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RNC hosp– Photo: Emergency personnel wait with stretchers at the emergency entrance to Orlando Regional Medical Center hospital following the shooting at Pulse Orlando nightclub on June 12, 2016.

Hospitals Increasingly Anticipate Mass Shootings

During the Emergency Nurses Association‘s annual meeting in October at the Orlando Orange County Convention Center, 40 nurses and 100 actor volunteers simulated a to prepared for a Mass-Casualty terrorist attack before 3,000 people. Please read that paragraph again. What a coincidence!

During the Nurses Association’s exercise, a mock shooter blew himself up, killing and injuring 100 local volunteer actors.

There was blood, screams and moans, wounds and dead people – all fake – to create a “realistic training exercise.”

The association had “no way of knowing” that a nearby nightclub just eight months later and 10 miles away would become the site of the “deadliest mass shooting in American history,” (except Wounded Knee and Waco) but the training illustrated the growing recognition by health care providers that treating victims of bombings and mass shootings is becoming increasingly commonplace in U.S. hospitals.

ORLANDO MASSACRE– Photo: Orlando terrorist drill.

“Hospitals are preparing and recognizing the need to prepare for these kinds of events,” says Dr. Jay Kaplan, president of the American College of Emergency Physicians (ACEP). “It’s not a matter of if, it’s a matter of when. That’s a sad commentary in that it’s a reality.”

Even Orlando Regional Medical Center, a hospital that treated 44 victims of the mass shooting that occurred at Pulse nightclub had been preparing for such an attack.

“We do weekly trauma simulation, regular all-hospital preps, as well as city-wide simulations that cover all possible situations,” a hospital spokesperson posted via social media.

The gunman at the nightclub, identified as Omar Mateen, killed 49 people and wounded 53 others. The details surrounding the shooting are still emerging, but there is growing speculation that many of those killed and injured were from police gun fire.

os-emergency-nurses-mass-casuad-jpg“This collaboration between hospitals and law enforcement has grown, says Dr. David Callaway, who is on the American College of Emergency Physicians’ (ACEP) High Threat Emergency Casualty Care Task Force . “Hospitals are taking a much more aggressive stance with law enforcement to get [officers] on scene during mass shootings,” he says.

But health care providers are looking for better ways to treat victims of these mass attacks. Kaplan, who is also vice chairman of emergency services for Ochsner Health System in New Orleans, says research is needed. “The military knows how to deal with these incidents, but there hasn’t been a lot of knowledge and training in our hospitals to deal with this,” he says. “We need to better understand these kinds of injuries and deaths for these kinds of civilian casualties.”

Callaway, who is also director of Operational and Disaster Medicine (ODM) at Carolinas Medical Center in Charlotte, North Carolina, agrees. “If you were to ask me for the major preventable cause of death, I would say I don’t have any data,” he says. “We need a system in place to gather and analyze this data. The lack of this information hampers our ability nationally to effectively train and equip first responders and trauma professionals.”

Emergency doctors and nurses now expect to treat victims of terrorism

MetroHealth Ohio– Photo: The steel structural beams are now in place on top of the Emergency entrance at MetroHealth’s main campus. The construction is slated for completion a few weeks before Cleveland hosts the Republican National Convention the week of July, 18 2016.

Eight months before Cleveland hosts the Republican National Convention, local hospitals are working to prepare for whatever the large and high-profile event may throw their way.

Hospital operators, along with public health and public safety officials, are plotting a strategy to maintain normal operations, while also preparing to accommodate for as many as 50,000 extra people who will travel to Cleveland during the convention. The chief medical officers for the Cleveland Clinic, MetroHealth, St. Vincent Charity Medical Center and University Hospitals have been holding regular training’s to coordinate resources for the RNC, scheduled for the this week (July 18, 2016).

“Who knows what this will bring,” said Dr. David Perse, CEO of St. Vincent Charity Medical Center. “We’re just trying to be prepared for whatever comes.”

