When Tragedy Strikes: The Critical Role of the ED

by Tony Briningstool, MD, FACEP

Coordination, Communication, and Compassion Win

On Monday morning, America woke up to news of the deadliest mass shooting in U.S. history. As emergency physicians, we are trained to understand it’s not a matter of if, it’s when. We live in a dangerous time where tragedies like this have sadly become expected and are no longer unimaginable. The massacre in Las Vegas is still unfolding. The first calls went to the emergency responders, the second to the Level One Trauma Center at UMC. They were ready.

The Emergency Department Front Line

Why? Hospital emergency departments recognize that preparedness matters. When significant events occur, higher patient volumes often reveal weaknesses. As the critical front lines of the hospital, deploying a mass casualty ED response requires a well-coordinated effort. UMC and Sunrise Hospital and Medical Center’s emergency departments exhibited both the training and coordination that exposes any potential weaknesses to ensure the staff and the region were ready.

It Takes a Team

The size and scale of the Las Vegas massacre are staggering. Mass casualty response comes from every corner of the hospital and beyond. From nursing, administration, post-op, to the ICU, everyone must work together as a team. Working with EMS, emergency department leadership creates a systemized response effort providing continuous communication to prioritize patient triage efforts appropriately. And because no one hospital could possibly handle the patient volumes, connecting with other hospitals and collaborating with secondary facilities throughout the region means the right medical and surgical resources are provided where and when they are needed.

Response Rates

More than 500+ patients. EMS was overwhelmed. Citizens stepped in and delivered patients to the hospital. Although necessary, there was no-prehospital care or communication prior to arrival. Triage took on whole new meaning. Who was injured? And who was a hero? It takes time to assess and triage patients, identifying the most serious level of patients needing immediate care and those that with less severe injuries. With gunshot wounds, there is an ongoing threat and mechanism of injury. Different operative management resources are needed, requiring a high level of acute care and surgical intervention.

An article in 2016 in the Journal of Critical Care, reviewed studies of “re-hospital management of mass casualty civilian shootings,” citing the importance of triage in mass casualty incidents. The other major consideration? With gunshot wounds, there is a critical need for hemorrhage control, requiring tourniquets, hypothermic blankets and most importantly, blood.

Extraordinary Effort

The incredible effort by the Level 1 Trauma Unit at UMC, Sunrise and the other Las Vegas hospitals to band together is nothing short of extraordinary. From the EMS responder’s bravery, entering an “active shooter” situation to the professional dedication from hospital staff at every level to the bystander citizen’s care, to the 6-hour lines of those waiting to donate blood proved once again, human compassion wins. The lives saved are a testament to the ED and hospital’s staff’s emergency readiness.

What We Can Learn

As the days and weeks unfold, it’s important to understand there is a grieving process for everyone. Victims and their families, bystanders, emergency responders, physicians and everyone who provided care pay an emotional price. Once the adrenaline wears off, hospital leadership needs to provide long-term counseling and pastoral support to the nurses, physician and other providers on the front lines. That’s how healing begins. As the greatest single mass casualty event in U.S. history, we understand now, more than ever, the importance of a well-run emergency department and the need for operational readiness.