Phyllis, above left: Our Spiritual Care protocol is to give me the earliest heads up when something out of the ordinary is happening -- even when it is only a possibility, but especially if it is something BIG. So when my house phone rang at 2:14 am and the caller ID showed it was Orlando Health, I immediately thought, Oh, God, this is not good! Regina Nevels was our chaplain on duty on the campus, and she told me there was a possibility of 20 gunshot-wound victims coming from the Pulse nightclub only three blocks away. That proximity to our campus meant the patients would arrive before additional chaplains could get there. Once again, I thought to myself, This is not good!

After getting her update, I texted every chaplain on our team at 2:25 am. I indicated “Mass Casualty Incident,” “Gunshot Wound - 20 victims,” “Report to ORMC IMMEDIATELY.” Two chaplains texted back immediately, “getting dressed, on my way, about 30 minutes ETA.” I then began to call chaplains’ cell phones and home phones. My call scared the wife of one chaplain so much that she told me I had the wrong number. I knew it was the right number and that at this time of the morning I probably scared her, so I immediately called back. Our chaplain answered, “Yes, chaplain, what is wrong?” I informed him of the mass casualty incident (MCI) and the number of patients. He said he would dress and be on his way into Orlando Regional Medical Center (ORMC).

Synopsis

June 12, 2016, happened to be a Sunday and many of us were expected to be in our church pulpits or at least on the platform for morning service. It also fell during Ramadan, so my Muslim chaplain had been fasting. Regardless, our feelings were that we had to be at ORMC Level One Trauma Center and do what we do every day: identify the patients, obtain next-of-kin contact information and notify them their loved one was here.

Preparation

After notifying our chaplains, I continued to communicate with the chaplain on campus. Regina was our per diem chaplain and only had been with ORMC for six months. Her only trauma experience was from her orientation time and those six months. She had completed her first unit of Clinical Pastoral Education at another hospital system, but it did not have a Level One Trauma Center. Trauma is very, very different in the type and number of patients ministered to, and the role, duties and responsibilities of the chaplain in collaboration with the clinical interdisciplinary team. Six months of experience, wow! Thank God, in March when we had our community-wide MCI drill, I had approved for her to come in and participate. Never before at ORMC had a manager approved any per diem chaplains participating in MCI drills, but my thought was they serve on the weekends and at night when there is a huge possibility of them being on duty, by themselves, when a MCI could occur. My fears proved to be correct. She was the ONLY chaplain on the campus when this incident began. The budget and the hours for her to be at the drill proved invaluable. She followed department protocols extremely closely, which enabled our rapid response. Through our training and team work, we were able to identify patients in a more timely manner, rotate chaplains so they could preach in their churches or our Muslim chaplain could pray during Ramadan and limit to only three the number of chaplains working more than an eight-hour shift.

Response

While I drove to the hospital, I continued to speak to my chaplain on duty. My concern was not what I was feeling, but what my chaplain was feeling. As a manager -- shepherd of the chaplains -- it is my responsibility to care and support them. I didn’t want her to feel abandoned or that she was in this all ALONE. We, her colleagues, were coming to support and assist her as quickly as possible. Reinforcements were on the way. Before long, two chaplains had arrived and others were nearing campus.

At this point, my focus moved to the arriving chaplains. I knew there was concern that a shooter could be on our campus and wanted to avoid anyone having to walk in alone. We do not wear uniforms, but dress in professional business attire and wear our ORMC team-member identification badge. I tried to reach one chaplain who was on his way, but he did not answer his cell phone. I called the other chaplain still en route and she could see him walking down the sidewalk toward the hospital entrance. I told her of my concerns and asked her to pick him up in her car and park on the 3rd floor of the garage so we could all walk in together. Which is what we did. As we walked into the employee entrance, we encountered a SWAT team walking out of the cafeteria with rifles drawn. I am so glad I focused on “my” chaplain team members first and provided the best possible support and care for them and their safety. This is the heart of the manager, “the shepherd,” to care for his sheep.

With six of us now on the campus and patients continuing to fill the ED/Trauma Center, our focus all went to our patients. All trauma patients are given a doe name, City, Month, Doe (Albany, June, Doe). It is the chaplain’s role and responsibility to identify the patient, obtain date of birth and emergency or next-of-kin name and contact information. Many of the patients from the nightclub did not have a driver’s license or other identification on their person. It is essential that we have a picture identification to ensure this is the patient. Our chaplain team had identified 24 of the 44 victims by 7:00 am and family/friends had been identified for 19 of these patients. This is what we do as chaplains in the trauma center on a normal daily basis, just not to this magnitude and intensity. Our chaplain team did an amazing job! We were prepared, followed protocols and procedures, and will never look at MCI drills and each other the same.

Since my feelings are from the manager “shepherd” point of view, I wanted to share the perspective of the chaplain on duty. She had taken the role of trauma chaplain at ORMC only six months earlier. In her own words, this is how she felt and what happened as she processed the night’s events.

