Lessons Learned

It is natural to reflect on one’s actions in an event such as this. Many of those who were involved have openly shared their stories of what happened. It is imperative that these recollections are documented and told so others can learn from them.


A response required for events such as the Pulse nightclub shootings is not something that can be done without prior preparation. Teams need a working basis of structure, familiarity, group cohesion and robust procedural exercise to be effective. When patient intake volumes stress teams and processes potentially to the point of failure, prior knowledge and training are the tools available to prevent it. Improvisation and the expectation that team members rise to the occasion should be the norm. A work environment that values each individual’s opinion and fosters growth is imperative.


Logistically, the response should be led by an experienced trauma surgeon, in concert with other experienced personnel at the institution. It requires a surgeon to make surgical decisions. The surgical leader is therefore unable to aid in the operating room or elsewhere. That leader must delegate and direct patient flow to other surgeons and physicians strategically placed in the operating theater, intensive care unit and other treatment areas.