On June 12, 2016, a shooter opened fire on Pulse Nightclub in Orlando, Fla., killing 49 and injuring 58 more. At the time, it was the deadliest terrorist strike in the U.S. since the September 11 attacks and the nation's deadliest mass shooting. All of the victims were rushed to Orlando Health, where CEO David Strong's team was charged with not only caring for dozens of critically injured patients, but navigating the aftermath of unprecedented tragedy.
Mr. Strong had no blueprint to follow in his response to the Pulse shooting. In the year since the incident, he and his colleagues have become devoted to helping other hospital leaders with their own disaster preparedness plans. Orlando Health produced a short film sharing stories from departmental leaders and will soon release a book on the topic, while Mr. Strong and his colleagues have toured the country speaking with healthcare executives.
"We really felt this was our obligation, because there wasn't a script for many of the challenges we had to deal with. So, we talked about how to be prepared for what you can't prepare for; how to respond and work through activities as best as you can," Mr. Strong said. "So that's the idea. It's related to everything from billing and registration of patients to how long until you take down memorial — here are the things no one knows about until you have to deal with it."
When people think about dealing with a tragedy of this magnitude, many focus on the logistics of critical patient care. While this is undoubtedly any provider's highest priority, the effects of a mass casualty event stay with an organization long after the news cycle moves on. In fact, the news cycle is the first of many non-care related challenges for which Mr. Strong and his team had no preparation.
"I've had individuals come and say, 'I never would have though about how to handle the media response.' We had Geraldo [Rivera] and Anderson Cooper and everyone else camped on our front lawn for a week. You have reporters trying to sneak into the hospital, you have long-range microphones focused on the organization and picking up conversations between our staff and others," Mr. Strong said.
Mr. Strong does not resent aggressive media efforts — he says journalists were just doing their jobs — but he urges hospital administrators not to underestimate the hurdles that may arise from increased media presence. Mr. Strong even recalled one meeting with Gov. Rick Scott (R) on the floor of the hospital where an unidentified man, whom the governor's staff thought was a member of the hospital team and hospital staffers thought was an aide to the governor, was revealed to be a foreign journalist recording the entire conversation. Remaining aware of the media presence and learning to conduct private business under intense public scrutiny are just two lessons Mr. Strong learned.
The outpouring of support from around the country overwhelmed the staff at Orlando Health, but even gestures with the best intentions raise their own set of logistical issues.
Supporters turned a sign outside the hospital into an ever-expanding memorial that was adorned with gifts from all over the world. However, when is it appropriate for the hospital to take down the decorations and return the sign to its original state? A man who made 49 large crosses to commemorate victims who died presented them to the hospital, but where could they be kept? Eventually, Orlando Health established a permanent memorial on its grounds that gives the victims of the shooting the recognition they deserve while allowing the system to continue and provide care for the community.
Administrators at the hospital had to find a place to store thousands of bottles of water shipped as gifts, and even pizzas sent to the hospital were flagged by FBI investigators as posing a potential threat of poisoning. The team at Orlando Health faced these challenges with no expectations for what lay ahead, but it is Mr. Strong's goal to educate others who may benefit from his firsthand experience.
He says the only way an organization can be prepared to respond to a crisis such as the Pulse shooting is to ensure every member of the staff feels as though they are part of a team. Only with a strong sense of duty and community can a hospital handle the seemingly insurmountable task of providing necessary patient care. This kind of environment is established from the top down, and Mr. Strong made it clear that teamwork extends beyond clinicians.
"It takes a team. That day, there were security guards, nurse techs, nurses, physicians that were working well beyond what they would typically do. There were administrators getting supplies — it took a team," Mr. Strong said. "It takes a team every day in healthcare. We think about the outstanding clinicians, but if the operating room isn't cooled properly, then the operation can't occur. It confirms that in healthcare, a good functioning team is essential in making things great."
For his team to perform to the best of their abilities, Mr. Strong deployed counselors on the hospital floor just hours after the first victims arrived. He knew the stressful circumstances could take an intense mental toll on his staff, and felt it was essential to deploy professionals to help work through these complex emotions.
Over the past year, these counselors have spoken with more than 2,000 employees at Orlando Health. For all the grief and pain that caregivers experienced when treating victims of the senseless shooting, the most significant employee response came from those employees who were not on site when patients were admitted, says Mr. Strong. These workers expressed overwhelming feelings of guilt because they were not there to help. For Mr. Strong, this kind of dedication holds a lesson he hopes hospital administrators will not forget, a lesson he believes is vital when responding to even the most adverse circumstances.
"We should not confuse the work we do with the business we're in. As a health system CEO, I spend a lot of my time trying to grow the system, add a hospital, open a new ambulatory center and negotiate with different managed care companies," Mr. Strong says. "But the real work we do is the work that occurred that day in the trauma center, in the units and across the enterprise. And that work is what really gives dignity and value to the business."