laying on a stretcher, surrounded by doctors, Nelson pretended to go into shock from shortness of breath. The doctors, including Carmody, made the call to treat her for shock before taking her into the operating room for her leg injury.

"They treated it very realistically," Nelson, who is normally stationed at the National Naval Medical Center, said after being released. "They did a great job. I wasn't sure how it was gonna happen. I knew I'd have these injuries, but I wasn't sure it would be this realistic."

Other participants also recognized that while their injuries were bogus, the drill was anything but.

"I work in the emergency room at the Anne Arundel Medical Center in Annapolis, so it's cool to be able to get a glimpse at what things look like before patients arrive in the ER," said 23-year-old Columbia resident Caitlin Hester as she adjusted her hair around splotches of blood drying around her temples. "I'm happy to do anything I can to help the EMTs and first responders."

Hester's friend, 21-year-old Germantown resident Ismail Nicolas agreed that helping the county's emergency medical personnel was important, but added that such exercises also helped keep residents aware of the need to be prepared for any kind of disaster.

"You have no idea when a disaster could strike," he said. "It could happen anytime; anywhere ... people need to keep that in the back of their minds."