The emergency room at Sunrise Hospital and Medical Center's response to last month's mass shooting in Las Vegas offers lessons for hospitals in how to prepare for a mass casualty incident.
Kevin Menes, M.D., was the attending physician in the emergency department on Oct. 1, and he told Emergency Physicians Monthly that he followed his own "mental plan" as he prepared to treat the influx of patients following the shooting.
He said he had long been mentally preparing for a potential shooting, but didn't want to bring it up with the team as they might "think he was crazy." So when he heard about the shooting, he began to clear out space in the emergency department and open operating rooms. The team sorted patients based on need, so that they would treat those who needed immediate resuscitation first while clinicians monitored those who were stable but would need to be resuscitated next.
To maintain "controlled chaos" in the ER during a disaster, hospitals must also:
- Place patients in sight of clinicians if there aren't enough monitors
- Cut off choke points to ensure that patient flow moves quickly
- If there are no enough ventilators, pair patients of similar size and use Y-tubing to connect them both to the same ventilator
The shooting in Las Vegas was another reminder that ERs need to have a plan in place for mass casualty incidents, whether that means a violent incident or a natural disaster.
Hospitals often overlook a number of key areas when planning for emergencies, including ensuring that there are blood supplies available to handle wide-reaching traumatic injuries. Half of doctors don't think the facilities they work for are prepared for emergencies.
Healthcare organization leaders can provide needed support for clinical staff and allow them to handle their own emotional needs as they treat patients. It is easy to for clinicians to forget their own needs during these incidents. Facility leaders can also work to keep the public informed and calm, and address concerns of patients' families while clinicians perform trauma and emergency care.