It’s not if, but when.
That was the mantra that Wayne Freeman, the South Carolina Active Shooter Training Coordinator, repeated over and over again throughout the course of his presentation last Thursday at the 2016 SC Healthcare Preparedness Program (HPP). Freeman induced fear and urgency, while emphasizing that training for this kind of emergency event is of absolute necessity for hospitals.
The recent tragic and heartbreaking massacre in Orlando brought his presentation, and the conference as a whole, from hypothetical scenarios to harsh reality.
HPP is an annual conference put together by DHEC, SCHA, and the South Carolina Society for Healthcare Emergency Management (SCSHEM) to advance the preparedness, coordination, and collaboration of health care organizations and partners throughout the state. Geared towards all kinds of emergencies, from natural disasters like hurricanes and floods to mass casualty situations like the one that just occurred in Florida, the meeting serves to renew efforts and focus on the broad array of concerns and issues that can arise unexpectedly in these situations.
As far as mass shootings, Freeman covered the importance of preparing for the active shooting scenarios and talked about the free training he and other training coordinators offer through SLED. He offers a wealth of experience to hospitals, schools, and all large organizations on how to deal with such a traumatic event, having worked with personnel from Columbine, Virginia Tech, Sandy Hook, the Naval Yard Shooting, and more.
The conference also featured a keynote presentation from Maureen McMahon, the Director of Emergency Management at the Boston Medical Center, who oversaw operations on the day of the Boston Marathon Bombing in 2013. Her presentation, which dealt with how to handle the mass surge of patients that occur following an event like the bombing, was an excellent model of how hospitals relentlessly prepare for these events, collaborate together, and hone their practices following each event.
Boston is the home of ten hospitals, including six Level One trauma centers, but they all work together in their Health Care Preparedness Coalition to handle emergencies, and they will often run joint exercises. McMahon’s Boston Medical Center is the largest of these hospitals, with 496 licensed beds and the busiest emergency department in New England.
BMC had a number of assumptions about mass casualty incidents that their emergency planning was predicated on: that about 10% of total casualty numbers would be critical, 85% would be minor injuries that self-present and arrive first, and that casualties would begin arriving approximately 30 minutes after the incident itself.
Based on that plan, the hospital was prepared with 10 “red,” or critical care, arrivals which would need an operating room and had a 30-minute prep routine followed by a next-30-minute plan after that.
Prior to the bomb going off on April 15, 2013, BMC was having a relatively uneventful marathon day. That changed rapidly upon getting a report of an explosion near the finish line at 2:50pm. The first causalities rolled into the emergency room within 8 minutes of the initial word, with 23 casualties at the hospital by the half hour mark, and constant calls asking if they could take more.
While the timeline of their plan was thrown out the window, the hospital reacted swiftly. After first holding or calling off all non-emergency surgical cases, they opened and staffed 12 operating rooms, 10 ICU beds, and 10 medical/surgical beds. They also opened their Family Assistance Center, administered nearly 80 units of blood, secured the hospital, and maintained their situation awareness.
The hospital would eventually perform 16 surgeries in the 10 hours following the bombing, including amputations and repairing major vascular injuries. Every patient who reached the hospital alive survived.
Although BMC’s planning assumptions were wrong in terms of the number, type, and speed of the casualties they received, they found their logistical planning, rapid triage, and robust preparedness systems and exercises made them successful.
In the wake of the bombings, they did make a number of tweaks to their plans, adding check sheets and action guides to make their initial directives more efficient, as wells as new rules for monitoring and controlling information flows surrounding the event. They also realized they needed to think more about staff recovery, something which occurs in terms of weeks and months rather than days given the traumatic nature of the event.
While preparing for violent attacks and other disasters is a grim task, it is a necessary one that hospitals and other emergency care providers are constantly thinking about.