As the number of mass casualty incidents in the United States continues to tragically mount, trauma systems and their surgeons need to create a culture of constant preparedness, frequent training and coordination with other facilities. Those are some of the lesson trauma surgeons with experience in MCIs shared at a recent annual congress of the American College of Surgeons.
Many of those who spoke were from the Las Vegas hospitals who dealt with the chaos and devastation of the recent mass shooting there, when a gunman opened fire from his suite window at the Mandalay Bay resort on a crowd of thousands who were attending a country music festival across the strip.
Physician and ACS Fellow Robert J. Winchell from New York-Presbyterian Weill Cornell Medical Center said "A strong trauma system that functions well on a daily basis is the best preparation for mass casualty events." These systems operate in a constant state of preparedness and utilize an MCI model, which is based on the following ideals: rapidly and sequentially engage additional resources, optimize communication, ensure accurate triage and control patient distribution, provide trauma centers and other facilities time to prepare, and anticipate the need for secondary transfers.
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University Medical Center Southern Nevada medical director John Fildes described the structure of the Southern Nevada Trauma System, which is comprised of 17 hospitals with emergency departments capable of treating injured patients based on the extent of their injuries, and three trauma centers: University Medical Center which is a Level 1, Pediatric Level 2 trauma center, Sunrise Hospital Medical Center which is a level 2 trauma center and St. Rose Dominican Hospital which is a level three trauma center. Fildes stressed that preparation and collaboration enabled them to respond effectively to the incident and urged all surgeons to plan and practice their own response plans and drills to an MCI at their institutions.
Deborah Kuhls, who serves as medical director for UMC's trauma intensive care unit, was at work the night of the mass shooting earlier this month, and said their first notification was that there were five to 10 patients enroute to their trauma center, however a second one said there were 50 to 100 or more patients coming. At that point, UMC activated its disaster plan.
"There were more than 20 self-transports to trauma and to the main emergency department," she added. "We triaged outside [in the parking lot] of the trauma center." Kuhls said there were more than a dozen trauma surgeons working that night, as well specialty surgeons, nurses, and more than 70 medical residents and fellows and eight operating rooms running at once. Matthew Johnson, a physician with the Sunrise Hospital and Medical Center said in the first 24 hours, Sunrise saw 212 patients and performed 58 surgeries. He said Sunrise staff grouped pods of operating rooms together for treating specific types of cases. A total of 83 surgeries were performed. Johnson said their take-away was, "preparation and practice…engaging in regular drills, and strong leadership from emergency room physicians and trauma surgeons" enhanced his facility's ability to respond to the MCI.
St. Rose Dominican Hospital physician Sean Dort said a "very detailed assignment of roles" helped steer their course in efficiently treating the victims of the Vegas MCI, but admitted even the most detailed disaster plan can't prepare you for every variable and strongly stressed MCI training for staff before you have an incident. He warned that it is important to be wary of varying news reports that can swirl as incidents unfold.
"Don't believe everything you hear. We kept hearing reports about a second shooter, but the only reality is the patient right in front of you."
Lenworth M. Jacobs, chair of the Hartford Consensus, emphasized the importance of incorporating first responders in your plans and even the public. First responders can be trained to provide hemorrhage control, specifically through the College's Stop the Bleed campaign. But Lenworth also pointed to the public's apparent desire to step in where necessary, highlighting a national survey that showed 98 percent of the public would like to be able to stop bleeding in a family member if the need arose, and 92 percent would like to be able to stop bleeding if they came upon a stranger in a car crash, Jacobs said.
Also, the plans shouldn't just pertain the peak hours dealing with the incident and clinical and operational issues, said Alexander L. Eastman, a physician with the University of Texas Southwestern Medical Center, Dallas, and deputy medical director of the Dallas Police Department. He said these incidents can leave scars on the medical staff that help navigate them and it is important to "establish a culture where it is okay not to be okay after these events." Offering support for medical colleagues in the weeks and even months that follow is crucial.