Orlando Regional Medical Center (ORMC) is an urban, academic, Level 1 trauma center with an ED that treats in excess of 85,000 patients each year. There are more than 4,500 annual trauma admissions, including penetrating and blunt mechanism injuries. We have a 3-year emergency medicine (EM) residency program, originally established in 1986, that now has 14 residents per year. The events that we experienced on the early morning of June 12, 2016 were tragic and unexpected and tested our community, our teams, and our organization. The following is a description of activity perspectives, personal reflections and feelings, and important lessons learned from which other EDs may benefit.
Prehospital/Rescue Period
The prehospital approach to a mass-casualty incident (MCI) caused by gunfire has changed significantly over the last decade, with lessons gleaned from the experience of military and domestic attacks. The Orange County (Florida) Emergency Medical Services (EMS) System, including the agencies involved in the response to the June 12, 2016 Pulse nightclub shooting incident (Orlando Fire Department, Rural Metro Ambulance, and Orange County Fire Rescue), have trained specifically on the evolving priorities during an active shooter incident. This includes targeted hemorrhage control, swift extrication, minimal interventions, and immediate transport to the appropriate receiving center. In June 2015, 1 year prior to the Pulse nightclub shooting, a protocol variance was written by medical directors, explaining that “EMS providers may engage in initial patient care with only the supplies deemed absolutely necessary for rapid evaluation and removal into a safe triage zone.” This variance applies when there is an active shooter scenario. In addition, in 2014, 2015, and 2016, we conducted large scale, multiagency community exercises, encompassing shooting/active shooter scenarios and drills.
On June 12, 2016, EMS units were on scene of the Pulse nightclub in downtown Orlando less than 5 minutes after shooting began. It became immediately obvious that additional resources would be necessary. Soon after the incident, an MCI alert was activated from the Orlando Fire Department Communications Center, utilizing a software system to notify area hospitals and the medical directors that up to 20 patients had been shot, and requesting status on bed availability. Christopher L. Hunter, MD, PhD, one of our associate EMS medical directors, was working in the ED at a hospital several miles away from the incident and began coordinating efforts to distribute patients to the appropriate destination via radio and phone communication between the scene, the communications center, and the trauma center.