Lessons Learned

A common theme from residents has been that they each found different ways to cope. The existence of a counselor and the encouragement of program leadership to pursue this option have been very valuable. Program directors should encourage their trainees to seek help. Most physicians are taught to accept challenges as “part of the profession.” But violent mass casualty events are anything but. Debriefing sessions should be done as soon as possible for the involved residents in a non-judgmental setting. It is important NOT to turn these early debriefings into quality improvement events. These sessions should include a small session where only the providers who were present are involved, but also a larger session where the entire department is involved. Trainees have found it very therapeutic to see how their actions fit into the larger scheme of efforts to save lives. It is very important for each participant in a mass casualty event to see how their specific actions, no matter how small or seemingly insignificant, played an important role. Trainees and faculty are otherwise left with the feeling of “I could have done more.”


There should be an easy mechanism, other than Doe names, whereby trainees can follow up on the patients that they treated acutely. This follow-up is helpful to trainees.


Preparation for mass casualty events should include more than the clinical response.  It also should include training in the management of limited resources. For example, during a disaster drill, we not only should practice achieving optimal patient care results, but we should anticipate an event like this occurring simultaneous with loss of EMR or computer access. Drills should be done with unexpected absence of specific support personnel, such as EMS providers or radiographers. This will create a practice environment where healthcare providers train for and are empowered to act during the unexpected.


It is vital to prepare residents for the things that will occur after a mass casualty event.  This includes media involvement, law enforcement presence and federal government appearance. Residents should be educated on the impact of media presence and the potential for harm. It is easy for a trainee to be awestruck by the international stars who appear. But it is important for them not to be tempted to share information personally or through social media with these organizations. They also should be prepared for the onslaught of calls and emails from conspiracy theorists who will accuse them of fabricating stories. They need to be warned about the importance and consequences of their actions. Trainees should be made aware, ahead of time, of the community resources that will exist during an event, such as National Guard, Red Cross, FBI and volunteers. A coordinated response with all stakeholders will be a smooth response.


And finally, program directors should be aware and taught to recognize signs of depression and burnout that may occur in the weeks and months following a disaster.


As a program director, I hope that no other program director will have to guide their residents through a mass casualty event. But, in an evolving world, it is best to be prepared for the unexpected. Although the credit for the response goes to the residents who were involved, it was the efforts of our late program director, Dr. Sal Silvestri, who ensured that each trainee was cared for. Response and actions during times of crisis truly help shape the future of our doctors in training.