#VegasStrong UMC PROUD Trauma Tough
One October Shootings A summary of events and lessons learned
Antoinette (Toni) Mullan, RN Clinical Nurse Supervisor Trauma Resuscitation
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com DISCLAIMER The views and opinions expressed in the written materials and in any of the presentations at this conference are those of the presenter and do not necessarily reflect the official policy or position of the Department of Business and Industry, Division of Industrial Relations. The Division does not warranty the materials’ completeness or accuracy.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Disclosures
• I do not have any relevant financial relationship(s) with any commercial interest that pertains to the content of my presentation.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Objectives
• Review the timeline of events from the One October Shootings • Identify the strengths associated with this response • Discuss the challenges that were identified • Summarize the lessons learned
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com UMC Key Facts • Year Founded: 1931 • Academic Affiliation: UNLV School of Medicine • Employees: More than 3,800 • Physicians on Staff: Approximately 1,100 • Registered Nurses on Staff: More than 1,800 • Number of Beds: 541
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com UMC Offers: • Nevada’s ONLY Level I Trauma Center and ONLY Designated Pediatric Trauma Center • The UMC Lions Burn Care Center, the ONLY burn care center in Nevada • The ONLY center for transplantation in Nevada • The most advanced surgical technology in the state • The ONLY Children’s Hospital of its kind in Nevada
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com UMC Trauma Center
UMC Trauma Center
• Providing the highest level of trauma care available, the UMC Trauma Center serves patients in a 10,000-square-mile area.
• The UMC Trauma Center is the ONLY free-standing trauma center west of the Mississippi. • One of four free-standing trauma centers in the United States
• In 2017 alone, the Trauma Center treated approximately 12,000 patients.
• The Trauma Center offers 11 resuscitation beds, 18 ICU beds and three surgical suites
• The Trauma team frequently trains for mass casualty incidents, including a recent visit from Dr. Gary Parrish of Orlando Regional Medical Center.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Lazy Sunday
This Photo by Unknown Author is licensed under CC BY-NC-ND
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com 1 October
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Event Timeline
September 25 – Gunman Stephen Paddock checks in at the Mandalay Bay Resort, eventually occupying a room on the 32nd floor of the hotel with a direct view of the nearby festival grounds.
October 1, 9:40 p.m. – With a crowd of approximately 22,000 people in attendance, the closing act of the Route 91 Harvest Festival begins as musician Jason Aldean takes the stage.
9:59 p.m. – Paddock fires approximately 200 bullets through the door to his room, wounding a hotel security guard.
10:05 to 10:15 p.m. – Paddock opens fire on thousands of concertgoers from his suite, firing more than 1,100 rifle rounds from multiple weapons during the 10- minute period.
10:25 p.m. – The first shooting victims arrive at UMC.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com
Timeline of events on One October
• Bystanders rescued the injured and used improvised tourniquets • The crowd evacuated the scene on their own • At 10:15 pm EMS began transporting the injured from an active crime scene • By 10:22 pm UMC received the first shooting victims • 58 people died • More than 550 people were wounded • Approximately 80% of these patients were ‘self-directed’ to medical care • More than half of the dead and injured were visitors to Las Vegas
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Locations
Distance to UMC Trauma Center 6 miles – Approximately 23 minutes away Distance to UMC Trauma Center 6 miles – Approximately 12 minutes away Locations
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Arriving at UMC
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com UMC’s Response
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com
1 October Statistics Notification
Initial Notification: “Active Shooter on the Strip” • Night and day Trauma teams were at the hospital and stayed
• Five to 10 patients from the scene expected to arrive at UMC
• Back-up surgeon and anesthesia called
Second Notification: • 50 to 100 or more patients expected
• UMC activates Disaster Plan
• Teams begin placing gurneys with IV bags in hallways and outside of the Trauma Center to prepare for an influx of patients
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Patients Arrive
Patients Arrive
• In the span of just five minutes, 40 patients arrive at UMC, including more than 20 self- transports to the Trauma Center and Adult Emergency Department.
• Team members utilize a triage area set up outside of the hospital
• Patients arrived in ambulances, pick-up trucks, cars, Uber vehicles and taxicabs.
• UMC receives 104 total patients, 60 of whom are admitted.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Access to UMC
Local Streets or Interstate 15 Highway Adult Emergency Room
• 59 Beds • Triage Area • Multiple EM Physicians, EM Residents, PAs
Main Operating Rooms
• 20 Rooms • Endoscopy/ Procedure Suites Trauma Resus 11 Beds + 4 PACU Beds
Adult ED 59 Beds
PACU & ASU 46 Beds Surgery
• The most critical patients were brought to Trauma Resuscitation, assessed and evaluated for surgery.
• Team members opened the Trauma operating rooms and main operating rooms at UMC, preparing for a significant number of surgeries.
• At one point in the evening, UMC had eight operating rooms running simultaneously.