Chaplain Regina Nevels, above right, was on duty June 11, 2016, for the overnight trauma shift that typically goes from 11:30 pm to 8:00 am.

On June 11, I was on the midnight shift. I kind of rested all day, but felt this uneasiness the entire day. I spent the first part of the morning with my grandchildren, then went over to my daughter’s house so she could do my hair. I got home about 6:30 pm and ate something, ironed my suit for the night and laid out all my accessories. I finally got in bed around 7:00 pm after covering my window with a navy blue sheet to darken the room. I set my alarm for 10:00 pm.

I must have dozed off after a while, but it was not a deep sleep, because I still felt like I was awake. When my alarm went off I remember jumping up and having that uneasy feeling strong in my stomach. I thought it was from being startled awake by the alarm clock. I began to get ready for my overnight shift. I remember praying on the way to work, Lord, I don’t know what’s going on, if this is anxiety, your word says be anxious for nothing, so please take it away. Lord, I’m not sure what this is but I need your help, you know what’s going on.

As I headed to the Trauma Bay, I walked as fast as I could because I know how important it is to get there before EMS leaves. We have to make sure that we gather as much information from them as possible in case the patient is non-verbal. I got on the elevator and pushed the button for the first floor. I was looking through my bag to gather pen and my log sheet so that as soon as I walked in I would be ready.

I walked in the Trauma Bay and there were about 20 nurses, physicians, techs and others surrounding two patients in trauma bays 2 and 3. The room holds 6 trauma bays. I stood there for a moment when I heard over the speaker that police were bringing in another victim by car and two more were on the way. I thought, What is going on? I am going to need to call Phyllis because the two patients I was just with are going to die tonight and I am going to need help.

Panic started to rise in me. Again, I thought, I have to call Phyllis. I grabbed my Ascom and with shaking hands tried to look for her number and could not find it. Then I pulled out my personal cell phone and tried to remember where her number was, but I could not think straight. I knew I had her numbers as I called her so many times from my phone, but I could not find it and time was wasting. I recalled the yellow sign in the office with her number and her daughter’s number, and took off running down the hall to find it. I tried a few times to put the code in to get in the door but I kept messing up. Finally, I got in and dialed her number as I was running back out of the door. I told her about the two patients up on other floors and the patients in the trauma bay. She said, “OK I will get dressed and come in.”

As I got back to the trauma bay, there was another patient being brought in the room. Then I heard something that I never imagined I would hear. There are 20 more on the way and then more after that. I thought, Oh my God, what is happening. They said there is a shooting at a nightclub. I immediately dialed Phyllis back and said there is a shooting at a nightclub, 20 more are on the way and that there will be more coming. She said she would call for back up and be there as quickly as possible.

Immediately I began to get to the eight patients who were now in the room. I knew that I had to identify them before they died, were intubated or moved, or taken to surgery. In my six months as a chaplain at ORMC, I had never witnessed anything like what I saw that night.

As I worked my way through the room, I thought… This is not happening, this is crazy Lord.

I looked over and saw a man on a stretcher still tubed and his body was still jumping...

Finally, I looked up and either Chaplain Steve or Chaplain John arrived first...

By then, I was emotionally, physically and spiritually exhausted...

I got into the office and looked in the mirror and I wanted to rip my chest open...

I had to go back to the ED and see more patients...

The hurting thing for me about that night was not providing pastoral care...

One thing I learned about myself is that through the grace of God...

I know those I spoke to were relieved...

Lessons Learned

For the Pulse incident, the supplies that we used the most were trach tubes, chest tubes and dressings. Days after the event, we met with the ED team to see how we could improve our trauma emergency carts. The ED staff wanted to change the amount of the dressing and tubes that we stocked on the cart. We also revamped the trauma supply area in the ED so it, too, could hold more supplies. We also learned that you need plenty of staff to help and you cannot do it alone.

What We Changed

We will bring our newly hired chaplains as well as our weekend/night pool chaplains in for the annual March community mass casualty drill.
We added not just a scribe to maintain and communicate the “master” list of patients, but a second scribe in case the first scribe is not available.
We will obtain patient lists from other Orlando Health hospital sites as well as other local hospitals.
More communication was added, not only with the incident command center, but with business office manager/representative and care coordination as well.

Conclusion

A bedside chaplain’s and a manager’s feelings and concerns are very different, but each has a ministry role and cares for the “flock” they are “called” to serve. This is an example of servant leadership, and the role of leading by serving and demonstrating how to care for those under your leadership. As chaplains, we minister to different “patients” — there is the patient in the bed, the family, the clinical team and those we manage/lead.

Key Takeaways

Call in additional chaplain support as needed in a mass casualty event, per our department protocols.
If a manager is out of town, ensure that the mass casualty plan/contact/role/protocol plan is in place throughout the absence.
It is vital to include our newest hires in our emergency preparedness exercises, including the March community mass casualty drill
We must have a scribe and a secondary scribe to maintain the “master” list of patients in a more timely manner.