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May 3, 2018

3 mass shootings in 7 months: Here's what 2 Vanderbilt surgeons have learned—and how they've coped

Daily Briefing

    In less than a year, Vanderbilt University Medical Center's trauma team has treated patients from three mass shootings. Two of Vanderbilt's trauma surgeons in an interview with the New York Times reflected on their personal experiences—and their hospital's approach—to treating shooting victims.             

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    Responding to tragedy

    Richard Miller, the chief of trauma and surgical critical care at Vanderbilt, and Oscar Guillamondegui, trauma medical director, noted that Vanderbilt sees thousands of trauma's each year, including single-victim shootings.

    But Guillamondegui said, "Every single one of these events, we have a plan in place." He explained that the clinical aspect of care is fairly consistent even in the event of a mass shooting: you find the trajectory of the bullet or bullets and address the damage.

    But, he said, the logistics are where there's generally room for improvement. "You think about the logistics: It's not just the injury, it's not just getting the patient here, but it's the entire onslaught of everyone else around the institution that thinks that now is the moment that they can help."

    He continued, "We have a set amount of people that are supposed to be in every single trauma room," but "[t]he flow gets changed by onlookers who are trying to do the best they can to help, and what they don't realize is we see 6,000 traumas a year."

    Miller added, "You have to use your troops appropriately. ... It's become, unfortunately, a science behind these mass shootings and disasters."

    There's also a shift in mindset, the surgeons said. When the team learns patients are inbound from a mass shooting, they focus on how to "deal with this circumstance from an injury standpoint, a systematic standpoint, and a smooth-running machine," Miller explained. He added, "We try to set our emotions apart from that immediately, but we're humans and we really care about the people we take care of."

    Oscar Guillamondegui, trauma medical director, added, "It's a tragedy for the people involved, the community at large. For us, it's a Tuesday."

    Coping with tragedies

    But Miller and Guillamondegui said it's essential for staff to have time to cope, particularly given the reality—as Miller noted—that the team "cannot save everyone's life."

    Miller said, "The balance between empathy and objectivity is very difficult sometimes because in the heat of the moment, you're trying to save somebody's life, but your empathy for the patient and the family after that can overwhelm you."

    Miller said his team encourages therapy to talk about the experiences. "We debrief after every tragedy," he said. Another important component is self-care, Miller said uses triathlons to separate his work and personal self. "We have to try and separate what we do here from what we do in the regular world," Miller said.

    Guillamondegui, who Miller said is an avid biker and swimmer in his spare time, added, "I don't think that all of the wellness in the world takes away from the burden that you carry." He said, "I'm not trying to make it into more than it is. I pray for grace and hope we make things better for the people around us. That's some solace" (Blinder, New York Times, 4/24).

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