Lessons Learned

More administrative help: Although clinical help flocks in, we also needed more administrative help. Because the administrative supervisor was in the ED and the ED charge nurse was calling staff in, there was a delay in activating the MCI alert. The patients came in so quickly that no one thought to activate the mass casualty alert right away. This delayed notification of the event to the rest of the hospital and made it difficult to initially get blood products because the blood bank was not aware of the magnitude of the event at first.

I also learned that we needed a better way to track patients. I assigned a secretary to log in each patient and document where they went. Incident command was preparing their press releases and needed accurate counts of deceased, patients who went to the OR and those in the ICU. 

Another administrative person is needed to track patient belongings.  We had cell phones ringing in the trauma bay, which was very upsetting to staff as we knew families were trying to reach their loved ones.

And a leader needs to coordinate with law enforcement. We had many different agencies investigating, and they all needed workspace and help navigating the system. 

Time to decompress: As the night shift was leaving at 07:00, I did not consider the same team was scheduled to work again that evening. I stayed all day at the hospital helping reunite families and put the department back together, but did not consider giving the team the night off. There was plenty of other staff who did not get called in and could have covered for them.  

Staying in touch with the staff:  I also learned how important it is for the leadership team to continually check in with staff. Four days after the event, a nurse let us know that the team was not OK. We arranged a big debriefing that evening with our employee assistance counselors and quickly shuffled schedules and coverage for the department so everyone who needed to could attend. The team was surprised at how quickly we pulled this together and commented on how comforting it was to be together and share.   

Starting the healing process: In the Emergency Department, we usually do not know the outcome for our patients. It was not until I was in a debriefing with a trauma ICU nurse that I realized all the patients we sent upstairs survived. The injuries were so severe and there was so much blood loss, I did not think there would be many good outcomes. I spent the week after visiting patients with front-line staff so they could see the results of their hard work. This made it real for us and refueled us. The patients were thanking us, but I had to tell them that seeing them was a gift for us. I believe this started the healing for the team.