A mass casualty event can, in an instant, overburden a hospital’s emergency room. The first step is to clear space. Minor cases might be moved out of the E.R., while discharges are sped up to open more hospital beds.
The E.R. also has two vehicles to take medical personnel to the scene, once it’s secure. This is another hard-earned lesson. Triage at a mass casualty scene can send the most critically ill patients to the hospital faster.
“Even in the best of cases, EMS might be four or five minutes away,” Jones said.
At the hospital, Jones and Huesgen noted, triage assumes the greatest importance.
Under normal circumstances, a hospital will take all the time necessary and devote all possible resources to quickly treat a severely injured patient. That isn’t practical during a mass casualty event.
Medical personnel, instead, focus on lifesaving efforts on the most critically injured.
“That’s emotionally hard,” Jones said. “We’re all used to giving the maximum care to every patient, every time. Instead, you’re focusing on giving lifesaving care to as many patients as you possibly can. It’s tough stepping away from one patient when they’re stabilized to say I need to help your 15 neighbors.”
Huesgen, an EMS fellowship-trained physician, agreed. “It’s a very difficult thing to do, to realize there are some people you can’t fix.”
Research has shown, he said, that this cold calculus saves the most lives.
Meanwhile, at the hospital, an emergency operations center is opened, directing the overall response and marshaling resources from throughout the medical system. Personnel get called in based on pre-existing lists, called A, B or C teams.
Personnel now wear vests identifying their job — nurse, trauma surgeon respiratory therapist. This allows emergency personnel to quickly identify one another and eliminates a potential source of confusion, said Jones.
Besides patients, another source of crowding in the E.R. are the volunteers who show up wanting to help.
“Human nature is, I’m a physician. I’m a nurse. I’m a paramedic. I want to help,” Jones said. “It can be overwhelming to figure out how best to place different folks. You may have a well-meaning podiatrist. But we may not have an immediate need for them.”
Tyndall said some of these nonemergency department physicians and trauma surgeons can be deployed to take care of the walking wounded, where trauma care isn’t needed.
“In the triage algorithms, there are clearly patients who need a lesser level of care than others,” he said.
All training scenarios and planning emphasize the one thing that has often broken down in prior events: communication. And that includes communication not just internally, but also with the community as things like rumor control can help assuage public anxiety.
Spellman, the UF Health Shands safety and emergency preparedness manager, said it is important to recognize a disaster, in any form, is a community event. The hospital works in partnership with first responders, county and city emergency managers and political leaders.
“You don’t get through something like this alone,” Spellman said, adding that repeated training and planning brings a tempered confidence.
Emergency medical experts at UF Health and around the country recognize that the landscape has changed dramatically, and they must adapt.
“I believe the biggest change in EMS has been the loss of, ‘It can’t happen here,’ to ‘Let’s be ready when it happens,'” Corey Slovis, M.D., of Vanderbilt University Medical Center in Nashville, Tennessee, told MedPage Today.
At UF Health, Jones said, the teams believe they are up to the challenge.
“That is one of the things that both EMS and emergency medicine take pride in,’’ he said, “creating order from chaos, organizing something scary and turning it into something that is manageable