I’ll never forget the 6:50 am call I got that Sunday from an HR exec who told me our downtown ED had been flooded with dozens of victims from a nearby mass shooting — a disaster beyond anything we’d responded to before. I couldn’t imagine how intensely this was affecting our team members and physicians, and I knew that I wanted to get there ASAP to provide support where needed. Shortly after I arrived on campus and had been briefed on the basics, I made it a priority to head for our ED, surgery and Trauma/ICU departments to find out how those teams were doing and let them know that we were nearby. What I did not expect to see was that the night teams had mostly gone home and things looked unrealistically calm and organized. Knowing that I’d circle back to those departments in the hours and days ahead, I wanted to find out how some of our other departments were doing. It was clear that our Environmental Services team had done a remarkable job of cleaning up a sea of blood in our ED; our Security teams were everywhere, keeping us safe from the next possible wave of threats; and our Guest Services team was helping the growing number of distraught family members looking for wounded or deceased loved ones. It didn’t take long to see that this crisis was sending shock waves through our entire hospital system, and many other departments would be pulled into the collective response to this tragedy.

Then, an even bigger picture began to emerge: Every one of our team members was also part of our Central Florida community, and we were all shaken by the fact that some form of terrorism had crept into our own backyard. How on Earth was our small EAP team going to support dozens of departments and thousands of team members at the same time?

Mary, above left:

My phone went off at 5:00 am and the 10-minute drive to the hospital seemed an eternity. All I was told was, “We need you.” The walk to the incident command center with the HR leader gave me time to gather my thoughts and develop a plan. The request was to support the physicians. Immediately I knew the physicians were in full response mode. They would not need psychological supports yet. As I left the command center and walked through the hospital, my previous training in crisis intervention/PTSD was running through my head. The physicians and residents would not require or accept any kind of support for at least 24-48 hours post trauma. The theme that emerged for me was: Make yourself available when and where possible. I spent the next 12 hours with the families of the victims. As the time past and the traumatized family members waited, I worked alongside the guest service personnel, chaplains and EAP counselors to comfort, console, provide updates and pray. Just around noon, I connected in a back hall with the head of our EAP. We said very little but shared our mutual understanding of the magnitude of this event and that we would partner by end of day. This connection became important as we moved through the next days and weeks.

Synopsis

Pat:

Orlando Health’s internal EAP is a small, quiet department that provides a safe place for team members to discuss personal or job-related concerns with a licensed psychotherapist in complete confidentiality. Most of our work happens in private sessions, but when a traumatic event affects an entire department, we facilitate critical incident debriefings to support the staff’s natural recovery process. We advise HR and leadership on behavioral health matters, deliver presentations when times permits and keep up with community resources. For nearly 30 years, our services have been highly utilized, and our work has always felt very meaningful by knowing that we’re helping those who help others. At the time of the Pulse event, our team consisted of three therapists and a department secretary.

Mary:

The utilization of a physician coach was a new endeavor for Orlando Health. My role was developed only seven months earlier to address physician burnout. All of my work was confidential and most physicians had yet to be exposed to the resource. Up until the time of the Pulse event the purpose of a physician coach/counselor was to provide support and training in such areas as leadership, communication and conflict resolution. My role expanded dramatically after the Pulse tragedy.

Preparation

Pat:

Our EAP counselors were seasoned at working with the symptoms associated with traumatic events including shock, grief, and anxiety, and we knew how to address symptoms of PTSD, albeit within the short-term EAP model. We’d debriefed hospital teams for well over 20 years and had been trained and experienced in the use of psychotherapeutic “power tools” to rapidly ease mental and emotional distress (Energy Psychology and Rapid Resolution Therapy.) In minor ways, we’d participated in Hospital Incident Command exercises over the years, and we’d already created an EAP Crisis Response Plan for a “grab-and-go” response. But this Pulse shooting was beyond anything we’d ever seen.

