Lessons Learned from the Vegas Shooting – Simulation Is Key
A recent interview with Dr. Dale Carrison from the University Medical Center (UMC) Las Vegas revealed interesting details about how the Medical Center responded to the huge influx of patients following the mass shooting in Las Vegas. Dr. Carrison is the chief of staff and chairman of the department of emergency medicine at the University Medical Center and in addition, is the medical director for the Las Vegas Metropolitan Police Department. He was interviewed by Dr. Robert Glatter assistant professor of emergency medicine at Northwell Health, New York City.
The University Medical Center is Nevada’s only Level 1 trauma center. The facility has a stand alone 11 bed trauma center with 3 operating rooms which were all operational on the day of the shooting. The 26 operating rooms in the main hospital were opened up to treat casualties. On the day of the shooting when Dr Carrison arrived, 9 of the trauma beds were occupied and a total of 50 trauma patients were being treated. Of the 50 patients, three had chest tubes being placed and multiple tourniquets were in place. Dr. Carrison initiated the opening of the Incident Command Center. A total of 104 patients from the shooting were treated at UMC on the day of the shooting. Dr. Carrison and Dr John Fildes (trauma surgeon) triaged the 50 patients and made decisions who should go to the Trauma Center, CT, operating room and who should be evaluated further. Eighteen of the patients were sitting in chairs with various levels of extremity wounds. Off-duty healthcare providers, EMS workers, and police officers showed up to help. Every available facility in the center was opened up. The 9 existing trauma patients were moved to a postoperative recovery unit. (PACU). Patients with fatal injuries had to be moved to make way for patients with a chance of survival. The critical injuries included chest and abdominal injuries. There were a large proportion of shrapnel injuries from projectiles hitting the asphalt. Many of these patients arrived with either military grade or make do tourniquets. The Las Vegas police and EMS have received extensive training in the use of tourniquets. Dr. Carrison noted that every police officer carries a tourniquet. He also noted that tourniquets can save limbs and all medical personnel, EMS and police officers should be trained in their application.
The Sunrise Hospital and Medical Center, a Level 2 Trauma center treated another 214 patients with 30 requiring surgery.
The blood bank at UMC has massive transfusion protocols in place. The bank can provide enough blood for 3 patients in the operating room on massive transfusion protocols at the same time. O-Negative blood is used for females and O-positive for males. No shortage was experienced during the response to the shootings. The local community responded to the need and the lines to donate blood were long.
Dr. Carrison thought there were two key take-away points from the day. First he noted that many of the patients were self-triaged. He indicated that these patients are difficult to plan for. When patients come in through the EMS, hospital emergency rooms get notice that patients are on their way, with self-triage, patients show up unannounced. On October 1st, people arrived by police cars, private cars and taxis. Patients continued to arrive. Dr. Carrison noted that not all the patients needed to go to the trauma center but could have been seen in the Emergency Department because they did not have limb-threatening or life-threatening injuries.
The second key message is that practice for such events is crucial. Las Vegas has two major events each. Before old casinos are torn down, the Las Vegas Police department uses them to practice emergency drills. The Multiple-Assault Counter-Terrorism Action Capability (MACTAC) practices tactics for removing patients when there is an active shooter. The hospital practices disaster drills. Dr. Carrison noted that practice makes all the difference. Training with simulation is imperative if institutions want to be prepared for multi-casualty events.
Since this article is written around Thanksgiving, let us give thanks for all those involved in every aspect of simulation. You make a difference saving lives and preparing healthcare personnel for their work!
Today’s article was guest authored by Kim Baily PhD, MSN, RN, CNE, Simulation Coordinator for Los Angeles Harbor College. Over the past 15 years Kim has developed and implemented several college simulation programs and currently chairs the Southern California Simulation Collaborative.