Hospital officials increasingly are training physicians to prepare for the chaotic aftermath of a mass shooting—and they've honed in on four key practices to increase patients' odds of survival, Ruben Castaneda reports for U.S. News & World Report.
Hospital staff are no stranger to mass casualty drills. They often practice for scenarios such as hurricanes, earthquakes, and other natural disasters. But the increase in mass shootings in the United States has prompted more hospitals to add shooting-specific drills to their training roster.
Scott Scherr—regional medical director for TeamHealth, Emergency Medicine West Group and chair of emergency services for Sunrise Hospital and Medical Center in Las Vegas, where he was in charge the night a gunman opened fire on outdoor concert—said, "It's not a question of if it's going to happen again, but when it's going to happen again."
How hospitals are training for mass shooting casualties
Stephanie Davis, a board member with the American College of Osteopathic Emergency Physicians, who is overseeing mass shooting training in Chicago this month, said, "The goal of the training is for doctors to know exactly what it's like to operate inside the epicenter of these tragedies, and to enable them to return home and create action plans specific to their hospital. We want communities across the country to be ready."
The trainings hone in on four critical ways hospitals can prepare to respond to mass-casualty shooting incidents:
1. Be prepared to expand ED capacity—rapidly: After a mass shooting, hospitals may only have minutes to ramp up ED capabilities before patients arrive. Scherr said victims will get to a hospital "in Ubers, taxis, in the back of a truck, by wheelbarrow—however they can." As such, hospital staff will need to make use of every available room and space, putting patients in the pediatric ED and post-anesthesia care unit, and setting up some patients in the hallway.
2. Mobilize physicians, nurses, and first responders. To prepare for the sudden influx of patients, hospital officials will need to call in additional staff and, if needed, coordinate with first responders from local fire departments. Within a few hours, Sunrise Hospital went from having four physicians and a handful of NPs and PAs on staff to about 100 physicians, 200 nurses and NPs, and several first responders from local fire departments to treat and assess patients.
3. Create a special triage process to better assess large numbers of victims. It's important that hospital staff determine as quickly as possible which patients need immediate treatment. Davis said many hospitals default to the START method, which stands for "simple triage and rapid treatment," to evaluate patients upon arrival. With the START method, physicians or first responders determine a patient's need for treatment by assessing how well they walk, their breathing, and their mental status.
4. Stop the bleeding. According to Castaneda, bleeding from even the smallest wound can quickly put a patient's life in jeopardy. Hospital staff should deploy all available hands—even civilian bystanders—to stop bleeding. Use tourniquets, apply direct pressure to the injury, or pack it with gauze or other material, according to Adam Zwislewski, trauma educator and outreach coordinator at Hahnemann University Hospital. "We have to train physicians to teach bystanders effectively and quickly how to provide care," Davis said. According to Davis, teaching civilians to stop bleeding "is a major aspect of ACOEP's MCI training" (Castaneda, U.S. News & World Report, 9/13).
From shootings to hurricanes: How can your 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.