City prepared for the unthinkable
Hospital, first responders trained, ready
NEW HAVEN — If it happens here, first-responders and Yale New Haven Hospital will be ready.
While the 59 concert-goers that Stephen Paddock killed in Las Vegas on Oct. 1 make it the worst mass shooting in modern U.S. history, it was the more than 500 injured that put the greatest stress on the city’s emergency services. Saving lives became the paramount concern for police, firefighters and ambulance crews and for the city’s hospitals.
New Haven’s emergency services and its Level 1 trauma center train continually to handle high numbers of injuries, their personnel well aware that the unthinkable could happen anywhere.
“We work on the premise that it could happen here. We’re ready for it,” said Abe Lopman, senior vice president for operations at Yale New Haven and the director of the hospital’s incident command center. “We practice. We have a system. What appears to be chaos — and there is chaos — inside that chaos there’s a system, an incident command system.
“It is a well-structured entity with individuals responsible for the multitude of things that have to be coordinated and take control of a situation that appears to be out of control.”
When a major incident occurs, the hospital begins the process of determining the extent of casualties.
“We have a team of paramedics that goes out to the site where the incident is and gives us information about what we can expect,” said Dr. Victor Morris, associate chief medical officer of Yale New Haven and medical director of the incident com-
“You have to be able to triage the patients quickly, they literally score people” to determine who needs surgery immediately, “who’s critical care, [who’s] the walking wounded,” Morris said.
Yale New Haven has 10 trauma surgeons on staff, but many other surgeons can be called on, such as those specializing in ear, nose and throat, neurology and orthopedics.
“In a shooting like that, not everybody [suffers] a gunshot to the abdomen,” Morris said. “It’s to the head, to the neck,” so other specialties are needed. In addition to the hospital staff, community surgeons can be called in to deal with an emergency.
“There’s nothing we can’t do here, and because we’ve drilled, we know how to coordinate these people,” he said.
Rooms and resources
The hospital has 49 operating rooms at its York Street campus, 24 at the St. Raphael campus and nine at Temple Medical Center. Three helicopters are available to transport patients.
Mark Sevilla, a registered nurse by training, is vice president for behavioral health and emergency services at Yale New Haven. The Emergency Departments at 20 York St., St. Raphael and the Shoreline Medical Center in Guilford all report to him. He sees an emergency situation in terms of “surge” — when the number of patients arriving puts the hospital over its capacity. When that occurs, the hospital tries to release as many people from the Emergency Department as possible and to free up beds by discharging as many patients as it can.
“The template for planning is typically the same for every hospital and that’s governed by regulatory requirements,” Sevilla said.
He said the hospital is in the process of setting up a capacity command center, which will be able to centralize the numbers of patients admitted, how many beds are available, how many will be available in six or 12 hours.
“It looks like a NASA launch control,” Sevilla said. “In a surge situation, it’s going to be very helpful moving into the future to have that ability.”
Yale New Haven also is working with American Medical Response, the ambulance service, to have an Emergency Department nurse “working with their dispatch center. She’s working with them to direct ambulance traffic towards the place that’s best able to receive it in terms of current activity and volumes,” Sevilla said.
Besides medical personnel, the hospital has translators available — Chinese translators, for example, were brought in from Yale University when there was a bus crash involving passengers from New York’s Chinatown — as well as chaplains and counselors available for the “worried well”: families and friends who come to the hospital seeking information about their loved ones.
“All of it gets coordinated through a sizable system,” Lopman said. “We practice many, many times a year. … At all times we’re in direct contact with the city of New Haven” or whatever municipality is involved, as well as the state.
While the New Haven area doesn’t have a concert venue as large as the Mandalay Bay Resort in Las Vegas, “We do have some large facilities where anything could happen,” said Rick Fontana, deputy director of emergency operations for the city of New Haven. “We do put a lot of people in small areas.”
Those include Yale Bowl, the Connecticut Tennis Center and Yale University’s Old Campus during graduation weekend, he said.
Training is conducted regularly for anything from a school bus crash, such as the one in February 2016 that injured more than two dozen, to a hypothetical active shooter in City Hall.
That incident training was conducted in March by the Naval Postgraduate School Center for Homeland Defense and Security.
“It was a (mock) civil unrest case on the New Haven Green and it escalated into an active-shooter incident in City Hall,” Fontana said.
There also are regular training exercises at Tweed New Haven Regional Airport with up to 50 anticipated dead or injured persons. A tabletop exercise is held
“I’m not sure if you can ever prepare [for] 500 people shot. I can only imagine what those responders were going through, especially in a hot zone” where the gunman is still firing. Rick Fontana, deputy director of emergency operations for the city of New Haven
once a year and a full training exercise, with volunteers acting as dead or wounded casualties, is conducted every three years.
“You’re actually involved in managing mass injuries, triaging the injuries and then transporting the people to the hospital,” Fontana said.
In a true emergency, as many as 100 police officers, 72 firefighters and 30 ambulances could be summoned, and that’s before neighboring cities and towns are brought in, he said. Then there are state police, FBI and the federal Bureau of Alcohol, Tobacco, Firearms and Explosives ready to assist.
“I’m not sure if you can ever prepare [for] 500 people shot,” Fontana said. “I can only imagine what those responders were going through, especially in a hot zone” where the gunman is still firing. He said the city is looking into “tactical medics. They work alongside police in a hot zone. You never heard of this stuff before.”
While those killed in an attack are the biggest tragedy, “It’s a lot easier handling a person who’s deceased than a person who’s shot,” Fontana said. “We’re not moving them. The other ones require all of the assets.”
Those assets aren’t all trained first responders. As in Las Vegas, where some of the wounded were brought to hospitals in pickup trucks, people will respond in any way they can, he said. “That’s good Samaritans trying to help and most of those people’s lives were saved by those good Samaritans.”
Dr. Victor Morris, left, medical director of the incident command center at Yale New Haven Hospital, and Abe Lopman, senior vice president of operations at the hospital and director of the incident command center, in an operating room at the 20 York St. campus.