As a major tourist destination, Orlando has the unique identity of being a major target for terrorism. Due to its geographic location, it also is frequently endangered by tropical cyclones.  As such, ORMC has continually developed its disaster plan for more than 20 years. Since 2010, a community-wide disaster drill, or Full Scale Regional Exercise (FSRE), has been implemented with multiple community partners and agencies. The exercise that was performed three months prior to the Pulse nightclub incident included an active-shooter scenario. FSREs involve triage of multiple victims and are practiced by all facets of responding agencies with hundreds of volunteers. Inter-agency and inter-hospital communication also is tested during these events to develop improvement in the trauma system as a whole.


Trauma surgeons are vital to this preparatory process. It is of utmost importance that they familiarize themselves with disaster protocols and have a robust understanding of proper triage and scarce-resource utilization. Direct patient care of multiple victims is only one part of being able to mount an effective response. Trauma surgeons are ideally suited to perform the patient care, but they must also be knowledgeable and comfortable with all aspects of a multiple or mass casualty incident. The most effective means of gaining this knowledge is through repetitive practice.


A laissez-faire attitude toward mass casualty drills has the potential to inadequately prepare an organization for what it may someday face. Team members will look to the leadership of the trauma surgeon and other physicians in charge during a drill, and will likely emulate their attitude regarding the exercise. If leaders take their responsibilities seriously and practice as if it is a real situation, the team will be much more engaged. This leads to a more effective exercise from which more can be learned.