IHI 2016: Orlando Health looks back at Pulse shooting and how hospitals can prepare for the worst

Doctor and nurses wheeling patient in gurney through hospital corridor
Photo credit: Getty/Sam Edwards

ORLANDO, Fla.–Core members of the Orlando Health trauma team who cared for the victims of the Pulse nightclub mass shooting gathered together Wednesday on the six-month anniversary of the attack to reflect on their actions that night and what they learned.

The clinicians and hospital executives were emotional as they relayed their stories and relived the horrific moments in the aftermath of the worst mass shooting in U.S. history. Their message to the attendees of the Institute for Healthcare Improvement’s 28th annual National Forum on Quality Improvement in Healthcare in Orlando, Florida: If you don’t have a disaster plan, make one. And then practice that plan over and over again.

“It’s not a question of if, it’s a question of when” said Michael Cheatham, M.D., a 20-year veteran on the hospital’s trauma team who serves as the chief surgical officer.

The city’s only Level 1 trauma center treated 44 of the victims. Although they had an immense amount of training and coordination in preparation for a disaster, hospital executives credit the fact that they had a mass casualty drill focused on an active shooter event about three months prior to the shooting at Pulse. Fifty-six agencies participated in that drill and the administrators say there is no doubt that the work they did during the practice event helped to save lives that night.

“Do table-top exercises as much as you can,” Mark Jones, president of Orlando Regional Medical Center, said. “And you need to do it when it’s not convenient. You always think you can’t do it when the hospital is busy. But that’s when you should. Practice on the weekend at nights because what comes out is gaps that you can address and prepare for.”

He also recommends building relationships with law enforcement. That relationship proved to be invaluable that evening. “It will save lives,” Jones said.

Disaster drills didn't cover everything

But there were many things the hospital didn’t prepare for. For example, the shooting occurred in the early morning hours when it was still dark and no other community locations were open. As a result, family members and loved ones of victims began to arrive at the hospital, looking for information, and hospital staff spent hours taking care of them.

Leading that effort was Holly Stuart, director of patient experience, who said she and staff provided nourishment, emotional support, blankets and cell phone charges. And she was there when some families received word that their loved one didn’t survive. “I’ll never forget the desperation and raw agony,” Stuart said.

Hospital staff learned a lot in the family room. During drills for a disaster, they would gather water and blankets. But there is much more that is needed, she said. “The families we cared for had so many emotional needs. We needed grief counselors, chaplains. Some had medical needs and we needed physicians to come in to care for them. For many their primary language was Spanish and they needed a translator,” she said.

Staff also weren’t prepared for the aftermath of the incident. Some families were there for months so nonclinical managers were assigned to families to help navigate through the situation. They helped them find places to stay and arrange for other members to come to Orlando. The hospital was overwhelmed by the number of people who wanted to visit. As a result, administrators brought in staff from its corporate center, government relations, and marketing team to help manage the visits.

“We were also overwhelmed from the support we received from all over the country. Gifts arrived every single day for victims, families and for our team,” she said. Among those gifts: boxes of greeting cards made by hand by kindergarten classes, 50 bouquets of flowers and boxes and boxes of pizza. And right before Thanksgiving, the hospital received 250 quits from the Orlando quilting guild with the message “we hope these comfort you as much as you comforted people on June 12.”

In addition to arranging for counseling services for patients and families, the hospital also had professional grief counselors talk to the trauma team during the first few days after the incident. And counseling support is still available for staff members.

It’s difficult to move forward, Cheatham admitted, because since the shooting, he and trauma team members have given countless interviews to the media and they are asked to speak all over the country. “It’s been difficult to move on because we have to relive it,” he said.

Suggested Articles

Humana filed suit Friday against more than a dozen generic drugmakers alleging the companies engaged in price fixing.

Ochsner Health System is partnering with Color to launch a population health pilot program to integrate genetic information into preventive care.

Medicare Advantage open enrollment kicked off last week, and insurers are taking new approaches to marketing a slate of supplemental benefit options.