Mary:

There was no preparation in the role of physician coach. It was my previous training as a clinical therapist in crisis intervention/PTSD that allowed me to respond. The understanding of long-term effects of trauma and how to mitigate were crucial. I had researched topics such as emotional exhaustion, depression and burnout among physicians in preparation for taking on the role of coach/counselor. This step would prove invaluable even at the one-year anniversary of the Pulse tragedy.

Response

Pat:

Timing may not actually be everything, but it’s pretty critical when you’re trying to provide effective behavioral health support after a highly traumatic event. Our impulse was to be there for as many team members as possible within the first 24 to 72 hours to help lessen any lasting psychological effects from this MCI. We knew that people would need witnesses for their emotional distress, support for their recovery process and ideas on how to heal. However, the realities of scheduling debriefings for a 24/7/365 workforce with its shift changes, varying work schedules and different levels of need was not a simple process -- at least not in the first few days.

Day 2: We started facilitating “open” debriefings called Team Member and Physician Support Groups for anyone who, regardless of role or department, wanted to connect with others to talk about what happened, to share reactions and to express concerns. Our hospital’s physician coach, who had decades of clinical experience, instantly allied with our team and helped facilitate these debriefings every two hours, around the clock for a 24-hour period of time. As debriefing facilitators, our jobs were to hold the space in which people could talk about how stunned they felt, how angry they felt and how scared they felt in a world where massacres were happening more frequently. We fostered conversation about how to regroup psychologically.

I continued checking in with key department managers to find out how their teams were doing and got responses that fell along a continuum from “Yeah, this really hit us hard and we want to bring you in” to “We’re fine, thanks, this is just what we do.” Really? A hundred people were just shot next to our hospital, half of them died, the other half were in our hospital; we thought there’d been an active shooter inside the hospital; police, FBI, media and family members were crawling all over the place; and helicopters were still hovering overhead. It felt as though the modern understanding that psychological support really can help reduce long-term effects was bumping into the bravado of certain groups. So I knew that I’d have to find another way to offer these particular groups well-deserved support.

Day 3: Our EAP counselors and some of our HR professionals began calling the managers of our behind-the-scenes departments such as telecommunications, patient transporters, patient access and the blood bank to find out how their teams were doing. We also checked in with our other hospitals to identify any critical needs that they might be having, and it eased our minds to know there were chaplains at each site to provide some needed up-close-and-personal care.

Days 3-9: Our debriefing schedule downshifted to four open debriefings a day, including times for those on night shifts, and we began facilitating department-specific debriefings (as opposed to those that could be attended by any team member).

To reach the thousands of team members who didn’t attend debriefings, we sent out corporate-wide messages that acknowledged what had happened and the different ways that this MCI was likely affecting our Orlando Health work family. We offered individual sessions at the EAP and sent out educational materials through our intranet on such topics as 1) normal reactions to a traumatic event, 2) the need for self-care in the healing process and 3) tips for managers on helping their teams after a crisis.

It wasn’t until day 5 that our ORMC ED/Nurses were ready to talk. More than 30 members from this team gathered to discharge wave upon wave of shock, sadness and tears. They got real. For two hours, they told stories about what they’d experienced in the ED that night, they comforted one another, they shared such deep respect for one another, and they even allowed for an occasional wave of laughter to dilute the emotional intensity of the conversation. This team’s willingness to connect so profoundly with one another made for a remarkable, perfect debriefing, and I left in awe that such people existed.

Days 10 – 13: We were still providing 2 debriefings per day, knowing that some folks needed more time before they were ready to talk. Outside counselors, who had been brought in to supplement what our own team could offer, continued to sit in HR offices and classrooms to provide drop-in sessions. They also helped by debriefing outlying areas within our system, and we appreciated their contributions.

We sent out more system-wide messages that addressed Grief and Loss as well as the subject of PTSD which, though not formally diagnosed until three months after a traumatic event, was a topic that we felt team members should understand.

Day 14: By the two-week mark, the statistics that I kept regarding the collective efforts of our EAP, our physician coach and our chaplains showed that we’d provided 44 debriefings and supported nearly 1,200 team members with some form of direct contact (not including individual EAP counseling sessions).

