4 key ways hospitals brace for treating mass shooting victims

In response to mass shootings in cities nationwide, hospital officials are conducting real-life simulations to prepare to treat victims, according to U.S. News & World Report.

During mass shooting training, physicians are shifting from doing everything possible to save severely wounded patients to prioritizing who gets treated according to who has the best survival chances, said Stephanie Davis, DO, board member with the American College of Osteopathic Emergency Physicians.

Here are four key concepts hospital officials are focusing on when preparing to treat mass shooting victims:

1. Expand the emergency department's capacity quickly. After a gunman opened fire on a crowd of concertgoers in Las Vegas last year, a Federal Emergency Management Agency report found local civilians significantly helped in transporting victims from the shooting area.

"We tripled or quadrupled the capacity of our emergency department in a matter of minutes," said Scott Scherr, MD, regional medical director for TeamHealth, Emergency Medicine West Group and chairman of emergency services for Sunrise Hospital and Medical Center in Las Vegas. Hospital staff placed victims in hallways and in available rooms outside the ED, including the pediatric ED and post-anesthesia care unit.

 2. Mobilize physicians, nurses and first responders. After learning how severe the Las Vegas attack was, Sunrise officials contacted dozens of additional physicians and nurses to respond to the facility. Before shooting victims arrived, the ED had four physicians and several nurse practitioners/physician assistants ready.

Within hours, over 100 physicians and about 200 nurses, NPs and other support staff were ready to treat victims, Dr. Scherr said. Hospital officials also brought paramedics and emergency medical technicians from local fire departments to help assess patients.

3. Create a triage system to promptly evaluate incoming victims. When responding to a mass shooting, it is critical to determine which patients need to immediately go to the operating room and who can wait, Dr. Davis said. Some hospitals may put small tents outside to quickly assess patients needing immediate assistance.

Putting a physician exclusively on triage duty and assessing victims using the START method, or "simple triage and rapid treatment," could be effective in mass shooting responses, Dr. Davis said. In the START triage system, patients are triaged based on their ability to walk, if and how well they're breathing and their mental status.

4. Stop patients' bleeding as soon as possible. Nurses, support staff and civilians can save patients using tourniquets, applying direct pressure to a wound or packing it with gauze or other material, said Adam Zwislewski, RN, trauma educator and outreach coordinator at Philadelphia-based Hahnemann University Hospital.

Teaching civilians how to help stop bleeding is common during mass casualty incidents, and the ACOEP hopes to see it become a routine part of medical providers' response, Dr. Davis said. "This is a major aspect of ACOEP's MCI training," she said. "We have to train physicians to teach bystanders effectively and quickly how to provide care."

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