EXECUTIVE SUMMARY

With the increasing frequency of mass-casualty events, the American College of Emergency Physicians has assembled a High Threat Task Force to look for ways to improve the emergency response to these events. The panel intends to focus on training and operations, but the ultimate goal is to find ways to eliminate preventable deaths.

  • The panel intends to standardize and unify improvement efforts that have thus far been disparate.
  • The co-chairman of the panel says one of the biggest gaps is the lack of evidence-based guidelines for how emergency personnel should respond to mass-shooting events.
  • Noting that the incident command structure was created for fighting wildfires, the co-chairman of the task force notes that mass-shooting events require a more dynamic leadership response.

The Importance of Emergency Preparedness

While national organizations and policymakers study what they can do to improve the response to mass-casualty events, hospitals around the country are scrambling to integrate the latest expert advice from these events into their operations, but it’s a continuing challenge, observes Karen Doyle, MBA, MS, BSN, senior vice president of nursing and operations in the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center (UMMC) in Baltimore.

“Hospitals get little to no funding for preparedness, so conversations certainly should occur, and we do conduct mass-casualty exercises,” Doyle notes. “We conduct active shooter training through our emergency management committee, we talk about lessons learned, and then we try to incorporate what our colleagues have learned across the nation into those exercises.”

At UMMC, there is a formal process for implementing improvements in the way the hospital prepares for mass-casualty events. “All our plans come through the emergency management committee, which every hospital needs to have according to Joint Commission standards,” Doyle explains. She observes that the catalysts for such changes often come from professional conferences.

“Someone will present a situation, and we will make sure we garner the information from there,” Doyle says. “Then we take that information, whether it is publicized or whether [a member of our staff] has attended the conference, and incorporate it into our disaster [approach] based on what we think we need to bolster in our plans.”

The hospital has not yet had to deal with a mass shooting, but it has dealt with mass-casualty events, and the first order of business is always making sure the resources required to handle the situation are available, Doyle explains. “We had riots in Baltimore ... and we certainly had a lot of patients descend on us,” she explains. “Making sure that you garner your resources, get them to the right place, and that you triage appropriately is first and foremost.”

“Once that aspect is under control, managing the environment outside the hospital requires planning, which can be quite difficult,” Doyle observes. “The press, the people, the rumors, and all the communications that exist — those are things that become very complicated. Delivering care is probably the easiest piece of it.”

As shooting incidents have escalated, UMMC has increased its preparations for this type of event. “We do active shooter training, and we have incorporated escalation techniques into the training of many of our staff,” Doyle notes. “We also have employed a different level of security to monitor the perimeter of our hospital.”

Further, there is a much greater focus on workplace violence at UMMC. The hospital installed panic alarms that employees can use when they feel threatened and hired a security consultant as part of an effort to improve the safety culture. “It’s a huge issue. We have done a lot of work in our institution, and we have a lot more work to do,” Doyle admits. “I don’t feel like we are ever done, but we have a heightened sense of awareness.”

Doyle feels fortunate that she works in a major medical center in a city where resources are plentiful, but she worries about smaller community hospitals. “We can partner with Baltimore City Police and with our rehab centers,” she explains. “Other places that are out there in these rural areas really struggle. Critical access hospitals have very few resources around them.”