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Ways to Enhance Hospital Preparedness for Mass Casualties

The case study of the tragic 2017 Las Vegas shooting provides multiple examples of how healthcare organizations can enhance hospital preparedness for mass casualties. One of the key takeaways is that the responses could have been much improved with better communication systems in place.

On October 1st, 2017, Stephen Paddock opened fire on concertgoers attending the Route 91 Harvest music festival from the nearby Mandalay Bay Hotel. Within ten minutes he had fired 1,100 rounds of ammunition into the crowd - killing 58 people and wounding 422. A further 371 people were injured trying to escape the incident.

Emergency response to the incident was complicated by more than 22,000 concertgoers - many with life-threatening injuries - fleeing the scene in different directions. Most of the injured made their own way to area hospitals or medical centers, while paramedics treated those incapacitated by their injuries in twenty different locations across metropolitan Las Vegas covering four square miles.

How Nevada's Hospitals Had Prepared for Mass Casualty Emergencies

Since 2011, Nevada's Division of Public and Behavioral Health has maintained and updated a Medical Surge Plan (PDF) as part of its emergency preparedness planning. The plan aligns with the National Incident Management System (NIMS) and National Response Framework (NRF) for all-hazard emergency planning, and outlines phases of activation, along with the role each entity plays in executing the plan.

Related Blog: A Day in the Life of a Hospital Emergency Manager

The plan is comprehensive inasmuch as it lays out the responsibilities for each healthcare facility, emergency service or law enforcement agency, local health authority, the Division of Public and Behavioral Health, and Nevada's Division of Emergency Management through the four phases of activation. The plan was often tested via drills prior to the shooting incident, and updated as necessary.  

The plan also explains which internal and external systems should be used for communications between paramedics, dispatchers, medical facilities, emergency operation centers, and incident command posts. Back-up systems are also listed for events in which - for example - cellphone networks are overloaded or Internet-based communications are unavailable.

Why Nevada's Planned Hospital Preparedness for Mass Casualties Didn't Work

It's not entirely accurate to claim Nevada's planned hospital preparedness for mass casualties didn't work at all. Indeed, many elements of it were executed successfully. However, due to the unprecedented scale of the incident, the case study of the Las Vegas shooting - “A Day Like No Other” - found multiple shortcomings and lessons to be learned. These included:

The Rate at in Which Victims Arrived at Hospitals

Medical facilities were totally unprepared for the rate at which victims arrived and the random nature of their injuries. At one stage there was a queue of cars a quarter of a mile long outside one hospital carrying both victims with life-threatening injuries and those that had suffered minor abrasions.

The Rate at Which Medical Staff Arrived at Hospitals

As news of the shooting spread, many medical staff arrived at their places of work to provide help without being called in. This was described by the case study as both a blessing and a curse as it raised concerns about staffing levels for later shifts. Excess staff told to go home reported feeling “unwanted”.

Hospital Environmental Services were Understaffed

While there was an excess of medical staff, hospital environmental services (EVS) were understaffed due to hospital call lists being primarily comprised of medical personnel. This created concerns about cross-contamination due to medical equipment being reused without being disinfected.

Both Medical and Non-Medical Supplies Ran Low

As the shooting occurred on a Sunday night, most medical facilities were at minimal Periodic Automatic Replenishment ahead of a delivery of supplies on Monday morning. However, it was not only medical supplies that ran low. Hospitals reported shortages of basic equipment such as pens and tags.

Call Lists and Phone Trees were not Up-to-Date

The Medical Surge Plan calls for healthcare facilities to update their call lists “quarterly or annually”. This created a problem with both internal and external communications because many numbers had changed or individuals had dropped their landline services in favor of mobile services.

The shortcomings and lessons to be learned were no reflection of the efforts of managers and healthcare professionals who did everything they could to tend for the injured and dying. Several individuals received bravery awards for treating victims at the site, while multiple events were held once the emergency was over to thank healthcare professionals for their efforts.

How Better Communication Can Enhance Hospital Preparedness for Mass Casualties

The case study dedicates a significant amount of space to how better communications could enhance hospital preparedness for mass casualties. In the context of the issues raised above, the case study notes there was no individual with responsibility for alerting entities to the shooting, the scale of the shooting, or the likely rate at which victims would arrive at hospitals.

Had there been a dedicated channel of two-way communication providing a reliable source of information, this could have helped dispel rumors multiple assailants were active and multiple venues were being targeted. It would have also helped overcome the issue of updates not being received due to multi-purpose channels being overrun by enquiries from law enforcement and concerned relatives.

Related Blog: How Denver Health Improved its Emergency Notification System

The issue of shift management could have been better handled by implementing an alerting system with geo-polling capabilities. This could have been used to prevent excess medical staff arriving at hospitals or to redirect them to other medical facilities that were acting as temporary trauma units. It could also have been used to call in EVS personnel or share supplies updates with neighboring facilities.

One further way in which healthcare authorities can enhance hospital preparedness for mass casualties is to implement a multi-modal communication system that synchronizes with personnel and other databases to ensure contact information is constantly refreshed. The system's communication database can then be segmented into groups according to role, location, or other attribute.

Healthcare organizations reviewing their hospital preparedness for mass casualties are invited to get in touch and speak with our team of safety experts about solutions to address the shortcomings and lessons to be learned identified by the Las Vegas shooting case study. Our team will be happy to discuss existing communication strategies and how the suite of Rave Mobile Safety solutions can help healthcare organizations better prepare for a mass casualty incident.

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Tara Gibson
Tara Gibson

Tara is a Marketing Coordinator on the Rave Mobile Safety marketing team. She loves writing about all things K-12, State & Local, Higher Ed, Corporate, and Healthcare, and manages the Rave social media channels. When she's not working, she's taking care of her smiley, shoe eating, Instagram-famous fur baby, Enzo!

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