Mass Shootings Challenge Trauma Center to Respond Quickly
Last November, Regional One Health (ROH) trauma surgeon Dr. Peter E. Fischer was driving to Jonesboro, Arkansas, when he heard news that almost literally stopped him in his tracks.
A tour bus with 46 people headed to the casinos in Tunica had overturned on an icy highway near Byhalia in North Mississippi. Two were confirmed dead, while first responders were working frantically to determine the extent of injuries to the 44 others.
"I did a quick turnaround on the highway to come back to Memphis and when I got back to the hospital the ER had been cleared out, we had six trauma bays ready for these patients, and we had our triage area set up," Dr. Fischer recalled. "We actually didn't receive any patients from the scene, but we were ready to go if we needed to. That was an unplanned drill, and I was extremely proud of our organization's response."
Being prepared for disasters that could produce a medical surge of patients is an important part of being a Level 1 trauma care hospital, one with specialized physicians and nurses, high-tech equipment and specially trained support staff.
ROH's Elvis Presley Memorial Trauma Center, the only Level 1 trauma center within 150 miles of Memphis, treats up to 14,000 ER patients each year, including some 1,000 gunshot wounds.
Training goes on constantly for the "what if" moments such as the Mississippi bus crash, but times are changing for hospitals in the era of increasingly common mass shootings, the worst being at a Las Vegas music concert in October 2017.
On that night, a madman fired more than 1,000 shots in just 15 minutes, killing 58 and leaving more than 580 in need of emergency medical attention, according to the Nevada Hospital Association. Hospitals, EMS and law enforcement in Las Vegas were overwhelmed, and emergency providers elsewhere in the country have taken notice.
"Ten or 15 years ago when we would think about disasters we would think about a building collapse or a plane crash, and that's what we would practice for," says Dr. Fischer. "In those scenarios, you don't have a lot of time, but you do have 10 or 15 minutes for EMS to mobilize and for those patients to come to you.
"A mass shooting is a little bit different in that the first patients you get are people who have literally been picked up by somebody or who have run from the mass shooting to your hospital. With ROH being the regional trauma center and well known throughout the community, it's important for us to be able to respond extremely quickly, and more quickly than we've ever had to do before."
As an example, he points to the Pulse nightclub shooting in Orlando, Florida, in 2016 that left 49 dead and 53 others wounded. The wounded began showing up unannounced almost immediately.
"That shooting occurred only a mile or mile and a half from the actual trauma center, so they were getting patients within two minutes from when the actual shooting started because patients were getting in cars and driving right down the road to the trauma center," said Dr. Fischer. "So mass shootings have changed our preparations since we have to be ready even quicker than we've had to in the past with different sorts of disasters.
"We've changed our surge-capacity plan in the past three years with a collaborative effort to try to respond better to these types of events. The biggest part of that is to set up triage and then be able to clear out our emergency rooms very quickly so we can accept the new surge of incoming patients and set up alternate treatment zones."
The triage process is crucial to an efficient use of medical resources when every patient cannot be treated immediately. Doctors have to determine the order and priority of emergency treatment, as well as the destination of that patient.
"For example, the walking wounded are going to be the first patients you get and you can't let those patients bog down your system," Dr. Fischer said. "Those patients would be sent to the cafeteria, which is set up as an alternate treatment site so the critical-care patients can be taken care of in the critical-care staffed area. We've done a lot of work in the past three years to rearrange our plan so that we can adequately respond."
In addition to the hospital's own drills, ROH participates in the annual mass-casualty drill of the Mid-South emergency Planning Coalition, a partnership of hospitals across a three-state, six-county region, the Shelby County Health Department's Public Health Emergency Preparedness Program, and local fire Emergency Medical Services.
"You can never plan for everything, and part of our drill is that the plan is usually destroyed in about the first 30 seconds," said Dr. Fischer. "We have to be flexible and be able to respond as the situation changes. Almost every Friday and Saturday night we're going through almost a mini-drill to handle the mass surges. It's not uncommon for us to get a surge of six patients at a time. We are prepared for that, but six patients is one thing and 20 is another.
"In a mass-casualty situation, the information can change dramatically, from 'You've got 20 patients' to 'You've got two.' Or there's the worst-case scenario: 'You've got two patients. No, you've actually got 20.' How do you respond to that? That's important. It has to be a true mobilization of the entire hospital, not just the ER, to be able to work at a high capacity for the next 24 to 48 hours."
Because emergency medical intervention within the first hour can mean the difference between life and death with trauma injuries, Dr. Fischer says he would like to see everyone become a first responder.
"ROH and the American College of Surgeons are advocating the Stop the Bleed course (www.bleedingcontrol.org), which is how you stop life-threatening hemorrhaging at an accident scene or a shooting event," he said. "A bystander at a scene can potentially help save the life of someone who's been injured if, God forbid, one of these incidents ever happens here."