A significant part of the challenge posed by this mass casualty
intake event was timing. The event occurred in the early morning
on Sunday when staffing and capacity were at lower levels. By
rapidly combining the resources of ORMC, APH, and WPH,
we were able to effectively meet the needs of the victims.
of patients to a Level I trauma center only three blocks
away greatly facilitated early cessation of hemorrhage
and rapid resuscitation. With the exception of the nine
victims who arrived with either absent or limited vital
signs, none of the remaining 40 victims succumbed to
their injuries. Some of these victims would undoubtedly have died had it not been for their rapid transport
to the trauma center.
A significant part of the challenge posed by this
mass casualty intake event was timing. The event
occurred in the early morning on Sunday when staffing
and capacity were at lower levels. By rapidly combining the resources of ORMC, APH, and WPH, we were
able to effectively meet the needs of the victims. We
briefly considered distributing patients among the
three facilities but were concerned that this option
would divide our manpower and resources, weakening our response.
Instead, we chose to bring the care providers and
supplies to the patients, preserving their “golden hour.”
Transferring patients to other hospitals 15 to 30 minutes away also was an option, but the victims were
already in a Level I trauma center that had the capacity to meet their health care needs. It is notable that
through effective triaging of existing inpatients, we
still had available critical care beds and operative capacity had the “third wave” of victims materialized. Given
the multiple gunshot wounds and traumatic brain injuries they sustained, however, these potential 40 patients
would most certainly have been of very high acuity. By
9: 30 am, the ORMC Level I trauma center reopened.
Within the first 24 hours following the Pulse
tragedy, our surgeons and OR team performed 29 operations on the victims. On the day after the event, two
ORs were made available solely to facilitate the ongoing exploration and repair of these patients’ injuries.
By the end of the first week subsequent to the event,
54 surgical procedures had been performed.
Because of the large number of gunshot wounds
and the nature of the event, many victims reported
being exposed to the blood of other victims. After
consultation with the Centers for Disease Control and
Prevention and the Orange County Health Department, all patients were offered baseline testing for
hepatitis B, hepatitis C, and the human immunodeficiency virus (HIV).‡ Patients without a history of
previous vaccination to hepatitis B were started on
a vaccination program. Post-exposure prophylaxis
against hepatitis C and HIV was not recommended.
Local television and newspapers publicized these
same recommendations to ensure that all individuals who had been inside the club during the mass
casualty intake were aware of how to take care of
Disaster plan enhancements
It has long been recognized that adversity can bring
out the best in people. Many of the 33 surgical residents
and fellows in our program immediately responded
to this tragic situation and worked tirelessly over the
subsequent 36 hours to care for the victims. Our team
members commonly provided care on patient units and
in ORs with which they were unfamiliar, frequently
crossing job descriptions in doing so. Further, we were
inundated with offers of assistance from surgeons from
our own facility, as well as other area hospitals and
even other states. By the time these offers had been
States, 2008. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/
rr5706a1.htm. Accessed September 7, 2016.