Mass shootings spur new emergency medicine task force: ACEP president shares details

In the wake of the deadliest shooting in American history, healthcare providers across the country are faced with the grave reality that they should be ready to respond to a violent mass casualty event. The American College of Emergency Physicians, which helped lead part of the Ebola emergency response, is spearheading an effort to help providers prepare for worst-case scenarios.  

"On behalf of the nation's emergency physicians, I wish to express our deepest condolences to the families and friends of those who were murdered in Orlando this weekend," Jay Kaplan, MD, ACEP president and vice chair of emergency services at Ochsner Health System in New Orleans, said in a statement following the Orlando mass shooting on June 12. "In addition, we extend our prayers for healing and recovery to the many injured who are still fighting for their lives. While the shock and grief from this horrific tragedy are still fresh, we are resolved to redouble our efforts at dealing with what has unfortunately become a regular occurrence in our nation."

In January, ACEP approved the launch of a High Threat Emergency Casualty Care Task Force. This task force is dedicated to understanding how to effectively respond to mass casualty incidents and spreading that knowledge to emergency response teams across the nation. Becker's checked in with Dr. Kaplan to discuss this new task force and the state of emergency response in high-threat situations.

Editor's Note: Responses were edited lightly for length and style.

Question: What is unique about the emergency response to a mass shooting or bombing, as opposed to another mass casualty event, like a natural disaster or bus accident?

Dr. Jay Kaplan: Most of what we have prepared for in the past in terms of disaster preparedness has been multiple patients with blunt trauma injuries. What's different about the mass shootings that we are seeing — and even the Boston Marathon bombing, for example — is that we had multiple patients with penetrating trauma. When people think of penetrating trauma, they think of knives or guns, but as was the case in the Boston Marathon event, there was both blunt and penetrating trauma. That's probably the biggest difference. That and the fact that you are looking at multiple victims with multiple gunshot wounds — and I'm not talking about just two or three gunshot wounds, we can see that even on an everyday basis in emergency rooms and trauma centers — I'm talking about victims with 20, 30 or more gunshot wounds.

Q: What, if any, are some aspects of the emergency response to these high-threat events you feel healthcare providers could improve on?

JK: In some ways you've seen the best of the best when you look at what happened in Orlando, because as I understand it, Orlando Regional Medical Center was 3.5 blocks away from where this all took place. In Boston, when we had the Boston Marathon terrorism incident, we had multiple high-quality emergency departments very close to where it all occurred. We have to expect we may be seeing similar events where we don't have that adjacent trauma center or the high-quality hospitals that had done a drill several months before and were totally prepared. For emergency response in general, we have to take the best of the best and spread it to the all of the all.

We also don't know so much about wound patterns and what causes people to die in these kinds of incidents. If you have someone in front of you and an autopsy is done, then perhaps it helps triage future patients who come in and you understand what to look for. I don't think we can blame or say we are not doing things well. We do have to do things better in terms of spreading our knowledge base and understanding what injuries patients might have.

It's interesting. I was in New York City at the end of last week speaking at a faculty retreat of a highly regarded academic medical center, and the chairman said, "If my pager goes off a couple times, my immediate thought is, 'Is it happening again?'" As much as I hate to say it, for many of us, we are starting to think not ifit's going to happen again, but when.

In emergency medicine we are the front lines, along with EMS. We are available 24/7/365. We need to figure out what we need to do as a specialty to be as prepared as possible and save as many lives as we can in these incidents.

Q: ACEP approved the launch of a High Threat Emergency Casualty Care Task Force in January. Can you tell me a little bit more about it — what spurred this idea?

JK: What spurred it was really a number of our members who have been very involved with disaster preparedness trauma care in the past. When the Ebola epidemic occurred, my specialty — emergency medicine — in a very rapid fashion created an Ebola epidemic expert panel. We had specialists on whom the CDC relied in terms of building and crafting their strategy of healthcare response.

Taking that as a model, we thought again that we needed to create a comprehensive strategy to address the care of patients in these kinds of incidents from point of injury to hospital-based care. The thought behind the task force was to build and coordinate external partnerships regarding high-threat emergency casualty care. We are looking at developing best practice recommendations for division of care in high-threat environments, identifying clinical and operational knowledge gaps and articulating what we need to know in terms of research. We are looking at creating an expert panel, not just of emergency physicians, but an expert panel available to the federal government, CDC or whoever, that would be available to better plan and serve as a resource during evolving acute high-threat incidents.

Q: What do you hope to accomplish with the task force?

JK: We need to understand, capture and disseminate critical lessons learned from these incidents to our first responders across the U.S., spearhead efforts to gather and analyze data from these kinds of events so we can advance evidence-based response guidelines, and we need to gather, analyze and validate best practices from the pre-hospital setting to the hospital-based response.

Finally, what my hope would be for the task force is to begin to look at not just the hospital setting, but also our communities. I am envisioning a toolbox of resources we could give communities ahead of time and after the fact to help prepare, respond and recover from these incidents.

Q: As you mentioned, one goal of the task force is to disseminate lessons learned from incidents to the first response community across the U.S. What lessons can we take from the Orlando mass shooting?  

JK: I think that's to be elucidated. We are a little bit too close to it. However, I would like to communicate our gratitude to our colleagues on the front lines there. We need to take and learn from them. As I have said before, information is power. When these kinds of things happen, we all feel helpless. My perspective is we need to figure out what we can learn from this so we can do as well and even better next time.


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