Last month, the tragic mass shooting in an Orlando nightclub rattled our nation. In all, 49 people lost their lives, with many others injured. But fortunately, the trauma teams, first responders and the staff of the Orlando Regional Medical Center were well-prepared. Their ability to quickly organize and spring into action to treat the shooting victims in the midst of war-like chaos certainly resulted in many lives saved.
Trauma centers were first created in Chicago in 1966 at Cook County Hospital as a way to improve survival among victims of severe injuries. Historically, the development of civilian trauma centers in the U.S. has been linked to war. Advances in trauma services were almost always developed on the battlefield or in a field hospital. Subsequently, the techniques employed during times of war were brought home and implemented in domestic hospitals as a way to improve care.
A trauma center is a special designation given to a hospital that is specifically equipped and staffed to provide care for critically ill patients who have suffered significant injuries, such as falls, car crashes or gunshot wounds. Trauma centers are rated by the American College of Surgeons and levels are designated based on the type of patient each center is capable of receiving during an emergency. Level I centers are typically the most well-trained and have access to the very best trauma surgeons. A Level I center is able to provide comprehensive care for every aspect of a traumatic injury. Orlando Regional Medical Center is the only Level 1 trauma center in Central Florida, and the hospital received almost all of the critically injured patients from the shooting in June.
[See: The Honor Roll of Best Hospitals 2015-16.]
Preparing for the Worst: Developing a Disaster Plan
While many hospitals have had so-called disaster plans in place for years, the Sept. 11 terrorist attacks led to more widespread adoption of these plans. Since that time, hospitals all over the country have put plans in place to deal with mass casualties. Academic societies and organizations of trauma surgeons have worked to develop best practices and conducted large-scale studies in order to determine the most effective ways to handle these types of disasters.
These plans involve extensive, centralized communication systems and a way to quickly alert all essential personnel and mobilize resources. In addition, disaster plans involve providing intensive education and training for all hospital staff. Most hospitals, once plans are in place and staff education is complete, have regular “drills.” Many institutions even have mock disasters with actors posing as critically injured patients. These drills allow hospital personnel — doctors, nurses, techs, first responders and communications specialists — to hone their skills and find ways to improve responses in the case of a real disaster.
Keys To Success in a Disaster
In a disaster or mass casualty event, trauma research shows communication is critical. Effective communication allows for patients and personnel to be where they need to be at all times in order to provide the most efficient and effective lifesaving care.
In addition, cooperation and coordination between surgeons, nurses, administrators and personnel is key to the successful treatment of large numbers of patients. And staff education is critical. Extensive education and training must take place in order to prepare staff for mass casualty events. When called upon, staff must be able to react in an organized and calm way, which comes from preparation over time.
Finally, it’s important to practice a response to a mass casualty event. Drills allow for those in charge of the disaster plan to assess response times and identify areas for improvement.
[See: 5 Common Preventable Medical Errors.]
An Inside Look at Trauma Care
The heroic efforts of those in Orlando cannot be overstated. These men and women should serve as an inspiration to all of us in medicine. Each person did their job and worked through the night to help as many victims as they could.
For many of us, the thought of being faced with such a large number of seriously wounded can be overwhelming — this is the stuff of war. However, those first responders in Orlando met the challenge head on, working quickly to identify and triage the most critically ill patients. Emergency personnel attempted to quickly stabilize each patient, and then decided who needed the most urgent treatment in the operating room. Patients were sequentially moved from the scene to the emergency department and to the operating room very quickly.
In order to triage the large number of victims, health care professionals are trained to use the ABCDE approach:
1. Airway: Make sure each patient has a stable airway — if not, we must quickly establish an airway.
2. Breathing: We must make sure that every patient is breathing on his or her own. If not, we must put him or her on a respirator.
3. Circulation/hemorrhage: First responders must quickly assess if the patient has a pulse and if there is major bleeding. If there is no pulse, CPR is initiated. If there is an obvious hemorrhage, efforts must be made to apply pressure, field dressings and other interventions designed to stop bleeding prior to treatment. In many cases, blood and fluids are administered in order to restore blood pressure and adequate circulation.
4. Disability: First responders must assess each victim’s level of consciousness and if he or she has suffered any type of neurologic or brain injury. These injuries must be quickly triaged to a neurosurgeon in cases of head trauma.
5. Environment: In many disaster situations, there are environmental hazards — like being exposed to dangerous chemicals — that may contribute to the trauma. In the case of the Orlando shooting, this was not at issue.
The Rise of Mass Casualty Events
Unfortunately, mass shootings have become more common in the U.S. in the last decade. Medical personnel and hospital systems are learning to better care for patients in these large-scale emergency situations.
[See: Top Reasons Children End Up in the Hospital.]
Events like the Orlando tragedy should prompt all health care systems and medical professionals to review protocols, plans and readiness procedures so that we will be more equipped to handle these tragic emergencies when they occur. Were it not for the heroic efforts of first responders, trauma teams, doctors, nurses and other hospital personnel in Orlando, the number of casualties could have been much greater.
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How Hospitals Prepare for the Worst originally appeared on usnews.com