Health officials are preparing for scenarios ranging from the mundane to the catastrophic.

Also, emergency medical services will need to reconfigure their protocols for transporting patients to hospitals to account for security measures and crowds that may make it difficult to travel around downtown.

And then there are volatile circumstances that uniquely apply to the RNC and other high-profile, large events. Police could pepper-spray protesters, requiring a mass-decontamination. Or, either by accident or through an intentional act, hospitals may need to deal with a wide-scale disaster resulting in numerous casualties.

Marek Owca, director of emergency management for MetroHealth, said he expects a “flawless, beautiful convention.”

“But we’ll still be ready for anything less than that,” he said.

If something does happen, MetroHealth will be a little more prepared than usual. That’s because the healthcare system plans to finish an expansion of its Critical Care Pavilion, the first phase in a nearly $1 billion long-term construction plan, a few weeks before the RNC began.

That means for the short period of time after the expansion is complete and before the old space is decommissioned, MetroHealth will have double its normal ICU capacity.

“If there’s a need for complex, monitored care, we’ll have a surge capacity,” Owca said.

Orlando-Active-shooter-simulation-noon– Photo: Mock mass casualty event/drill.

As part of its ongoing emergency preparation efforts, MetroHealth in June sent a team of senior employees to a federal facility in Alabama for disaster training.

Owca said he expects local health officials will receive similar training geared toward the RNC — either in Alabama or here — early next year.

“The value of that is we will be able to learn from the same playbook,” Owca said.

Perse, the CEO of St. Vincent Charity Medical Center, said his hospital often is overlooked in favor of the other larger and more celebrated facilities in town.

But he said since St. Vincent is the closest hospital to downtown, where convention activities will be concentrated, it could be thrust into an unusually prominent role.

“We are very well aware that we are the most proximal major institution to the event,” Perse said. “For that reason, we have already given notice to our employees that during the week of the convention, we’re suspending our paid time off scheduling during that period.”

“Due to the presence of as many as 15,000 credentialed members of the media, as well as high-profile politicians and other dignitaries, anything short of a perfect response could result in negative national or international attention, he said.

“We have our concern focused on providing service in a quality way … But I guess when you soberly look at the issues, there’s reason to be concerned about the reputation of St. Vincent Charity Hospital” and how that might affect the reputation of Cleveland overall,  he said.

University Hospitals is preparing to make sure that care for its regular patients is not disrupted due to the convention. Its location near University Circle and its access to highways east of downtown should help minimize that, according to Chief Medical Officer Michael Anderson.

RNC police“The citizens of Northeast Ohio and the delegates of the RNC now will have the benefit of having two level 1 trauma centers in town,” Anderson said. “I think that  means we really will provide care across the continuum, goodness forbid that something should happen.”

Anderson said local hospitals have dealt with large events in the past, but nothing on the scale of the RNC. He said he hopes the media spotlight will present Cleveland with an opportunity to showcase its strength as a medical center to RNC delegates.

“Obviously when they come to Cleveland, the delegates are very, very busy, and they want to just nominate their candidate and finalize their platform,” Anderson said. “But Northeast Ohio has such a rich heritage of biomedical care and research and medicine … We just want to make sure that we can show off and demonstrate our great resources here.”

Cleveland Clinic is prepari for a number of “RNC-related scenarios,” including “staging an emergency-related evacuation,” safely transporting a dignitary for treatment or even figuring out the event’s impact on parking, according to Chief of Protective Services Gordon Snow.

“Planning for the convention from a law-enforcement standpoint has involved a number of different agencies,” said Snow, whose department also oversees the Clinic’s police force.

“Everybody’s coming to the table, and I know it will be a multi-state event, but it seems like they’re doing a really good job on communication, preparation and coordination, from the mayor’s office on down.”

Officials with the administration of Cleveland Mayor Frank Jackson declined an interview request for this story.





** Both Cleveland and Philadelphia has an incident command center, where a central authority will make top-line medical decisions in the event of an emergency


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