October 29, 2018

Mass shooter kills 11 in synagogue shooting: How Pittsburgh hospitals responded

Daily Briefing

    Three hospitals in Pittsburgh received patients after a gunman opened fire in a synagogue Saturday, killing 11—including a UPMC doctor.

    From shootings to hurricanes: How can your hospital prepare for disasters?

    Man kills 11 at synagogue

    According to police, Robert Bowers, the suspect in Saturday's shooting, entered the Tree of Life Synagogue in Pittsburgh armed with an assault rifle and three handguns. According to reports, Bowers opened fire on congregants who had gathered for Saturday morning service.

    Police arrived as Bowers tried to leave the synagogue. Bowers exchanged gunfire with police and then barricaded himself inside a room. Bowers eventually surrendered to police. As he surrendered, Bowers said he "wanted all Jews to die," according to a criminal complaint from the Pittsburgh police.

    Federal officials charged Bowers with 29 criminal counts, including obstructing the free exercise of religious beliefs and using a firearm to commit murder. Those crimes could carry the death penalty, according to the New York Times.

    The state of Pennsylvania also has charged Bowers with 30 counts, including criminal homicide and ethnic intimidation.

    Hospitals, EMS launch into action

    Around 10:15 a.m., Pittsburgh's four Level 1 trauma centers received an emergency operations alert to prepare for potential mass casualties.

    Three UPMC doctors as well as Pittsburgh EMS and other first responders arrived on the scene within half an hour, according to the Pittsburgh Business Times. Leonard Weiss, EMS medical director and assistant medical director of STAT MedEvac, who lives near the synagogue, was there "within minutes," according to the Business Times.

    Eleven people were pronounced dead at the scene, while six others, including four police officers, were treated and transported to hospitals. According to Business Times, the victims' injuries ranged from "hands, arms, and legs to multiple gunshot wounds to the abdomen."

    UPMC Presbyterian—the closest and the largest Level I trauma center—received five patients, two of whom had critical injuries. UPMC Mercy and Allegheny General Hospital (AGH) each received one patient, with AGH treating the suspected shooter.

    Don Yealy, UPMC's chair of emergency medicine, said, "At the beginning, when we didn't know how big this could be, we actually did call in extra physicians at both facilities," including emergency physicians, trauma surgeons, nurses, social workers, and others.

    At UMPC Presbyterian, six emergency medicine attending physicians, six attending trauma surgeons, and others were "on hand to treat the patients," according to the Business Times.

    AGH, which was initially put on standby, "ramped up in preparation," according to the Business Times.

    In a Twitter update on the status on shooting victims Sunday night, UPMC reported that at UPMC Presbyterian:

    • a 61-year-old female was in stable condition;
    • a 70-year-old male was in critical condition;
    • a 55-year-old male officer was in critical condition; and
    • a 40-year-old male officer was in critical condition.

    UPMC Presbyterian treated and released the hospital's fifth patient, an officer, on Saturday. UPMC Mercy's patient, a 27-year-old male, was released on Sunday, according to the tweet.

    An AGH spokesperson said Bowers was released from the hospital at 9:45 a.m. Monday, WPXI reports.

    On Saturday afternoon, Yealy said, "There was a lot of interaction right at the scene, all the way through to the hospital, about what’s the best care that needs to happen."

    'One of the most advanced EMS systems in the country'

    Yealy and Thomas Stein, Allegheny Health Network emergency medical doctor who leads AGH's disaster response, separately said the city's mass casualty plans worked just as intended.

    According to the Business Times, Pittsburgh is unique in that it has four Level 1 trauma centers within the city, and they all work together to practice and respond to emergencies. The response is designed to prevent any of the hospitals from getting overloaded.

    "We have one of the most advanced EMS systems in the country ... decades of investment and people, excellent EMS," Yealy said. "It's not by luck. It's by design of local government and the local health care facilities."

    Yealy also noted that there's a strong physician presence in the city's EMS. "What people don't recognize about Pittsburgh, there's a well-integrated physician presence in EMS, separate from the outstanding EMS providers that the city has hired, trained and continue to train." He added, "Most other cities don't have that type of involvement in the field."

    Stein pointed out the benefits of having several Level 1—the highest level trauma centers—in the area. "Very few places have four Level 1 trauma centers and five Level 2s within striking distance."

    UPMC doctor killed, chaplain injured

    Jerry Rabinowitz, 66, a family physician with UPMC, was among those killed in the shooting.

    Rabinowitz, a family physician, was beloved by his patients, according to colleague Ken Ciesielka.

    Jan Grice, a patient of Rabinowitz, said he "was the kind of doctor that treated the whole person." She explained, "You could go to him and present a jumble of physical symptoms and emotional reactions," and he could sort it out.

    Rabinowitz is also being remembered as a hero during the AIDS crisis, according to Buzzfeed News. A friend of one of Rabinowitz's patients in a tweet said, "In a time when doctors refused to treat HIV patients like humans, Rabinowitz would hold their hands."

    Tami Minnier, UPMC Chief Quality Officer, said, "The UPMC family, in particular UPMC Shadyside, cannot even begin to express the sadness and grief we feel over the loss of Dr. Jerry Rabinowitz."

    Daniel Leger, a nurse and chaplain for UPMC, was among those injured. According to a UPMC physician, Leger suffered a gunshot wound to the torso.

    Leger's family expressed thanks to Pittsburgh's Department of Public Safety, the FBI, "and the medical staff that saved Dan's life" (Gough, Pittsburgh Business Journal, 10/27; Smeltz, Pittsburgh Post-Gazette, 10/27; Giammarise, Pittsburgh Post-Gazette, 10/27; Robertson et al., New York Times, 10/28; Wadas, CBS Pittsburgh, 10/29; Sacks, Buzzfeed News, 10/28; WPXI, 10/29; UMPC News Twitter feed, accessed 10/29).

    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.

    Download the Resources

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