EXECUTIVE SUMMARY

U.S. hospitals handle, on average, victims from a mass shooting every day. For most case managers, it’s not a matter of whether they and their colleagues will experience that traumatic event, but when. Case managers who have gone through such events offer some advice.

  • Case managers can play important leadership roles in the event of a mass shooting incident.
  • Dealing with the media is a problem that many are unprepared to handle.
  • Protecting patients’ privacy becomes more challenging when the shooting event is widely publicized.

Within days of the horrendous Orlando, FL, mass shooting in which 49 people were killed and more than 50 were injured, surgeons at Orlando Regional Medical Center offered insights into how they dealt with the emotional aftermath of the chaotic situation. As one doctor told Orlando FOX 35 news, “Someone said to me, ‘Welcome to the club no one ever wants to be a part of.’”

In the United States in 2015, there were more than six mass shootings each week, resulting in hospitals of all sizes dealing with sudden influxes of gunshot victims.1

This past June’s mass shooting in a gay and Latino Orlando nightclub, Pulse, which was attributed to both terrorism and hate crime, was the most devastating terrorism incident in the U.S. since Sept. 11, 2001.

While mass shootings and casualties of that magnitude call for incredible community and outside resources, small and large rural and urban hospitals and communities continually must be ready to handle the far more common cases of a single gunman sending four or more victims to the hospital.

These types of traumatic events can affect everyone who works in the healthcare community, including case managers. As reported by some case managers who dealt with highly public mass shootings last year, case managers can play an important leadership role in helping patients and staff deal with both logistics and the emotional toll of such trauma.

Here’s one example: Roseburg, OR, with around 22,000 residents, was the kind of rural town few people had heard of before a mass shooter on Oct. 1, 2015, shot 17 people, killing 10, at the town’s Umpqua Community College campus.

Mercy Medical Center RN care manager Geoffrey Brownell, BSN, RN, who previously had worked as a nursing instructor at Umpqua Community College, recalls hearing the news of the shooting and worrying about the people he knew on campus.

“We weren’t sure how many victims were coming in and what the situation was,” Brownell recalls. “We listened to the news and tried to figure out what would happen that day.”

Three of the hospital’s care managers had ICU nursing experience, including Brownell. Once they learned that gunshot victims were heading to the hospital, the care managers headed to the ICU to staff that area so the ICU nurses could be extra hands in the ED as victims arrived. (See story about case managers helping patients, staff handle traumatic events in this issue.)

Although the case managers had years of experience in dealing with stressful situations at the hospital, this particular event was traumatic for everyone, Brownell notes.

“This is a small community, so a lot of the victims were known to many of our hospital staff,” he says.

A mass shooting in a small community can be particularly fearful because everyone expects to hear that someone they knew was shot, says Cindi Stephanos, BSN, RN, director of risk and quality/care management for Mercy Medical Center.

Nearly nine months after the mass shooting in Roseburg, the hospital had returned to its normal routine and pace — until the Orlando shooting occurred, bringing back memories of those first hours of dealing with the aftermath of so many dead and injured students and faculty. “When this mass shooting happened in Florida and I learned about it on the news, I had almost a flashback to that day, and the memory became more vivid,” Brownell says.

Stephanos was out of town when the shooting occurred, but when she returned the next day, she used her previous experience in psychiatric nursing to help staff deal with the trauma.

“We can handle things like this, but I’m getting teary thinking about it,” Stephanos says. “Afterward, for weeks, it was weird around here, and I spent a lot of time talking to staff, running into people in the hall and asking, ‘How are you doing?’”

For some case managers and hospitals, mass shootings and similar incidents have become so commonplace that they’re less personally traumatizing. For instance, there were seven young people shot in Panama City, FL, during spring break of March 2015, but that wasn’t terribly unusual for the coastal Florida town during its college student tourist season.

“We have so many incidents like that, shootings,” says Cathy Kearns, LCSW, case manager for the surgical ICU at Bay Medical Sacred Heart.

“We have a lot of spring break accidents, some shootings, and some pedestrians being hit by cars and some kids falling off eight-story buildings, drunk,” Kearns says.

One of the most traumatic, partly because it was so unusual, was when two teenage girls were parasailing and their parasail became untethered, flying them above land and into a tall condominium building before they crashed onto a car. The girls survived, Kearns recalls.

“These two girls are walking and talking; it’s just a miracle,” she says.

During the more common spring break shootings and accidents, Kearns and other case managers spend time trying to locate victims’ families, who often are miles away from where their children are hospitalized.

The next step is to meet with the family and do crisis intervention, helping the family understand what happened, who was involved, and to answer questions they might be asking their own children if they weren’t in a hospital bed, unable to speak, Kearns says.

“We provide families with community resources, including information on where they can stay, and we educate them on what to expect,” she says, adding that affordable lodging in Panama City during the spring is challenging to find, especially for families that might need a hotel room or rental for weeks while their child recovers.

“I have found two hotels that are gracious enough to lower their rates so families can afford to stay there, and those are the hotels we rely on,” Kearns says.

Kearns and Brownell say the focus must be on helping patients and their families cope and transition to the next step, even as they cope with having survived a traumatic tragedy.

“You don’t get to choose the patients; some come to you with issues and social concerns that are greatly amplified during that period,” Brownell says. “You have got to handle whatever they are dealing with because of the mass shooting, but also because of their other social issues.”

REFERENCE

  1. Gun Violence Archive 2015. GunViolenceArchive.org. The website is maintained by Gun Violence Archive, a not-for-profit corporation that collects gun-related violence data, checking each report for accuracy and redundancy. The site defines mass shootings as four or more shot and/or killed, not including the shooter, at the same general time and location. URL: http://www.gunviolencearchive.org/past-tolls.