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October 3, 2017

'This is what they're trained for': How hospitals responded to the Las Vegas mass shooting

Daily Briefing

Hospitals in the Las Vegas area treated an estimated 527 people who were injured when a gunman on Sunday evening opened fire on a music festival, according to officials. 

As of Tuesday morning, officials said 59 people had died as a result of the mass shooting, including at least one health care provider: Sonny Melton, an RN at Henry County Medical Center (HCMC), who was shot while shielding his wife, an orthopedic surgeon at HCMC. According to Vox, the number of causalities and fatalities may change as authorities continue their investigation.

About the shooting

On Sunday night at about 10 p.m., Stephen Paddock, a 64-year-old man from Nevada, opened fire on people attending the Route 91 Harvest Festival, a three-day country music concert. The concert had an estimated 22,000 people in attendance on Sunday.

Police found Paddock in a hotel room at the Mandalay Bay Resort and Casino, where he was believed to have carried out the shooting. According to officials, Paddock appeared to have died by suicide before police entered his room.

Police said they have not yet discovered Paddock's motive for the shooting, Vox reports. However, officials said Paddock appeared to be acting alone and did not seem to be part of a terrorist organization.

'This is what they're trained for': State's sole Level 1 trauma center takes in victims

The University Medical Center of Southern Nevada (UMC)—the only Level-1 trauma center in the state—as of Monday afternoon had 50 physicians caring for 104 patients injured in the attack. The victims presented with gunshot injuries, as well as injuries from falling while fleeing the scene and car accidents. Overall, four patients have passed away, and 12 remain in critical condition.

When asked how the hospital is managing the scale of the attack, Danita Cohen, a spokesperson for UMC, told CNN, "This is what they're trained for." Cohen added that despite the scope of the situation, she remains hopeful for victims treated at UMC, noting the center has a 97 percent survival rate.  

Separately, John Fildes, UMC's medical director, said UMC's response to the shooting went "just as planned." According to Fildes, UMC each year holds two major disaster drills, in addition to internal drills, and had even practiced for a mass casualty event at a concert venue.

On the frontlines at UMC

Toni Mullan, clinical supervisor in UMC's trauma resuscitation department, said on Sunday night, the facility received patients for between two and three hours straight—many arriving in private cars, driven by fellow concert-goers.

Amid the influx of patients, UMC declared a state of "internal disaster,"  the Wall Street Journal reports, a step that launches the hospital's disaster-preparedness plans and calls in additional staff, including nurses, administrators, and physicians. The hospital also requested additional staff from Nellis Air Force Base, with whom UMC has previously trained with for emergency situations.

Using lessons learned from physicians who cared for victims of the Pulse shooting, UMC rolled gurneys and wheelchairs outdoors to assess patients as they arrived and to minimize crowding indoors, the New York Times reports. Eight patients were immediately moved to ORs for surgery, Cohen said.

UMC also set up additional receiving areas for patients, including a recovery room, a preoperative space, and the ambulance bay, as well as an area where patients deemed too critically injured to survive could be comforted until they passed away. In addition, UMC set up two spaces for the "walking wounded," where patients with non-life-threating injuries could receive care. The cafeteria was designated as a respite area for families and friends.

According to the Times, UMC dispatched teams of medical professionals to assess patients throughout the facility on a continual basis, shifting patients out of the ICU as quickly possible to make way for others. And while the trauma center repeatedly ran low on supplies—including IV tubing, fluids, blood pressure cuffs, and blankets—they were able to borrow from other departments to compensate. According to Deborah Kuhls, director of UMC's trauma intensive care unit, the hospital never ran out of blood, ventilators, or other critical medical supplies and equipment.

Ultimately, according to Mullan, the trauma center was able to provide care for all patients in need, including two patients who presented with injuries unrelated to the shooting. She said the key to UMC's success was extensive practice responding to emergency situations every day, and she advised other health care facilities to take the same approach. "Be prepared and practice," Mullan said.