1 Month: We tried offering weekly support groups for those who had been more directly affected by the MCI — perhaps because they’d been regulars at the Pulse nightclub or because they’d lost someone dear to them, but by this time people really just wanted individual sessions.

6 Months and One Year: On these anniversary dates, we sent out EAP messages reminding people that we were there for them should the dates trigger emotions that were related to June 12, 2016.

Mary:

The first few days following the trauma, I partnered with EAP to provide open debriefings. Knowing that most physicians would not be comfortable in a group setting, I walked the ICU, ED and other locations to “randomly” meet physicians. This allowed for spontaneous conversation and an acknowledgment of what they had just experienced. My overriding question was, How do I minimize the likelihood of PTSD for the physicians and the residents? The six senior emergency medicine residents had all been working the night of June 12. This group was especially vulnerable due to limited experience.

Physicians are scientists, they are trained to respond to the needs of others and compartmentalize or deny their own emotional wellbeing.

As the days and weeks went on, I met with physicians and physicians in training individually, sometimes twice a week.

The media presence was overwhelming and permeated the entire physical campus.

On the six-month anniversary of the Pulse tragedy, I partnered with the chief of the medical staff to provide two sessions open to all physicians and team members.

The one-year anniversary was themed “resilience.”

Lessons Learned

For the Pulse incident, the supplies that we used the most were trach tubes, chest tubes and dressings. Days after the event, we met with the ED team to see how we could improve our trauma emergency carts. The ED staff wanted to change the amount of the dressing and tubes that we stocked on the cart. We also revamped the trauma supply area in the ED so it, too, could hold more supplies. We also learned that you need plenty of staff to help and you cannot do it alone.

What We Changed

Pat:

Our EAP Crisis Response Plan evolved into one with more details and more phone numbers for key people. Though no two critical incidents are ever the same, we’ve got the key elements of our response plan pulled together in one place and can re-order these elements as needed: questions regarding details of the incident, primary goals and the different forms of support we can provide. We have even more contact information for leaders, HR, key managers, chaplains, behavioral health professionals and others (such as who to call to arrange rooms for debriefings). These plans are kept in the trunks of our cars so they’re always at hand. There’s a deeper partnership between our physician coach and the EAP, and we know that we will work in tandem when there is a need within our healthcare system.

Conclusion

Pat:

Throughout history, when humans strategized about ways to deal with impending danger or how to recover from disaster, they likely focused on things such as improving defenses and stockpiling supplies. While these are critical elements, we now understand that they’re not enough. Our strategies also must include plans for helping the human heart to heal. This is no longer just a poetic notion, but a very real priority if people are to make the best recoveries possible. There are no perfect plans for providing psychological healing, and we still have much to learn about this dimension, but it’s important to elevate its importance within your broad Crisis Response Plan. Enlightened executives at Orlando Health immediately grasped the psychological fallout from this tragedy and fully supported the allied efforts of our EAP and our Physician Coach. They wanted as much care as possible for the team members who’d responded with such brilliance and heart to this Pulse shooting. May you never have to endure such a painful event, but should one occur, know that your teams will always remember the attention and care that you provided not just for their safety and not just for strategies to carry on in the face of unexpected difficulties, but how you cared for their hearts after the smoke clears.

Key Takeaways

You may be called upon to provide behavioral health support for a large, organizationally complex hospital system on a moment’s notice. Make sure your EAP has a “grab-and-go” EAP Crisis Response Plan that’s ready and updated with current contact info for key people in your organization. Your EAP will need to multi-task and connect with a lot of people in a short period of time.
Influence physician culture to recognize that they will be affected and that they deserve and need support in forms that work for them. Continue to educate and maintain a working relationship with physician leaders, and stress accessibility and confidentiality.
Be able to toggle back and forth between the big-picture needs of a large organization and the individual and departmental needs of those most acutely affected by the event.