Las Vegas shooting: How hospitals handle mass casualty events

A shooting at a music festival Sunday night in Las Vegas resulted in at least 58 deaths and over 515 people injured. This meant a surge of casualties being rushed to area hospitals for treatment.

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Las Vegas’ Sunrise Hospital reported having treated 180 patients from the shooting as of Monday afternoon and performing about 30 surgeries. Hospital emergency rooms in the city were jammed with the wounded.

Rep. Ruben Kihuen, a Democrat whose congressional district includes a portion of Las Vegas, visited a hospital where some of the victims were taken.

“Literally, every single bed was being used, every single hallway was being used. Every single person there was trying to save a life,” he said.

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Authorities have also put out a call for blood donations and people were waiting in huge lines to give blood to the wounded.

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Despite the seeming chaos, hospitals and cities plan for big disasters, said Jack Rozdilsky, professor of disaster and emergency management at York University. “When these things take place it’s not a state of pure chaos, it’s a state of organized chaos where specific first responders have plans, they’ve been trained, and unfortunately expect these types of events to happen.”

Here’s how he says medical authorities handle mass casualty events:

1. Triage

In the case of a mass shooting, you could expect a variety of injuries, from direct and indirect bullet wounds and broken bones to cuts, scrapes and stampeding injuries, said Rozdilsky. Different kinds of incidents, like a plane crash for example, would have different kinds of expected injuries.

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When paramedics arrive at the scene, they would have to triage the patients – trying to determine who most urgently needs medical care.

“It’s slightly grotesque but it would be important to sort out who’s already dead, who’s not in need of aid, versus those who can survive. That would need to be the first cut,” he said.

“Once that is done, the first responders go to aid the people who they have a chance of saving.”

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Emergency responders would rank people using information like their type of injury, their age (very young and very old people would likely get priority) and their level of consciousness. Then, they would usually give people a tag with some basic information on their injuries and try to get them to hospital.

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2. Transport

Festivals, as part of their preparation, generally set up areas where ambulances can arrive in case of emergency. So as emergency responders work to triage victims, hundreds of ambulances might be rounded up to take people to hospital and are sent to the “staging” area. There, they’re loaded up with patients and start making runs to hospitals.

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Different hospitals might have different specialties, said Rozdilsky. Some are designated trauma centres and would likely receive the bulk of cases in a manmade or natural disaster. But some hospitals handle crush injuries, or children’s hospitals would take pediatric cases. All of this would be worked out beforehand so that emergency services would know where to take people.

3. Hospital care

Once they arrive at the hospital, patients would once again be triaged and prioritized based on the extent of their injuries. All available doctors would be called and most likely, elective surgeries would be cancelled to free up space for emergency patients.

The hospital would decide who needed to go to surgery immediately, who needed to go to intensive care immediately and determine whether people can wait for other treatments.

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But a hospital’s emergency plan wouldn’t just be about receiving patients via ambulance, said Rozdilsky. In this kind of event, people would also be driving themselves or others to the hospital or even walking in. So, the hospital would have to have people waiting at various entrances to process these patients and get them into the triage queue as well.

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Not only that, but panicking families would be contacting the hospital or walking into the emergency room, looking for lists of patients to see whether their loved ones are there. So, communications plans and more administrative help would also be needed, as well as security zones set up to separate patients from others.

“It’s an entirely hospital-wide operation,” said Rozdilsky.

And despite all the planning for mass casualties that he believes authorities in Las Vegas and other major cities have done, he believes that this disaster would be hard for most cities to deal with.

“I think it’s safe to say that this event is extreme and it would be testing the capabilities of the system.”

-With files from the Associated Press

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