Orlando trauma surgeon on mass shootings: 'All hospitals need to be prepared'

Michael Cheatham, MD, trauma surgeon and chief surgical quality officer at Orlando (Fla.) Regional Medical Center, is all too familiar with what Las Vegas hospitals are experiencing in the aftermath of the Oct. 1 mass shooting.

On June 12, 2016 — the day of the Pulse nightclub tragedy in Orlando — Dr. Cheatham was brought in by the trauma surgeon on call to help. After working as a trauma surgeon for about an hour, he took on his more administrative role as chief surgical quality officer and helped with response efforts. Overall, ORMC treated 44 shooting victims.

Becker's Hospital Review caught up with Dr. Cheatham to discuss how Orlando Regional Medical Center responded to the mass shooting and lessons learned from the experience.

Note: Responses have been lightly edited for clarity. 

Question: What was it like in the aftermath of the Pulse shooting?

Dr. Michael Cheatham: It was a very kind of a surreal experience. We had trained for years and years for mass casualty events, but we had not anticipated that the event would occur [so close to] the hospital. So my first experience was trying to drive to the hospital past the Pulse nightclub because we didn't know at the time of the event where the shooting had occurred. So my first obstacle if you will was just to get to the hospital because I normally would drive right by the club to the trauma center.

Q: What types of injuries were involved and how did you approach treating various injuries?

MC: The first thing you do in a mass casualty situation is you triage patients. You determine who needs care immediately to survive. You determine which patients can wait to receive care because they're stable. We had numerous patients with gunshot wounds to the chest and abdomen, which are the life-threatening injuries, and we had a number of patients who had extremity gunshot wounds, which might not be as life-threatening. So we initially focused on those patients who were at risk of death imminently and provided them with operative care first. Then as our resources increased we started scanning the number of operating rooms we had available, and we were able to bring in orthopedic surgeons and vascular surgeons who are not in the hospital around the clock.

Q: What lessons did you take away from the experience?

MC: I think the biggest take-home lessons from the tragedy really don't have anything to do with providing patient care. We take care of a lot of patients. We're the busiest Level I trauma center in the state. We're used to taking care of gunshot wounds. We don't normally take care of 44 gunshot wounds in a matter of three hours, but the take-home lessons really have to do with nonmedical issues. No. 1 is we really have to practice and prepare. I think the trauma and disaster exercises and drills that we do on a regular basis definitely helped prepare us for how to take care of that large number of victims in a short period of time. I think the second take home point is you have to prepare to handle the large number of family members and friends who are clamoring for information. That is a part of disaster drills that few hospitals practice.

I think the third take-home point is you have to be prepared for your team members to be significantly impacted emotionally and psychologically by this type of event. At one point we thought there was an active shooter inside the hospital. We thought there had been gunshots fired in our emergency department. And that had a tremendous impact on our team members. Nobody comes to work each day at a hospital expecting their life [to] be put at risk.

The fourth take home point is you have to be prepared to interact and work with the media. Our hospital was thrust into the limelight with the local, national [and] international press. So you have to have a plan of how you are going to provide the information the media needs but at the same time preserve patient privacy.

The fifth take home point is you have to establish relationships with local government and law enforcement during your drills and not be introducing yourselves to them at the time of a mass casualty event. You really want to establish those relationships ahead of time. Involve them in hospital drills so as a hospital you understand how they work so in a mass casualty situation you have those relationships in place.

Q: How can Las Vegas hospitals or other hospitals dealing with a mass casualty event use these lessons?

MC: The five lessons learned really are things a vast majority of hospitals don't really consider in their disaster drills. Most disaster drills, mass casualty plans focus on how you're going to provide patient care. And really unless the hospital is absolutely overwhelmed and does not have the resources, you're actually going to do exactly what you do on a daily basis. If you try and use plans and patient care protocols that are solely used in disaster situations, nobody's going to be familiar with them, and you're not going to provide effective care. So it's much better to maintain the standard of care if you possibly can because that's what all of our team members — in the emergency department and the operating room and the lab — [are] familiar with.

Don't try and change your plan in a disaster unless you're absolutely forced to. Most hospitals focus solely on how they're going to provide patient care. They don't consider these other issues and they really ought to be practicing those in drills because in our experience that was what really required our time and effort and had a longstanding impact on the hospital. It wasn't how we cared for patients because the patients were cared for in a matter of hours. But, for example, the emotional and psychological effects on our team members — that has gone on up until present day. And if you talk with other hospitals that have had these events such as [those in] Aurora, Colo., they'll tell you even five years after the event their team members are still suffering emotionally from what they experienced that day.

Q: Any other general thoughts?

MC: With the increasing frequency of these mass casualty events, it's not a question of if a hospital is going to be subjected to some mass casualty event, it's just a question of when. So it's inappropriate for a hospital to adopt a plan they would send victims to another hospital. All hospitals need to be prepared. All hospitals need to practice and drill and maintain an up-to-date disaster plan so they can respond.

Editor's note: ORMC is in the process of writing a book on how each hospital department responded to the Pulse tragedy. The book is expected to be completed next year.



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