During the Pulse event, nurse leaders participated in the Hospital Incident Command System (HICS) in roles they had practiced in previous drills. Nursing resources were allocated to ensure the seamless delivery, coordination and transition of care without comprising the quality of care. Considering the event occurred less than half a mile from the ED, the current disaster plan had to be rapidly adapted because patients arrived without announcement and without EMS triage. Thirty-six patients arrived in 36 minutes during the first wave of the tragedy. This required the nursing team to be innovative in simultaneously triaging patients, staffing multiple operating rooms and decompressing the ED by discharging and expeditiously moving patients to various levels of care.


When the first Pulse victim arrived in the ED, 32 staff members were on duty. Learning that there were more victims, nurse leaders immediately elevated staff levels to 51 in the ED, pooling staff from our other hospitals. From there, the “Pulse team” was born, and an attitude of all-hands-on-deck permeated, not just at ORMC, but throughout the entire Orlando Health system. Physicians, residents and nurses placed tourniquets, dressed wounds and inserted tubes. Members of the Guest Services team helped hold pressure on bleeding wounds. Environmental Services turned over exam rooms quickly despite having to sanitize them for massive amounts of blood and Security rapidly unloaded patients from vehicles. One team member said, “We went where our hands could be helpful. It didn’t matter if it was your traditional role or not.” Four-hundred-forty-one units of blood, platelets and plasma were administered on June 12, and 28 surgeries were performed that morning.