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December 13, 2016

Managing the chaos: Hospital staff share lessons from Pulse nightclub shooting response

Daily Briefing

In the six months since the Pulse nightclub mass shooting, Orlando Regional Medical Center (ORMC) trauma team members have shared their experiences to help other hospitals prepare for crises.

How ORMC had prepared

Speaking at the Institute for Healthcare Improvement's 28th annual National Forum on Quality Improvement in Healthcare, ORMC clinicians and executives credited a particular drill with giving ORMC the ability to treat victims of the shooting.

About three months before the shooting, ORMC participated in a mass casualty drill that focused on an active shooter scenario. In total, more than 50 agencies participated.

Administrators say the preparation was instrumental to the work they did on June 12, when a man opened fire at about 2 a.m. in Pulse nightclub in Orlando, Florida, injuring 102 people, 49 of whom were killed.

Officials at ORMC, which houses the city's only Level 1 trauma center, also credited the hospital's preparation to its experience responding to casualties from natural disasters.

Doctors who treated Pulse shooting victims honored with award

However, the shooting also presented challenges that hospital staff had not prepared for.

For example, they learned on-the-go how to deal with the high volume of family members and others who came to the hospital seeking information. Holly Stuart, director of patient experience, led that effort, directing staff to provide nourishment, emotional support, blankets, and cell phone chargers.

Hospital staff also said they lacked preparation for aspects of the aftermath of the shooting, Ilene MacDonald reports for FierceHealthcare. Not only did large numbers of people come to the hospital in the wake of the shooting, but they also stayed for months. To deal with the volume, nonclinical managers were assigned to families to help them with tasks such as finding accommodations and getting other family members to Orlando.

Given the number of people who needed help, administrators brought in staff from the hospital's corporate center, government relations, and marketing team.

Orlando health doctors share lessons learned

In the aftermath of the shooting, hospitals across the country have sought ORMC's advice on how to deal with similar events. Now ORMC staff, including Chief Surgical Quality Officer Michael Cheatham, are visiting facilities and giving presentations about once a week.

Their No. 1 suggestion: Establish and practice a disaster plan.

"We can't encourage you enough, if you don't have a plan, you need to make one," Cheatham said. "Practice, practice, practice so you're ready [when] patients need you."

"It's not a question of if, it's a question of when" a crisis will happen, Cheatham added.

Chadwick Smith, the trauma surgeon the night of the shooting, said, "We've all studied and trained for triage, but making those decisions in real life is very different. ... Decisions like these have to be made to save as much life as possible, and the only way to make decisions like this is to have training and the team attitude that you know you'll be supported by team members."

Similarly, Mark Jones, president of ORMC, said, "Do table-top exercises as much as you can. And you need to do it when it's not convenient." He added, "Practice on the weekend [or] at nights because what comes out is gaps that you can address and prepare for."

Jones also suggests that hospitals build relationships with local law enforcement. Those relationships, along with preparation, "will save lives," he said (MacDonald, FierceHealthcare, 12/7; Jervis, USA Today, 12/11; Miller, Orlando Sentinel, 12/11).

How hospitals can prepare for disasters

Hospitals must be prepared for myriad disasters that can stress health care systems to the breaking point and disrupt delivery of vital health care services.

Advisory Board has compiled step-by-step procedures for various threats your facility may encounter—though we hope you'll never need to use them.


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