Planning, preparation, and practice are keys to mass casualty event readiness

Although mass casualty events are rare, no matter the nature of the event or what setting you’re in, preparation is essential to optimize outcomes. A session on Tuesday, October 6, Mass Casualty Preparedness, featured a panel of experts who discussed the importance of integrated all-hazards disaster plans in the areas of mass shootings, preparedness in the face of the COVID-19 pandemic, and the special challenges of rural preparedness.

The session will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.

Stephanie L. Bonne, MD, FACS
Stephanie L. Bonne, MD, FACS

Stephanie L. Bonne, MD, FACS, associate professor of surgery, Rutgers New Jersey Medical School, and trauma medical director, University Hospital, Newark, NJ, began the session with a discussion on how her institution managed the challenges brought on by COVID-19 and lessons they have learned about maintaining trauma and disaster preparedness in the time of a pandemic surge.

Dr. Bonne said that staffing issues and space/capacity logistics were among the immediate challenges they faced in balancing the demands brought about by the COVID crisis while maintaining the integrity of trauma center services.

“Many of the trauma surgeons were called upon to perform critical care management,” she said. “With elective cases canceled, we were able to backfill our trauma service with residents who had rotated on the service before. ENT, orthopedics, and plastics, for example, became our floor service for trauma. That allowed our surgical residents to devote themselves entirely to the care of the ICU that we were managing.”

As the pandemic continues, Dr. Bonne said that among the important things they’ve learned is that efficient communication and clear decision making are key to effectively managing crisis situations. Her facility adopted a troop command center model.

“You need to empower the command center for all aspects of bed management and staff management and have a clear hierarchy of who’s in charge and who’s making decisions,” she said. “There will be a wealth of data once this is all over. I think it will be really important to look back at our data and debrief our system and understand how we could do this better the next time there’s a pandemic or the next time there’s a crisis.”

Richard A. Sidwell, MD, FACS
Richard A. Sidwell, MD, FACS

In the next presentation, Richard A. Sidwell, MD, FACS, a trauma surgeon at Iowa Methodist Medical Center, a Level I trauma center in Des Moines, talked about the unique challenges of preparing for and responding to mass casualty events in a rural setting.

“There are a number of barriers to preparation for a disaster type events—time, expertise, interest, and certainly finances. Experience has shown us that all of these are worse in the smaller environments,” Dr. Sidwell said. “And then you throw in the difficulties of training. In rural environments, training tends to be more sporadic, and joint exercises—exercises between hospital providers and prehospital personnel and also preparation or drills across jurisdictions—tend to be fewer in nature when compared to urban environments.”

The lesson from this, he said, is that preventable errors only become apparent during real events when, ideally, they would be errors that could be recognized and corrected during drills or exercises.

Additionally, he said it is important to understand that preparation for a disaster in a rural setting is not simply taking what is done in the urban area and then scaling it down.

“There are different considerations and challenges that need to be addressed,” he said. “Working on the relationships that are present within and among communities in rural areas is important. We need to share our best practices. These may be lessons that are learned from actual events or lessons that are gleaned from doing drills. These need to be disseminated and shared among communities.”

Deborah A. Kuhls, MD, FACS
Deborah A. Kuhls, MD, FACS

In the final presentation, Deborah A. Kuhls, MD, FACS, discussed the topic of mass shootings and the importance of being prepared for both adult and pediatric victims. Dr. Kuhls is professor of surgery, University of Nevada-Las Vegas School of Medicine, and critical care section chief and medical director, Trauma ICU, University Medical Center (UMC), a Level 1 adult trauma center in Las Vegas.

Dr. Kuhls was on duty at UMC on the night of October 1, 2017, when the deadliest mass shooting in modern American history occurred as a gunman opened fire from a hotel window on a large crowd of people gathered for an outdoor concert.

One of the biggest challenges in preparing for a mass casualty event involving children, she said, is making sure that specialized pediatric equipment and supplies are on hand. She cited a recent survey which found that many hospitals did not have adequate supplies of items like pediatric tourniquets, pediatric endotracheal tubes, and pediatric intubation kits.

“There was also a surprising number that had not had any involvement with pediatrics being included in full-scale exercises for pediatrics disasters,” Dr. Kuhls said. “A preparedness plan should include children, elderly, and other special needs patients.”