City pre­pared for the un­think­able

Hos­pi­tal, first re­spon­ders trained, ready

The Middletown Press (Middletown, CT) - - FRONT PAGE - By Ed Stan­nard

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-

mand cen­ter.

“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.”

Peter Hviz­dak / Hearst Con­necti­cut Me­dia

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...

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