Las Vegas mass shooting shows once again the need for ERs to prepare for the unimaginable

Las Vegas hospitals were overwhelmed Sunday night by the hundreds of victims from Sunday’s mass shooting. One physician described it as a war zone and controlled chaos.

Fifty-nine people were killed and 527 were injured when Stephen Paddock opened fire from a 32nd-floor room in the Mandalay Bay hotel into a crowd of thousands attending a country music festival on the Las Vegas Strip.

Nevada’s one Level-1 trauma center, University Medical Center of Southern Nevada, received 104 of the casualties, most with gunshot wounds, and called in every available employee to help care for patients, according to U.S. News & World Report. “It was like a war zone,” Jay Coates, M.D., a surgeon at the trauma center, told the publication. “We were just trying to keep people from dying.”

Coates described a scene of 20 medical workers treating the most critical patients and eight operating rooms going at the same time. He called it “controlled chaos.”

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In July, the hospital trained for a mass casualty event, reports CNBC. Active shooting drills have become more common in recent years as hospital workers have cared for multiple victims after the Pulse nightclub shooting in Orlando, the Boston Marathon and the 2012 theater shooting in Colorado.

"More and more of us drill and get our faculty, residents, nursing, and staff ready for the unthinkable," Corey Slovis, M.D., of Vanderbilt University in Nashville, told MedPage Today. "We all just underwent active-shooter training."

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But it’s difficult to prepare for the sheer number of victims. "No one can say they've seen anything like this," Jeffrey Murawsky, M.D., chief medical office of Sunrise Hospital and Medical Center, a Level 2 trauma center, told NPR. "We've seen events that have brought us 30 patients at once."

The sheer number of victims means hospitals were calling in backup and then needed to call backup to the backup, Bruno Petinaux, the chief medical officer and co-chair of emergency management at the George Washington University Hospital in the District of Columbia, told the publication.

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Despite the importance of mass casualty drills, Benjamin Lawner, M.D., of the University of Maryland Medical Center in Baltimore, told MedPage Today he was worried that budget cuts for disaster planning may mean some U.S. emergency departments won’t be fully prepared for an event. Funding has dwindled since 9/11, he said.

But it’s necessary, Michael Cheatham, M.D, chief surgical officer at Orlando Health, which cared for victims of the Pulse nightclub shooting, said at a conference last year. Active shootings unfortunately have become more common in recent years and hospital staff need to know how to respond. “It’s not a question of if, it’s a question of when,” Cheatham said.

Mark Jones, president of Orlando Regional Medical Center, advised hospitals to conduct drills 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.”