Orlando Health book guides peers after Pulse

Hospital responds to information requests

Orlando Health is publishing a book by early next year that will serve as a how-to guide for handling mass casualties in response to many requests for guidance from other hospitals after the Pulse shooting last year.

The book, which the health system is planning to give away to other hospitals, is being written by leaders of each department — from surgeons to nurses to environmental services.

“We want this book to be something where someone could read the chapter from Central Supply and it’s written by somebody who runs Central Supply here,” said Dr. Michael Cheatham, a trauma surgeon and the chief surgical quality officer at Orlando Health. “So it’s actually peer talking to peer: Here’s what I learned from the Pulse event.”

The book will be about 200 pages and includes a chapter for each department of the hospital.

“We've told the authors that if it was just you and one of your peers, what would you want to know if you were asking someone who had been through an event through this. Like this is what was important. This is what we had

planned on. Here are the three key messages that we learned,” he said.

In the year since Pulse, the health system’s doctors, nurses and administrators have given more than 160 presentations in 27 states and three countries to share how they did it and what they’ve learned.

It’s a tradition in medicine to pass on knowledge through books, articles, research papers or presentations during meetings, whether the topic is a surgical procedure, effective bleeding control in the battlefield or handling mass casualties.

The Orlando Health team is doing them all.

“We look at every situation that we’ve had or has been experienced in the U.S. and try to learn from it and to built on it to see what we can make better here,” said Eric Alberts, Orlando Health’s emergency-preparedness manager. “I’m continually trying to inform and educate others that if something worse happens, unfortunately we’ve got to be better prepared.”

The health system has updated its emergency plans, including a mass casualty plan, to include lessons from Pulse. It has also been examining the Pulse massacre and has drafted a 51-page report, with a list of 66 areas for improvement, 17 of which are currently being worked on, Alberts said.

“One of the big things we found was that team members were saying, ‘Why didn’t you notify me or what took so long to get a notification on the situation,’ ” he said.

That need was further emphasized after Hurricane Matthew in September. The health system is now implementing a mass notification system across all its campuses in Central Florida, which is expected to go live by the end of this year, Alberts said.

The Pulse shooting also highlighted the need for increased security, so the health system limited the number of entryways to its downtown hospitals and has placed permanent security personnel and metal detectors at each entrance.

Meanwhile, several physicians are conducting research studies, which are expected to be published in medical journals by early next year.

One study focuses on the incidence of PTSD among the surgical residents who were working at the night of Pulse.

“That’s the first paper to show the impact of a mass casualty incident on surgeons in training,” Cheatham said.

The study shows that the incidence of PTSD increased among the residents after the events, although their symptoms began to subside with the passing months. It also showed that younger residents were more susceptible to developing PTSD than the more experienced residents, Cheatham said.

The Pulse shooting has also inspired some physicians to begin studying gun violence, approaching it as a public health issue, just like elderly falls or infections.

“We not doing our job as health care professionals if we’ve not trying to prevent injury and illness,” said Cheatham . “It’s all well and good to talk about lessons learned and what we might do differently, but the horse is out of the barn at that point. … But our purpose isn’t getting rid of firearms.”

During the talks, hospital officials recount the events of that night and share some of the important lessons they learned.

They talk about the im- portance of being prepared to handle family and friends. They advice their peers to be prepared for the “false flag folks,” individuals will contact the hospital to say that the event never happened and the doctors are merely actors; to be weary of accepting food from unknown sources, because it could be poisoned; and to know that their team won’t be immune from the emotional impact of the tragedy and may have to deal with it for months or years.

“The hospital’s role is huge,” said Alberts. “There are a lot of aspects of a [mass casualty] that the hospital plays a part in, and if the hospital fails, the community thinks it is not prepared, not just the hospital.”