Emergency providers at Orlando Regional Medical Center in Orlando, FL, faced multiple challenges in responding to the worst mass shooting in U.S. history. As the scene of the shooting was only three blocks away from the hospital, there was little time to prepare when notified that victims would begin arriving shortly after 2 a.m. on June 12. Also, fears of a gunman near the hospital briefly put the ED on lock down. However, using the incident command system, the hospital was able to mobilize quickly, receiving 44 patients, nine of whom died shortly after arrival. Administrators note that recent training exercises geared toward a mass shooting event facilitated the response and probably saved lives. 

  • Patients arrived at the hospital in two waves, with the initial surge occurring right after the shooting took place around 2 a.m., and the second surge occurring about three hours later.
  • At one point, more than 90 patients were in the ED, more than half for reasons unrelated to the shooting.
  • Clinicians contended with a much higher than usual noise level while treating patients, making it hard to hear reports from EMS personnel. Also, treatment had to commence prior to identification for some patients who arrived unconscious or unable to speak.
  • While surgeons and other key specialists were called into the hospital to address identified needs, administrators actually called hospital personnel to tell them not to come in unless they were notified. This prevented added management hurdles.

ACEP, AMA Call for Action

With yet another grim reminder that mass shootings are now occurring with increasing frequency, emergency management planners and clinicians are focusing more time and energy on preparing for such an event. For instance, in January of this year, American College of Emergency Physicians (ACEP) approved the creation of a multidisciplinary “High Threat Emergency Casualty Care Task Force,” which is focused on understanding, tracking, and responding to mass casualty events like the Pulse nightclub shooting.

“We are resolved to redouble our efforts at dealing with what has unfortunately become a regular occurrence in our nation,” noted Jay Kaplan, MD, president of ACEP, in a press notice following the Orlando shooting. “As a specialty, we will continue to lead and collaborate with partners across the emergency response continuum in efforts aimed at reducing potentially preventable deaths and disability due to these horrific attacks.”

Kaplan noted that the newly created task force will leverage the expertise of its members to improve responses to future violent events. Specifically, he noted that the panel will:

  • work toward developing a process in which ACEP can rapidly capture and disseminate lessons learned from specific incidents to first responders across the country.
  • collaborate with multidisciplinary researchers and public policy experts to develop a database of information on wounding patterns and causes of death for the victims of mass violence.
  • coordinate with partners such as fire, EMS, law enforcement, and trauma care providers to analyze best practices for both prehospital and hospital responses to such events.
  • press for resources so that communities can effectively prepare for, respond to, and recover from violent incidents that occur in the future.

“Information is power,” Kaplan noted. “At this moment when we feel powerless, we must focus on learning from this tragedy to improve our response in the future.”

Calling gun violence a public health crisis, the American Medical Association (AMA) said it will actively lobby Congress to lift its 20-year-old ban on gun violence research by the CDC.

“With approximately 30,000 men, women, and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship, and on live television, the United States faces a public health crisis of gun violence,” said Steven Stack, MD, AMA’s president and an emergency physician. “Even as America faces a crisis unrivaled in any other developed country, Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries.”

Stack noted that an epidemiological analysis of gun violence is vital so that healthcare providers, law enforcement, and society at large can work at preventing injury, death, and other harms resulting from firearms.