Key Takeaways

  • Have a dedicated and familiar emergency preparedness plan. The importance of a team of dedicated and knowledgeable individuals to develop and sustain an organized mass casualty plan cannot be understated. Developing relationships and leveraging preparedness with community leaders, law enforcement, medical examiners and EMS is imperative. The plan should be as close as possible to standard daily patient care activities, as the more a plan varies from standard work, the more difficult it will be to activate in the event it is needed. If a plan is in place, and is practiced regularly and with vigor, then regardless of the nature of the event or the time of day, staff and providers will be hardwired on what their institution’s response should look like.
  • Maintain a low activation threshold and have good notification.Responding emergency medical and trauma staff should be familiar with the aforementioned plan, and observe a low threshold for its activation. The plan should be activated early, even before definitive information on numbers of patients or nature of injuries is available. Delaying activation until accurate details of a mass casualty event are available may cause a critical gap in the staff response. When the decision is made to call for help, a robust notification system must be in place to contact additional staff and receive feedback on their availability.
  • Expect the unexpected. Even when institutions conduct regular training exercises and are familiar with preparedness plans, the controlled chaos that is typical of a true mass casualty intake will likely result in some unexpected occurrences. For us, one of those occurrences was the threat of an active shooter in our department at a time when patient influx and medical care were most intense and additional staff was needed. When these events occur, let experience, flexibility and creativeness be your friends and your guides.
  • Don’t underestimate the emotional impact. These tragic, horrifically violent, high-profile events, especially occurring so close to the receiving facility, leave an enduring impact on hospital staff. Don’t underestimate the lasting influence these have on your staff, your department, your institution and your community. Stand on the shoulders of others who have been through similar events to help guide your staff and counselors in developing a roadmap for caregiver recovery.
  • Don’t forget about the rest of the story.Although the focus of our preparedness planning most often emphasizes the initial care of patients involved in a mass casualty event, there is a great deal of planning that needs to be done for the post-incident chapter, after the last patient has been admitted or discharged, and the dust has settled. That is often the time when institutions may be caught off guard and may be underprepared and overwhelmed.