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Vegas shooting a lesson in crisis management for health care workers

Vegas shooting a lesson in crisis management for health care workers

NASHVILLE, Tenn. — The 2017 shooting spree during the Route 91 Harvest country music festival in Las Vegas provided some hard-learned lessons for health care organizations in preparing for and managing the response to mass casualty incidents.

Sunrise Hospital and Medical Center, a Level II trauma center with 692 beds that receives 170,000 emergency room visits per year, found itself at the center of the response to the mass shooting that killed 59 people and injured 527 others, which was “a life-changing event,” Dorita Ann Sondereker, administrative director for emergency services and a trauma nurse, told attendees at the American Society for Health Care Risk Management’s annual conference in Nashville, Tennessee, on Wednesday. That injury number is a low figure because the concert drew people from all across the country, and those who were not seriously injured returned home and receive care locally, she noted.

Sixteen people were declared dead at Sunrise, 10 of whom were dead on arrival on Oct. 1, 2017. But the Clark County, Nevada, coroner did not arrive at the hospital until about 6 a.m. the next morning because of the work to identify bodies at the scene of the crime, “which was really appropriate, but was really hard for all the family members who were at our hospital waiting because we couldn’t release any bodies or do anything until the coroner arrived and did positive identification,” she said.

About 100 physicians and 200 nurses responded to the emergency, with 83 total surgeries performed — 58 of which occurred in the first 24 hours — and 50 crash carts deployed in one hour.

Las Vegas is “one of the cities that has the fewest number of hospital beds per capita,” she said. “We don’t have enough hospital beds. We don’t have enough physicians. We don’t have enough nurses.”

The 50-bed emergency room responded to more than 230 patients and families in the immediate aftermath of the shooting; 92 of these patients arrived at Sunrise with no identification, having checked their bags at the venue for security reasons, she said. Many of the victims without identification were identified by their tattoos, sometimes submitted via social media channels by family members and friends searching for their loved ones, Ms. Sondereker said. “That was really hard,” she said.

The emergency room was so full at one point that health care workers started treating patients outside, but the hospital brought them inside the facility when the police showed up to guard the facility in the wake of reports of a potential second shooter, Ms. Sondereker said.

Sunrise’s location as the closest hospital to the Las Vegas strip was helpful in many respects, as the hospital had prepared for and practiced how to deal with complex events such as New Year’s Eve festivities, which leads to a surge in patients.

“You just have to practice this,” she said. “You have to practice it over and over.”

But even with those preparations, the hospital dealt with challenges such as running out of medical equipment like blood tubing, pressure bags and intubation tubes in the immediate aftermath of the shooting.

“We ran out of things very quickly,” she said.

There were human challenges as well, with hospital staff having to place waiting friends and family members of victims in an auditorium that was too small for all of them and not having clothes for them to change into from their blood-stained outfits. But the hospital had a chaplain who was present when they were pulled aside to be told their loved ones had perished.

“It really broke our hearts because we couldn’t let them see the family member,” she said. “We were not allowed because it was a criminal scene.”

Strong physician leadership from the emergency room and trauma physicians well versed in treating gunshot wounds — including the lead trauma surgeon, who was a military physician who teaches battlefield triage tactics — and the activation of a color triage system that predicted the needs of patients to allow for allocation of resources was helpful in dealing with the influx of patients in the aftermath of the shooting.

“But for all the critical victims, this is what really hurt my nurses: They were doing CPR … and the docs would say, ‘You have to cut it,’” she said. “And that’s not what we’re used to doing. We’re used to doing it until the code is called. We didn’t have time.”

“You ask me, ‘Did we suffer PTSD?’” Ms. Sondereker added. “Absolutely.”

Sunrise also learned some valuable lessons about the need for better communication mechanisms with staff and community resources, including having a point person to gather names and information.

“You have to talk to each other, you have to talk to the other hospitals, and we weren’t good at that in Vegas,” she said. “We weren’t good at calling (University Medical Center in Las Vegas) because they’re our competitor.”

Sunrise also learned about the importance of improved documentation and the need for greater detail to surge policies, she said.

“Surge policies and practices are huge,” she said.








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