• Within the first 24 hours, UMC completed more than 20 surgeries, providing life-saving care to critically injured patients
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Team Response
UMC Team Arrives in Full Force
• UMC Team members arrived in droves, with physicians, nurses and other medical professionals from across the hospital working collaboratively to save lives.
• Many team members arrived without being called in by their supervisors.
• UMC’s trauma surgeons and military partners also responded swiftly to reports of the mass shooting.
Trauma Surgeon Arrival Times 0 minutes 2 attending trauma surgeons in house, plus surgery, orthopedic and emergency medicine residents 30 minutes 4 attending trauma surgeons and 2 fellows (6 total), in addition to residents 1 hour 5 attending trauma surgeons and 4 fellows (9 total), in addition to residents 2 hours 8 attending trauma surgeons and 4 fellows (12 total), plus residents
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Day 2
Day 2 Response
• A fresh team was available to care for patients.
• Internal Medicine, Family Medicine, Hospitalists and the Medical Intensive Care Unit offered to take non-critical patients from the Trauma Center.
• The Trauma team transferred 12 ICU-level patients and many others to units across the hospital.
• The day-shift Trauma team performed a tertiary examination on every patient and completed detailed documentation.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Staffing
Key Staffing Advantages:
• More than a dozen trauma surgeons
• A wide range of specialty surgeons
• SMART Program providers
• Expertly trained nurses and techs
• Anesthesiologists
• Emergency medicine physicians
• More than 70 surgery and emergency medicine residents and fellows
• Every type of health care provider and administrator
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Lessons Learned
Clinical Lessons Learned
• Importance of Disaster Training • Multi-Specialty Care o Hospital, Systems • Send team members home to rest o Disaster Management and • Keep the next day team home Emergency Preparedness • Supplies o Advanced Trauma Life • Bed Control Support • Community Support • Triage • Analysis • Surge Capacity • Priority Hospital Needs • Military/Civilian Partnership • Media Attention • Communications • Recovery, Psychiatric Care
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Incident Command
• UMC administration immediately activated its Incident Command Center
• Brought together leaders from across the hospital to ensure the best possible responses to numerous challenges. o Team included: Nursing leadership, administrators, public safety, operations, communications and many other departments.
• The Incident Command Center served as a central hub for the team, conducting regular briefings to disseminate up-to-date information across departments.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Strengths associated with this response • PREPARATION !! – Plan your response – Practice your response – Execute your response • COLLABORATION !! • Nursing Leadership
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Challenges that were identified
• Las Vegas is an isolated metropolitan city • The accuracy of the radio communications – Mitigating the threat of an organized attack – Updating hospital status • Access and egress routes around the crime scene • Ability to level-load the hospitals in the system • Maintaining 24/7 staffing & services until ALL patients were definitively managed
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Hospital System Assets:
• There are 17 hospitals with emergency departments capable of caring for injured patients depending on the extent of the injuries • There are 3 Trauma Centers within this group: – University Medical Center is a Level 1, Pediatric Level 2, and Burn Center – Sunrise Hospital Medical Center is a Level 2 – St. Rose Dominican Hospital is a Level 3
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com
Challenges
Key Challenges:
• Mobilization of hospital resources and volunteer support
• Identification of victims
• Managing the flow of information
• Reunification of families
• Call volume – more than 5,000 calls in the first 24 hours
• Management of media outlets and protection of patient privacy
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Resources
Resources and Staffing
• Mobilized resources, including physicians, nursing, imaging, lab, blood, medical and pharmaceutical supplies, and transport by using up-to-date call trees.
• Many team members arrived without being called, and they wanted to help in any way possible.
• UMC prepared for emergency physician credentialing, but made the decision that the hospital had sufficient medical staff.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Resources
Resources and Staffing
• UMC’s leadership team maintained a constant presence throughout the hospital to check on resources, needs and the emotional wellbeing of staff
• Administrators canceled all elective surgeries to maximize the availability of resources.
• The hospital utilized its entire team, with many individuals serving in roles well outside of their traditional responsibilities.
• No one complained or asked when they could take a break. The entire team came together to provide our community with the best possible outcome.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Families
Family and Friends
• Immediately following the incident, family members and friends of potential victims began calling and visiting the hospital.
• Many visitors also lived through the horrific shooting and were understandably shaken and terrified for their loved ones.
• UMC utilized its cafeteria and family retreat room as designated locations for family members and friends of patients.
• UMC staff from various departments provided comfort to the families and assisted in identifying patients.
• In some cases, team members utilized photographs and descriptions provided by families to identify patients and provide updates.
• UMC Social Services, the Trauma Intervention Program and chaplains played key roles in assisting and supporting visitors who lost family members.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Families
Family Reunification
• Many patients with less severe wounds were treated and released quickly, some with bullets still in their bodies.
• In the hours following the shooting, police and UMC Public Safety locked down the hospital to ensure the safety of patients, visitors and staff.
• In an effort to help family members find their loved ones, UMC established a meeting destination at a nearby shopping center.
