Expect the Unexpected
Even when physicians and staff conduct regular training exercises and are familiar with policies and procedures, the controlled chaos that is typical of a true mass-casualty event will likely result in some unexpected occurrences. After injured patients began arriving at our ED, during a period when patient influx and medical care was intense, there was a brief time when we were concerned an active shooter was also in our ED. Since the mass shootings were only a few blocks from the ED, and we did not know the scope or number of shooters, it was a reasonable assumption that a perpetrator could present to the ED as a patient or active shooter. During an event such as this, it is the practice at ORMC to have security officers place the facility on lockdown; however; the added concern that an active shooter was physically present in the ED required additional law enforcement officers to methodically search the entire facility until the threat of a shooter was eliminated. Although this did not directly impact patient care, it did create another level of complexity and stress to the already challenging situation.
Emotional Impact
One should not underestimate the emotional impact of a mass-casualty event. Emergency physicians and personnel are well equipped to manage illness, injury, and death. However, an event of this magnitude, with the number and manner of injuries and deaths that presented to our ED, along with the closeness to a scene of bloodshed where many young lives were taken in a senseless act of violence, will likely have a lasting impression on many staff members. Any institution encountering such an event should have behavioral health and support counselors readily available as soon as possible.
Conclusion
When patients present in truckloads, as they did in our ambulance bay in the early hours of June 12, an ED may be inundated with injured patients without notice or preparation. Teams need to trust their instincts, their training, and one another. It is unlikely that your normal ED practice patterns will be sufficient to take care of a large surge of patients, and you will need to turn to your ingenuity, creativity, and resourcefulness to do what you think is best to save the lives of as many patients as possible. As Sarah Duran, BSN, the trauma nurse who was working as the ED charge nurse the night of the shootings, stated, “I don’t think anyone can fully prepare for anything on the scale of what happened in Orlando, but with a good foundation of protocols in place, strong set of staff, constant vigilance, and great teamwork, any hospital can be successful in handling a mass casualty incident.”