Mass shoot­ing in Las Ve­gas sig­nals new re­al­ity for hospitals

Modern Healthcare - - NEWS - By Maria Castel­lucci

Dr. Jeff David­son, a long­time emer­gency room physi­cian in Las Ve­gas, re­ceived two dis­turb­ing phone calls late on the night of Oct. 1.

The first was from an emer­gency med­i­cal re­spon­der who told him there was shoot­ing nearby at a con­cert. Then, a few min­utes later came a call from the emer­gency co­or­di­na­tor at Val­ley Hos­pi­tal Med­i­cal Cen­ter ask­ing him to come quickly; ex­tra hands were needed.

“You think you are pre­pared ... but you are never pre­pared un­til some­thing hap­pens,” he said.

David­son and his team treated 29 vic­tims from the mass shoot­ing in Las Ve­gas last week that in­jured 489 and left 58 peo­ple dead. Over­all, Val­ley Health Sys­tem, which op­er­ates six hospitals across Las Ve­gas, treated 232 in­jured in­di­vid­u­als. Eight pa­tients died.

The vic­tims came “in such high num­bers, so quickly,” David­son re­called. And they had wounds David­son doesn’t nor­mally treat. They were bleed­ing out from high ve­loc­ity gun­shot wounds typ­i­cally only seen in war zones. Such in­juries re­quire im­me­di­ate surgery to save the pa­tient’s life.

For­tu­nately, David­son was sup­ported by a group of sur­geons who were ral­lied as part of Val­ley Hos­pi­tal’s emer­gency pre­pared­ness plan.

“We had neu­ro­sur­geons avail­able, gen­eral sur­geons, or­tho­pe­dic sur­geons—al­most ev­ery spe­cial­ist on hand to as­sist with in­juries and to sta­bi­lize pa­tients in the emer­gency depart­ment,” he said.

On a typ­i­cal night, Val­ley Hos­pi­tal will see one pa­tient with a sin­gle gun­shot wound. The doc­tors will of­ten sta­bi­lize the pa­tient and then trans­fer them to one of two trauma cen­ters—Univer­sity Med­i­cal Cen­ter or Sun­rise Hos­pi­tal and Med­i­cal Cen­ter. “This was ob­vi­ously quite dif­fer­ent,” he said.

Many vic­tims were dropped off at the doors of Val­ley Hos­pi­tal by civil­ians try­ing to help. UMC and Sun­rise Hos­pi­tal were also busy, so not all the vic­tims were able to be trans­ported there.

Even though it’s not a des­ig­nated trauma cen­ter, Val­ley Hos­pi­tal was able to treat pa­tients quickly and ef­fec­tively, David­son said. Pa­tients were triaged quickly. ER beds were opened up to make room for the in­flux of pa­tients, some of whom were di­rected to des­ig­nated ar­eas to im­pose some sense of or­ga­ni­za­tion amid the chaos. “Any emer­gency depart­ment can staff up with sur­geons and act as a trauma cen­ter,” he said.

The ac­tions Val­ley Hos­pi­tal providers took that night to treat their pa­tients rep­re­sent a rel­a­tively new re­al­ity for hospitals across the U.S. As the in­ci­dence of mass shoot­ings per­sists—and the at­tacks worsen in num­ber of ca­su­al­ties—hos­pi­tal lead­ers un­der­stand their com­mu­ni­ties are not im­mune from a sim­i­lar tragedy and must be pre­pared.

“Maybe 20 years ago, you thought, no it won’t hap­pen here. But now (hospitals know) it could hap­pen here, and it just might hap­pen here,” said Dr. Gina Pi­azza, chief of emer­gency medicine at the Char­lie Nor­wood VA Med­i­cal Cen­ter in Au­gusta, Ga.

Trauma cen­ters and ERs pre­pare with fre­quent drills through­out the year meant to mimic real-life sce­nar­ios. For in­stance, Or­lando Health had

“Maybe 20 years ago, you thought, no it won’t hap­pen here. But now it could hap­pen here, and it just might hap­pen here.”

Dr. Gina Pi­azza Chief of emer­gency medicine Char­lie Nor­wood VA Med­i­cal Cen­ter

com­pleted a drill that sim­u­lated a mass shoot­ing at a lo­cal school just be­fore the Pulse night­club shoot­ing that sent 44 pa­tients to its ER in June 2016.

“One of the guid­ing prin­ci­ples of emer­gency pre­pared­ness is that what you do in re­sponse to an event most re­sem­bles what you do ev­ery day,” said Dr. Richard Zane, UCHealth ex­ec­u­tive di­rec­tor of emer­gency ser­vices. UCHealth’s flag­ship, Univer­sity of Colorado Hos­pi­tal, treated 23 vic­tims of the 2012 shoot­ing at an Aurora movie theater.

Ef­forts are also on­go­ing across the na­tion to amp up train­ing of ER physi­cians to ef­fec­tively treat pa­tients with in­juries usu­ally only seen in mil­i­tary set­tings, Pi­azza said.

The Amer­i­can Col­lege of Emer­gency Physi­cians in Jan­uary 2016 launched a task force to im­prove train­ing. The ef­fort in­cludes en­list­ing mil­i­tary-trained trauma sur­geons to host ses­sions with ER and trauma doc­tors on the best tech­niques to treat mass shoot­ing vic­tims.

Doc­tors who have been on the front lines of such tragedies have made it a point to visit other trauma cen­ters to of­fer ad­vice. “They take what they learned and speak to their col­leagues—share what went well and didn’t,” said Pi­azza, who co-chairs the ACEP task force.

UMC CEO Ma­son VanHouwel­ing, whose hos­pi­tal treated 104 vic­tims of the Las Ve­gas shoot­ing at its Level 1 trauma cen­ter, said in ad­di­tion to fre­quent drills, the hos­pi­tal “takes ev­ery op­por­tu­nity to learn lessons from other or­ga­ni­za­tions.”

A few months ago, UMC hosted an emer­gency physi­cian from Or­lando Health who lec­tured on prac­tices learned from treat­ing vic­tims of the Pulse night­club shoot­ing. “We took a lot of notes, and we fol­lowed up on those,” VanHouwel­ing said.

The emo­tional toll such trau­matic events have on hos­pi­tal staff also can’t be over­looked, Zane said. “This is not nor­mal medicine, this is mass ca­su­alty care. Providers need to be sup­ported in how they all deal with the af­ter­math.”

David­son at Val­ley Hos­pi­tal said they plan on hav­ing de­brief­ings for staff in a week or so to talk about their ex­pe­ri­ences. Right now, their time and at­ten­tion is still fo­cused on their many pa­tients who still need their help.

“There is go­ing to be a lot of mem­o­ries of what we saw,” David­son said. “You just hope it makes you a bet­ter physi­cian and you hope it never hap­pens again.”

“We had neu­ro­sur­geons avail­able, gen­eral sur­geons, or­tho­pe­dic sur­geons— al­most ev­ery spe­cial­ist on hand to as­sist with in­juries and to sta­bi­lize pa­tients in the emer­gency depart­ment.” Dr. Jeff David­son Emer­gency room physi­cian


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