Lessons Learned


  • Persist in your efforts to provide support for the departments hit the hardest by a mass casualty event such as the ED, Surgery, Trauma/ICU and Security teams. These hardy souls can make it look like they’re OK after the initial wave is over, and varying work schedules may make it hard to pull the teams together, but don’t accept the first “we’re fine.”Sometimes it may simply take time for them to decide they really do want some support. Make repeated efforts to be there when they’re ready, and if a debriefing is provided, follow up with them a few days or a week later.
  • Ask managers to help identify those who are suffering the most acute stress. Don’t overlook team members who had to perform in ways outside of their normal job descriptions. What about the ED patient business representative who had to hold pressure on a victim’s wound until a physician or nurse could step in?
  • Use both “open” and “department-specific” debriefings. “Open” debriefings can work well for those not directly involved in the crisis response or who may want immediate support.Certain departments, however, really warrant “department-specific” debriefings so they can talk privately about the experiences unique to their group.

    It is imperative to maintain complete confidentiality for all debriefings in order to maximize psychological safety, and we always held that to be sacred. We found, however, that while the groups wanted their individual reactions to be kept confidential, they often wanted their concerns and worries as a group to be shared with leadership.  With the groups’ permission and with the assurance that no individual speaker would ever be identified, we passed along their concerns – such as the desire for enhanced security measures to reduce future vulnerabilities.

  • Remember those who work in behind-the-scenes departments.A couple of weeks after the shooting, I was called in to debrief the group that does medical coding. They’d had to read some pretty horrific notes about the wounds sustained by the Pulse victims and about the clinical care that was provided. It’s not hard to see how this kind of exposure could create a form of secondary trauma, so I gladly spent time with this team.

  • Include the use of psychotherapeutic “power tools” in your repertoire.I’ve mentioned that ours included Energy Psychology, an evidence-based tool, and Rapid Resolution Therapy. These tools can rapidly deactivate the disturbing emotions connected to specific thoughts, memories or images.On several occasions, when I saw that a team member was physically shaking from the experience, I lightly held neurovascular points on his or her head (an energy psychology technique), with permission, to restore a sense of calm. A female team member told me after I’d gently placed by palms on her head for 5-6 minutes, “I feel normal again.” This was usually done in private settings. EMDR and several other approaches also are effective.
  • Find creative ways for team members to express their emotions. We recommended that HR put up poster boards on which team members could stick post-it notes that expressed thoughts and feelings about the event. Emotions carry a vibrational resonance that needs to be released in multiple ways, and this provided yet one more way for people to do just that.
  • Use different forms of support for different groups. Not everyone wants to talk with a counselor or attend a debriefing. We get that. Some people want to gather and pray, others want to chat in a hallway and others just want to be left alone. Our security team kept telling us, “We’re OK.” These guys had been front and center in a dangerous crisis, but said they didn’t want a debriefing. So I decided that every time I entered or left one of our hospitals, especially ORMC, I’d introduce myself to the security officer(s) guarding the doors and linger and chat for just a little while. I simply wanted to provide another layer of attention and appreciation for this important team, and I hoped that our chats would offer an informal way to swap stories. They’d been through a lot.
  • Advise your HR team. Other than leadership, this is the group that’s most dedicated to hiring, educating and cultivating of your hospital’s most important resource – its workforce. They’re often the first people in contact with department managers, so stay closely connected with them and provide expertise on behavioral health matters.
  • Identify outside behavioral health resources in your community, in advance, based on reputation.Look for those with experience and skill in crisis management.
  • Be there for the long haul. People heal in phases and the reverberations from a major catastrophe can resonate for weeks or months. Send out periodic messages acknowledging the reality of what happened and remind team members that the EAP will continue to be there when needed. These messages will taper off with time.
  • Debrief the de-briefers. Debriefers can soak up a lot of intense emotions from the many groups with whom they spend time. They, too, need a chance to decompress.
  • Have educational handouts ready in advance. In my next life, I will be a brilliant writer. Looking back, I can see that the educational handouts I thought I’d polished up reflected signs of sleep-deprivation and split-screen attention.Work on them ahead of time.


  • Acknowledge that physicians respond to a crisis differently. Be available, accessible and confidential in all contacts.
  • Utilize the established physician leaders within the organization, including the residency training program directors, to access physicians at all levels and specialties following a crisis.
  • Be patient and allow time for physicians to seek confidential support in a form that works best for them. This may be six months or a year later.
  • Be able to provide immediate referrals to an external therapist. Have the referral relationships established and notify those on the list that they need to respond quickly.