the hospital and requested the assistance of additional
general surgery residents. Having received the initial
mass casualty intake page, article coauthor Marc S.
Levy, MD, FACS, the APH pediatric trauma surgeon
on call, offered his assistance. All five surgeons rapidly
drove to the trauma center, although their arrival at
ORMC was hampered by the police blockade of surrounding streets given the proximity of and ongoing
gunfire at the nightclub.
Many of the initial victims arrived in extremis
with limited or absent vital signs. Three of the initial six patients required immediate resuscitative
thoracotomies to treat their traumatic injuries and
hemorrhagic shock. These thoracotomies immediately
revealed the devastating impact of the high-velocity
rounds. Ongoing resuscitation was unsuccessful and
these patients rapidly succumbed to their injuries.
Four more patients arrived with absent vital signs.
Patients who died from their injuries were moved to
the hallway outside the trauma resuscitation room
to allow additional victims to receive care. A total of
nine patients succumbed to their injuries soon after
arrival at the trauma center. The first wave of patients
consisted of 38 victims in 42 minutes.
Patients were triaged based on their acuity and
injuries. Resuscitation was implemented in accordance with Advanced Trauma Life Support® (ATLS®)
principles. Physical examination, plain radiographs,
and bedside ultrasound were used to assess patient
injuries. Computed tomography scans were rarely
used in the initial patient evaluations given the large
number of victims.
As additional trauma surgeons arrived around
2: 40 am, critically injured patients were taken
immediately to the OR. Sandeep Mukerjee, MD, the
anesthesiologist on call, rapidly expanded OR capacity
by summoning the on-call team, as well as bringing APH and WPH OR staff to ORMC. As a result,
four ORs were open within 60 minutes and six rooms
within 120 minutes of the first patient’s arrival. The
operating trauma surgeons remained in their ORs as
new patients were brought in from the ED. Orthopaedic and vascular surgeons, including Joshua Langford,
MD, FACS, and Shonak Patel, MD, FACS, participated
in the initial operative response as necessary, based
on the patients’ injuries.
The hospital’s mass casualty intake page resulted
in a rapid influx of additional physicians, nurses, and
allied health care personnel to help care for the large
number of victims. The hospital worked with law
enforcement to arrange clear avenues of entry to the
campus from the north, avoiding the ongoing active
shooter situation to the south.
After assisting in the initial surgical response,
Dr. Cheatham joined hospital administrators to activate the hospital’s incident command system. This
command post was responsible for fulfilling all logistical needs related to the mass casualty intake, as
well as working to facilitate normal hospital operations. Arriving staff were staged in the hospital and
deployed to the appropriate areas as the need arose.
The incident command center remained continuously
staffed for the first 36 hours following the mass casualty intake event.
The Level I trauma
department at ORMC
NOV 2016 BULLE TIN American College of Surgeons