• UMC provided transportation to patients and their loved ones. This included bringing patients to their hotels on the Strip once hotels resumed their normal operations.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Advantages
Key Advantages:
• UMC recently received an in-depth training from Orlando Regional Medical Center. o This made mass casualty preparedness fresh in our minds.
• UMC participates in county-wide mass casualty training sessions to prepare team members for the worst-case scenario.
• The CEO of Orlando Regional Medical Center contacted our administration within hours of the shooting to provide support.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Advantages
Key Advantages:
• The day-shift trauma surgeon happened to still be in-house
• Strong partnerships with payors and health care organizations throughout the continuum of care
• All leadership was present
• As the state’s ONLY Level I Trauma Center, UMC always stands prepared for mass casualty incidents
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Media
Media Response
• Throughout the incident, UMC worked alongside media outlets to keep the public informed.
• Dozens of local, national and international outlets lined up outside of UMC, with many staying for more than a week.
• UMC successfully protected patient privacy while allowing reporters to share thought- provoking stories about the hospital and the survivors.
• Physicians frequently participated in live interviews at 4 a.m. Most national outlets target the East Coast time zone.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Presidential Visit
Presidential Visit
• UMC hosted a presidential visit just three days after the largest mass casualty incident in the hospital’s history.
• Staff worked closely with the White House and Secret Service to coordinate the visit.
• President Donald Trump met with patients and thanked staff for their tireless efforts to save lives.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Celebrity Visits
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Community Support
• UMC received an overwhelming level of support from the community.
• Almost immediately after the incident, UMC began receiving donations of food, water and comfort items for the patients and their family members.
• Team members utilized half of UMC’s cafeteria to store the items.
• Restaurants and chefs brought meals and food trucks to UMC for visitors and staff.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Community Support
• Hundreds of community members lined up to donate blood to United Blood Services, which collected close to 1,000 units of blood.
• Volunteers visited the hospital to assist UMC team members.
• The Vegas Golden Knights hosted a special ceremony for the victims and their families. The Raiders offered a special lunch event for UMC staff.
• Organizations and individuals from across the country donated to the UMC Foundation, which supports the hospital’s mission to provide Nevada’s highest level of care.
• UMC directed many donors to the Las Vegas Victims’ Fund.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com The Healing Process
• UMC made counseling services available to all UMC staff, encouraging employees to utilize the resource and look out for one another.
• Located on the UMC campus, the Vegas Strong Resiliency Center plays a valuable role in supporting visitors, community members and first responders affected by the tragic shooting.
• UMC team members continue to receive letters of gratitude from across the world.
• To celebrate the tremendous work of UMC’s team, the hospital hosted a large-scale “UMC Strong” celebration.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com 1
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Education
Stop the Bleed
• Provides community members with the skills needed to stop life-threatening bleeding before emergency medical personnel arrive on the scene
• In many cases, friends, colleagues and other bystanders must take steps to save an injured person’s life. Mere seconds can mean the difference between life and death.
• Offers hands-on activities to ensure community members understand how to apply pressure, pack wounds and use tourniquets
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Education
• Through Stop the Bleed, UMC has trained thousands of people, including representatives from casinos, schools, health care organizations, and Red Rock Search and Rescue.
• To schedule a complimentary Stop the Bleed training session, please contact [email protected].
• In addition to Stop the Bleed, UMC’s clinical staff and leadership team will continue to provide other health care organizations with support and guidance to assist in preparations for mass casualty incidents.
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Summarize the Lessons Learned • Practice your disaster plan – county wide! • Practice your disaster plan…… – Identify your registration process – Everyone needs to know the location of Disaster Carts, extra supplies, where to locate additional resources • Be part of the Incident Command Center • Have effective security protocols in place at your hospital – HELP will be coming out of the woodwork • Have a plan to call in additional staff at every level – Be mindful of the continuation of care for the next shifts • Have a plan to expand into all the clinical and non-clinical space in your hospital – Controlling phone calls – designated lines • Triage arriving patients in a controlled area and transport them to specific areas of your hospital – Isolate gurneys and wheelchairs to triage areas – OUTSIDE • Concentrate patients with similar diagnoses – WALKING WOUNDED. OPEN CLOSED AREAS. UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Summarize the Lessons Learned
• Keep the ORs moving and cancel elective surgery – ‘Life over limb’ means ortho and soft tissue can wait • Have a cache of emergency supplies on hand, including but not limited to disaster carts • Develop a ‘DOE’ naming system. • Use abbreviated documentation. Documentation should never leave the patients bedside • Develop strategies and tactics to ‘level-load’ the patients across all hospitals in the system
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA www.umcsn.com Summarize the Lessons Learned
• Maintain the privacy of the patients and their families • Have a separate team to manage the media • Have a separate team to manage the community, outreach, and donations • Start counseling and psychiatric support right away • Realize that this changes everyone permanently • Understand that some staff will be angry that they were not called in.
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Coming together is a beginning; keeping together is progress; working together is success. - Henry Ford
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