February 16, 2018

How Broward Health System sprang into action after the Florida school shooting

Daily Briefing

    Following a deadly mass shooting that occurred Wednesday at a Florida high school, three Browad Health System hospitals used their training for mass casualty events to treat both the victims and alleged perpetrator.

    Shooting details and hospitals' response

    According to Politico, law enforcement authorities believe that 19-year-old Nikolas Cruz—a former student who allegedly had been expelled from Marjory Stoneman Douglas High School in Parkland, Florida, for disciplinary reasons—on Wednesday entered the school and open fired, killing 17 people and wounding at least 15 others.

    According to the Washington Post, Cruz had been known for displaying odd behavior, such as killing animals and selling knives. Cruz previously had received treatment at a mental health clinic, though he had not received such treatment in over a year, the Post reports.

    'People knew what to do': How Broward prepared to care for victims

    According to USA Today, at least 16 individuals were taken to three Broward Health System hospitals for treatment following the shooting, including Cruz. Doctors did not provide details regarding Cruz's treatment. Jerry Brooks, CMO of emergency services for Broward Health System, said physicians had about 30 minutes to prepare from the time they were informed of the shooting until patients began arriving.

    According to Brooks, the hospitals were well prepared for the incident and had increased mass shooting drills after last year's mass shooting at the Fort Lauderdale–Hollywood International Airport. He also attributed the hospital's response to lessons learned from the Las Vegas mass shooting in November 2017.

    "We can't predict when the next mass casualty will occur but we're always trying to stay ahead of the curve and learning," Brooks said. "We ramped up with exercises and code green drills," he said, adding, "We used that information to try to make the response for any further mass casualties better. So it definitely helped."

    Igor Nichiporenko, medical director of trauma services at Broward Health North, said the experience "was challenging because you don't see young kids being shot and dying in front of you." However, he said hospital staff "worked as a team" and were "very organized," adding, "People knew what to do."

    As of Thursday afternoon, officials said one patient was in critical condition, seven patients were in fair condition, and one was in good condition, USA Today reports. Two patients died Wednesday, according to officials.

    Trump affirms commitment to addressing mental health care

    In related news, following the shooting, President Trump called for more efforts to address mental health care. In a tweet posted Thursday, President Trump wrote that there had been "so many signs" that the suspected shooter was "mentally disturbed," and called on U.S. residents to be more vigilant about reporting such individuals.

    During an address to the nation on Thursday, Trump said, "It is not enough to simply take actions that make us feel like we are making a difference," adding, "We must actually make that difference." He continued, "We are committed to working with state and local leaders to help secure our schools and tackle the difficult issue of mental health."

    Trump also urged young U.S. residents to seek help if needed. He said, "I want you to know that you are never alone, and you never will be," adding, "If you need help, turn to a teacher, a family member, a local police officer, or a faith leader."

    Trump said he plans to meet with state attorneys general and governors within the coming weeks to discuss school safety.

    Some advocates caution against tying mental health to gun violence

    Some advocates criticized Trump for linking mental health with gun violence, saying it reinforces a negative stigma. For instance, Paul Gionfriddo, president and CEO of Mental Health America, said linking mental health with violence can "frighte[n]" individuals with mental illnesses and deter them from seeking treatment.

    Ron Honberg, a senior policy adviser at the National Alliance on Mental Illness, said while some mental illnesses have been linked to violent behavior, many other factors also can contribute to such actions. For instance, he said, "Untreated psychosis may be one, but there are definitely other factors." Honberg continued, "It feels like mental illness is being used as a political football to deflect attention away from some other important issues, like whether we need sensible gun control laws in this country."

    Sen. Richard Blumenthal (D-Conn.) in tweets expressed similar concerns, writing that Trump's "failure to recognize the need for reforms … risks more American lives." He added, "More than words, action needed now to confront gun violence and prevent future massacres."

    Policymakers call for federal research into gun violence

    The topic of gun violence also came up during congressional hearings Thursday, as lawmakers discussed long-standing restrictions on federal health care agencies' ability to conduct research into gun violence.

    An amendment added to a federal appropriations bill in 1996 limited and effectively ended CDC's research on gun violence. The restriction eventually was extended to NIH, and similar language has been included in appropriations bills throughout the past two decades.

    Despite those restrictions, HHS Secretary Alex Azar told lawmakers on the House Energy and Commerce Committee that he believes CDC under current law has the authority to conduct research into gun violence. Regarding the appropriations restriction, Azar said, "My understanding is that the rider does not in any way impede our ability to conduct our research mission." He continued, "We believe we've got a very important mission with our work with serious mental illness as well as our ability to do research on the causes of violence and the causes behind tragedies like this so that is a priority for us especially at [CDC]."

    Separately, House Judiciary Committee Chair Bob Goodlatte (R-Va.) on Thursday said he thinks Congress should consider ending the funding restrictions on federal research into gun violence. "If it relates to mental health, that certainly should be done," he said.

    However, Sen. Roy Blunt (R-Mo.)—who chairs the Senate Appropriations Committee's Subcommittee on Labor, HHS, Education, and Related Agencies—on Thursday said he does "not imagine" that lawmakers will remove the restrictions from federal spending bills they are currently drafting.

    Similarly, Rep. Tom Cole (R-Okla.)—who chairs the House Appropriations Committee's Subcommittee on Labor, HHS, Education, and Related Agencies—said, "It's just not helpful to turn a funding bill into a debate over gun control—particularly when it'll be part of a bill that funds the entire government" (Nelson, Politico, 2/15; Sullivan et al., Washington Post, 2/15; Romo, "The Two-Way," NPR, 2/15; Rogers, New York Times, 2/15; Sullivan, The Hill, 2/15; Cancryn, Politico, 2/15; Paletta, Washington Post, 2/15; Wong, The Hill, 2/15; Alexander, Politico, 2/15; Herrera/Blaskey, Miami Herald, 2/15; Holsman, TCPalm, 2/14; Chavez, CNN, 2/16; Shutt, CQ News, 2/15 [subscription required]; Riley, USA Today, 2/15).



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