The News Herald (Willoughby, OH)
PREPARING FOR THE WORST CASE
UH Geauga holds disaster drill to see how it could handle mass-shooting victims
University Hospital Geauga Medical Center in Claridon Township is taking steps to make sure it is prepared to deal with a mass shooting.
The hospital held a disaster drill May 23 based on the scenario of an active shooter firing into the grandstands during the Great Geauga County Fair over the Labor Day weekend.
The drill was carried out in the early morning, using only the staff of UH Geauga Medical Center. There were no rescue squads, or fire and police departments involved.
According to Don Zimmerman, the emergency management coordinator for UH Geauga, all hospitals are required to do an annual surge drill where they bring a lot of patients into the emergency room.
“So all hospitals do that, but the trouble is those are all based on assumptions that we had in ‘the industry,’ ” Zimmerman said.
“For instance, a mass casualty incident where a lot of people are hurt, EMS shows up, they tag patients with triage tags, put bandages on the injuries and triage based on how bad they are. They then balance which hospitals the patients go to… then they will call the hospital and warn them ‘hey, we are bringing you six patients.’ And that’s what we have been trained for.”
Zimmerman, however, pointed out that in the Las Vegas, Aurora and Pulse Nightclub shootings, none of those incidents followed these routines. They were shooting events where everybody was just trying to get away from the scene and they didn’t wait for ambulances but instead just took injured family members or friends to the hospitals.
He also noted that when police officers showed up they couldn’t get ambulances through traffic so they were putting patients in the police cars and transporting them.
“In those three events less than 10 percent were patients from ambulances,” Zimmerman said. “So now you have people being thrown through the door from police cars and pickup trucks whatever else with no treatment,” Zimmerman said. “They are all dumped on the closest hospital
instead of spreading them out and now the hospital is forced to do more than they had to do before ... use more supplies than they have had to use before, and so it’s a whole new ballgame.”
According to a UH news release, during each of the shooting events “the closest hospitals were flooded with patients every 66-100 seconds, with Las Vegas continuing for five hours. The ERs were overwhelmed, were surprised, and victims who were close to death from bleeding out.”
To see how well UH Geauga Medical Center would be able to handle such a situation with its emergency response, it staged the drill to last an hour using a combination of mannequins and volunteers covered in theatrical blood arriving at the hospital one every three minutes with injuries ranging from gunshot wounds. These included a pregnant woman shot in the belly, a teenager paralyzed from being shot in the neck , gunshot wounds to the head, and injuries such as broken ribs from falling or being trampled on. All victims required immediate surgery.
The hospital used its ambulance bay as a command center where victims were brought in and assessed for injuries and tagged prior to being sent to the X-ray/CT Department or the operating room.
The drill was held to see
if the hospital could keep up with the constant flow of victims coming in and to see where the weaknesses were and what it could improve on .
“We are going to try to push as many patients as we can within a certain time limit and keep them moving while having to do triage which is something they don’t get to do too often,” Zimmerman said.
“The drill can prepare us to provide better care for the patients,” said Limig Yu, a trauma surgeon. “Everyone seems to be engaged and it seems to me to be effective”
Yu noted that improvements could be made in the communication when the patient is brought in by some kind of short brief verbal report so the trauma of searching for the injuries isn’t prolonged and would allow the physicians to pay more attention to more patients.
One of the biggest issues discovered from the drill was they overloaded the Xray area with patients and created a bottleneck there while trying to move patients in and out.
Also, the X-ray receiving team needed orders on what the emergency staff wanted done for the patients. Normally they would get those electronically but the doctors can’t stop helping patients to enter orders so they are working on what they can do to improve that
Written feedback will be
reviewed from everyone on mistakes that were made and how they can improve. The hospital is graded on the drills to see how the mistakes are addressed and how training is done and improvements are made, according to Nathan Peters, a paramedic instructor.
Peters believes the drill went well with the volume of patients in the amount of time they had.
“Anyone is going to be ready to pull their hair out in this type of situation and that’s what we are trying to do — stress them out and make them think outside the box,” Peters said. “When it comes to finding out we don’t have this, what can we use instead, we are running out of supplies, who is getting more supplies, who can we have take a bed and run and fill it with supplies to bring back to restock.
“It really stresses them and then the team members realize ‘hey, I need someone to help me with this or help me drive a bed to the operating room.’ ”
Arlene Mollahan, an operating room manager, believes the drill helps prepare for a real incident.
“We have to be ready for anything especially with of us being in a rural area,” Mollahan said. “It is important for us to be prepared for something like this because our resources would be limited compared to something that would happen in the city where you have multiple areas to draw
resources from.”
Mollahan believes her team did well. She was in the emergency room on radio during the drill, telling the operating room nurses what was coming so they could be prepared.
“Now, in a real situation, it’s going to be a lot more hectic, so we take notes on what we need to do, any changes we need to make to get people in here,” Mollahan said. “Some of the victims may be people that actually work here because everybody goes to the fairgrounds, so we need to find a way to make sure that we have everything we need.”
According to Zimmerman, the hospital did not run out of supplies during the drill, but he did have to bring specialized equipment from other parts of the hospital, such as ventilators. Also, he is looking into purchasing those and a cabinet to stock with supplies in case of a situation such as a mass shooting.
The nurses suggested having a packet of supplies for every patient that would come in during this type of event, so Zimmerman feels the goal is to come up with a way to do that.
“We needed to try it first to see where the problems were,” he said.
In the case of needing blood for this type of emergency, Zimmerman believes the hospital could run low but the Red Cross is able to get some to the hospital within seven minutes.
“In planning meetings and this morning in discussions with staff, it was brought up that we would find a way to make this work,” Zimmerman said. “In my opinion I feel it would be unfair to have a nurse deal with this without ever trying to plan for this. You can’t plan for everything but at least you can get some guidance and come up with some drills and equipment and some flow paths to safely move patients through the hospital. Our goal is to be prepared for anything that happens.”
“UH Geauga is a resource for the community and this is our way of ensuring that we are here to cover even the most horrific thing you might think of,” Novelli said. “It may be unlikely but we want the community to know that we are prepared.”
“In today’s world we’re seeing so many tragic events happen and I just feel we would be doing a disservice to our community if we weren’t prepared,” said Toni Zemaitis, nursing manager for emergency room. “We have to be prepared for everything and so I want to make sure our staff has the resources available and the education we need. We are going to learn from this. We are going to debrief and sit down and see what resources we need, what education the staff needs, what supplies we need, and what training we need.”