Disaster Preparedness Tested in Colorado Tragedy

July 23rd, 2012


By , BSN, RN

By the time you are reading this blog the events of Friday morning, July 20, 2012 in Aurora, Colorado have played out on every news outlet imaginable. But, what happened at that movie screening will, like many other mass casualty disasters, have repercussions for some time to come.

This country has had more than its share of mass tragedies, some on a national scale such as September 11, 2001. For the people of Colorado, despite the fact that the Columbine school shooting disaster was in 1999 (13 years ago,) what happened just up the road in Aurora last week will bring back many unwelcome memories. And, people across the country, from Oakland, CA and the Oikos University campus, to Oklahoma City, to Blacksburg, VA and the students of Virginia Tech, will relive their own private nightmares.

When you work in the news business or in healthcare, events like these stand out immeasurably. I have had careers in both, been involved in covering these events from the standpoint of the media and as a nurse, and it is hard to explain the obsession that comes with being even tangentially involved.

I watched a nurse give press conference about the movie shooting from the parking lot of one of the hospitals where the injured victims were being treated. I saw a doctor from another facility do the same. Both mentioned that as soon as they received calls their hospital’s “disaster protocol” was put into play.

What that means, is phone trees are lit up, everyone from physicians and nurses, to OR and ER support staff and custodians are called in to work immediately. If the disaster drills have been practiced, what happens is almost seamless. ERs gather gurneys and supplies, ORs are opened and instruments readied, ICUs prepare vents and pumps, and all staff are on alert. It is an adrenaline rush at the beginning and exhausting at the end.

Disaster Preparedness

Many medical facilities run mock disaster drills in order to prepare for just such an emergency as the shooting in Colorado. All hospitals are required by The Joint Commission (JCAHO) to have disaster preparedness plans in play.

Standards of care developed by JCAHO have evolved from studying previous significant public disasters. JCAHO guidance centers on managing consequences to; provide safe and effective patient care during an emergency, clearly defining staff roles, training those roles and responsibilities; and sustaining staff competencies over time.

There are six focus areas that hospitals must address to demonstrate they have proper plans and response mechanisms to a disaster. During planned exercises, the organization monitors, at a minimum, the following six critical areas:

  • Communications – both internal and external to community care partners, state and federal agencies.
  • Supplies – Adequate levels and appropriateness to hazard vulnerabilities.
  • Security – Enabling normal hospital operations and protection of staff and property.
  • Staff – Roles and Responsibilities within a standard Hospital Incident Command Structure.
  • Utilities – Enabling self-sufficiency for as long as possible with a goal of 96 hours (this applies more for natural disasters such as hurricanes and tornadoes).
  • Clinical Activity – Maintaining care, supporting vulnerable populations, alternate standards of care.

The protocols for each facility’s disaster preparedness plan and how each individual department will ready should be found at a central location on each unit, usually the nurses’ station or front desk.

The Centers for Disease Control and Prevention (CDC) also are a great source for understanding what a healthcare facility and its providers need to be ready for in case of such an emergency as happened in Colorado. Through studying previous disastrous events the CDC even offers formulas for estimating how many casualties hospitals in the area can expect.

  • Within 90 minutes following an event, 50-80% of the acute casualties will likely arrive at the closest medical facilities.
  • The less-injured casualties often leave the scene under their own power and go to the nearest hospital. As a result:
    • They are not triaged at the scene by Emergency Medical Services (EMS).
    • They may arrive to the hospital before the most injured.
  • On average, it takes 3-6 hours for casualties to be treated in the emergency department (ED) before they are admitted to the hospital or released.

When trying to determine how many casualties a hospital can expect after a mass casualty event, it is important to remember that casualties present quickly and that approximately half of all casualties will arrive at the hospital within a one-hour window. That window opens when the first casualty arrives at the hospital. To predict the total number of casualties a facility can expect, you simply double the number of injured who arrived in that first hour.

When All Is Said and Done

Once the initial disaster has passed, the hospital is running at normal again and extra personnel have gone home or back to their regular shifts you would think you were done. But dealing with the aftereffects of such a community tragedy as happened at the movie theater takes its own toll on the healthcare providers.

To say that caregivers sometimes need counseling almost as much as the victims and their families is an understatement. Anyone who works in a hospital setting, or happens to be a healthcare provider on the scene of the events carries what they see and do with them for a lifetime.

There have been research studies and even the CDC addresses caregiver needs, not just victims’ needs, following public tragedies. Often, we as caregivers are not prepared for the post trauma stress. I know post traumatic stress disorder (PTSD) seems like a major term for people who are trained to deal with just such happenings but it can affect us too.

It is always good for a hospital or at least a department to have a post-disaster briefing. It is a good way to address problems that may not have been anticipated, to make plans for future emergencies, and to let everyone who worked blow off a little steam, take a deep a breath, and really face what happened, not just at work, but also in the neighborhood where you live.

None of us ever really want to have events like what happened in Aurora happen in our community. However, it is part of the package we sign up for when we come into healthcare. The paramedics, techs, nurses, doctors, and the rest of the staffs of the Colorado hospitals who cared for these victims are returning to normal now. But, what happened in their hospitals could just as easily happen in yours.

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