Pulse Shows Flaws In Mass Casualty Response

Jun 8, 2017

Health News Florida partner station WMFE in Orlando has produced an in-depth series for the one-year anniversary of the Pulse nightclub shooting. The following is an excerpt from that series.

There was a moment when Orlando Regional Medical Center trauma nurse Libby Brown realized how bad the Pulse nightclub shooting had been.

Nine patients died the morning of June 12 at the hospital. The dead were lined up in the decontamination area outside the trauma bay while health care workers tried to save the ones who could be saved.

“We didn’t even have a sheet to cover a patient that was deceased going to be lined up with the other bodies,” Brown said. “So that was one of the times when I was like this is very, very bad.”

The Pulse shooting shed light on a flaw in the health care system: The closest hospital gets the most patients in a mass casualty incident. It’s been documented in research looking at other disasters. 

And it’s something hospitals have to be prepared for.

“Well, I think you hit the nail on the head,” said Eric Alberts, the director emergency preparedness for Orlando Health.

Hospitals, Albert said, can no longer think I’m a general care hospital, I don’t have to worry about events like this.

“Those are excuses really, right? You can’t help where bad things are gonna happen,” Alberts said. “Bad things are happening in the community everywhere. It may be next door, like Pulse was for us, half a mile. That was just a coincidence. We were fortunate we were the Level 1 trauma and we had been trying to get prepared and were there to help care for the patients. But other hospitals are just gonna have to deal with it.”

Forty-four gunshot victims came to Orlando Regional Medical Center that morning.

Most of them came in the first hour, and were brought by police, not ambulance.

That concentration of gunshot victims stressed the hospital to the limit.

It was utter chaos: Nurses were running up to the blood bank in the hospital, bringing buckets of blood by hand back the trauma bay. During trauma, they use pressurized IV bags to pump blood into patients faster – but they were all being used. So nurses were literally standing at the head of the bed, squeezing blood into people by hand.

“There were so many coming at some point, there were people with gunshot wounds to the chest sitting in the hallway,” said Elizabeth Burrows, an emergency room nurse at Orlando Regional. “Gaping wounds, they’re sitting on the floor because we don’t have stretchers. We kind of systematically started going through to figure out how could we best help these people.” 

And then things got worse: Someone reported gunshots fired at the hospital.

No one is exactly sure why the call happened. Maybe someone heard the shots being fired three blocks down the road and thought it was happening at the hospital. Maybe one of the patients panicked.

Regardless of why it happened, at 3:19 a.m., the call came out: There was a shooter insider the ER at Orlando Regional Medical Center.

Police drive over to the hospital, guns drawn. The hospital was put on lockdown as police followed a trail of blood. They eventually handcuffed one of the victims who had the same style facial hair as Omar Mateen. 

In bodycam footage from a police officer, health care workers are seen crossing paths with police in the halls of the hospital: “Room 649. You know we’re on lockdown? We’re still on lockdown. You going to the ED? Haul ass straight down there and stay. Get out of the halls.”

But health care workers continued to care for patients. Dr. Chad Smith was the trauma surgeon working in the ER that night.

“I tell the story of one of our interns that took a patient to the operating room during the code silver,” Smith said. “This patient was dying, and she rolled the patient out there and did her job to take the patient to the operating room thinking she could be shot. And not just in the trauma bay into the elevator etcetera.”

Smith remembers coworkers texting their loved ones – but still working on patients. He says that was the hardest part for people working that night.