'No one has experienced patient volumes at this level': Other area hospitals provide care

Several other area hospitals treated people injured from the shooting, according to city officials.

Sunrise Hospital and Medical Center, Las Vegas' sole Level 2 trauma center, as of Monday had treated 180 victims of the shooting, including 124 people who sustained gunshot wounds and 14 individuals who have since passed away. As of Monday afternoon, the hospital had performed about 30 surgeries. "Our trauma center physicians and hospital staff have done an amazing job," Sunrise CEO Todd Sklamberg said. "Our trauma team and all supporting nursing units, critical-care areas and ancillary services are all at work this morning in the aftermath of this tragedy—and most stayed throughout the night—to help the victims and to assist their loved ones."

Jeffrey Murawsky, the hospital's CMO, said Sunrise called in an additional 100 physicians on Sunday and another 100 other health care professionals, including nurses, support staff, and technicians. Sunrise's parent organization, the Hospital Corporation of America, on Monday also requested permission from the state to bring in out-of-state providers to assist with response efforts.

Meanwhile, Dignity Health-St. Rose Dominican received 61 patients at three of its campuses in the area, including 32 at its facility in Siena, a Level 3 trauma center.  As of Monday, five patients were in critical condition, but none had passed away. "No one has experienced patient volumes at this level," Jennifer Cooper, a spokesperson for the health system, said.

And Gretchen Papez, a spokesperson for Valley Hospital System, said the system had received 228 people injured in the shooting, eight of whom have since passed away. According to Papez, within the hospital system, Desert Springs Hospital Medical Center treated 105 patients, Spring Valley Hospital Medical Center treated 53, Henderson Hospital treated 32, the Valley Hospital treated 29, Summerlin Hospital Medical Center treated six, and Centennial Hills Hospital Medical Center treated three.

Officials call for blood donations in coming weeks

Following the shooting, blood donation centers also saw an influx of people. On Monday, there was a six-hour-long line of blood donors at United Blood Services (UBS), according to the Las Vegas Review-Journal, and the organization had registered people to donate blood through Monday, Oct. 9. The "massive response" has spurred the organization to send out mobile donation vehicles and open additional facilities for interested donors, NPR's "The Two-Way" reports.

Separately, the American Red Cross as of Monday said it had allocated more than 250 blood products to health care facilities in the area, and the organization said it would send more as required. Red Cross officials added that even those who are not in the Las Vegas area can donate blood, as the organization will put the donation in a national blood inventory to address "any blood needs that arise wherever blood is needed."

Looking ahead

According to Modern Healthcare, as hospitals move beyond providing immediate care, they will shift efforts to ensuring victims of the shooting—and the health care providers who served them—have access to grief counseling. On Monday, Nevada State Medical Association Executive Director Catherine O'Mara said her organization was reaching out to volunteers, retired physicians, and other health care professionals to be prepared if the state requests additional medical staff—particularly mental health care professionals.

(AP/KSFY, 10/02; Mangan, CNBC, 10/2; Stump, Today, 10/02; Chappell, "The Two-Way," NPR, 10/2; Messerly/Snyder, Nevada Independent, 10/2; Sanders, Newsweek, 10/2; Wagner, WHAS 11 ABC, 10/2; Belluz, Vox, 10/2; Romano et al., Vox, 10/2; Fink, New York Times, 10/2; Rege, Becker's Hospital Review, 10/2; Castellucci, Modern Healthcare, 10/2; Kodjak, "Shots," NPR, 10/2; Whalen/Caldwell, Wall Street Journal, 10/2; AHA News, 10/2; Thielking, "Morning Rounds," STAT News, 10/3; Lee Myers, Chicago Tribune, 10/3; Harasim/Munks, Las Vegas Review-Journal, 10/2; St. Rose Dominican tweet, 10/2).

Members ask: How can our hospital 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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