Disasters—from wildfires, hurricanes and tornados to flu outbreaks and mass shootings—are unfortunately a part of life. During these difficult times, the benefits of a centralized approach to care emerge―and demonstrate how important planning and regular disaster readiness drills are. This type of preparation is tremendously impactful—especially when mere seconds can mean the difference between life and death.
Sandra Gonzalez, MSN, BSN, Trauma Program Director and Arturo Villalobos, RN, Administrator on Duty, know this firsthand—they were at work at University Medical Center of El Paso on that fateful Saturday last August when a gunman walked into a Walmart in El Paso and 22 lives were lost.
The team had done disaster drills and learned from other systems that had, unfortunately, experienced similar events, but never thought they would experience something like this at their hospital. In the first hour after the first call, the team received 14 patients, several in critical condition. The centralized approach they had implemented made it possible for them to identify open beds as patients arrived and place them as quickly as possible. Patients who came out of the ED or OR that day were assigned a bed immediately.
Every single person at the hospital came through that day and did whatever needed to be done to help care for patients—transporters helped with housekeeping; charge nurses went down to the ED and helped with IVs. The hospital and the entire community truly came together to create a sense of healing and peace.
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Arturo: My name is Arturo Vialogos, I am AOD, or the administrator on duty at University Medical Center, which was working bed accommodations on the day of the tragedy. My role was to make sure that everyone got to where they were supposed to get, keeping track of the beds and the patients. With TeleTracking, it was great, excellent tool to use is right before the tragedy we had our bed meeting at 9 o'clock that morning, so we were able to identify the projected discharges where we had opened the beds. At that time, we only had five open beds in our facility right before the tragedy. TeleTracking also is a great tool to use as far as communication. Through that I was able to get to the charge nurses and direct them where they needed to go, as well as keeping up to date on what was going on with the event and where they were needed. So we did utilize TeleTracking greatly for not only moving of the beds, but communication, as well, the day of the tragedy.
Sandra: Where we are located, everybody knows Juarez Mexico is just across the street literally, practically. In the last decade, it'd been the most deadly city because of the drug cartels and everything else. So when we hear active shooters and everything, it was always kept on the other side of the river. So El Paso is very safe. When we'd heard about all these shootings going around the United States, you need to prepare.
So we had some drills. We had one in October of 2018 in collaboration with the FBI and the multiple law enforcements and the scenario was an active shooter at the airport, and so we wanted to test our system and learning from other's experiences, the other trauma centers, they get a lot of patients that not only come in through the ambulance, but also private vehicles. I started making up patients that were just walking in, just to make sure we had enough blood bank, blood products and making sure we captured all the patients, getting them into the system and such. Then we had a tabletop exercise in March with an active shooter and learned opportunities with our communication. We had just implemented a HIPPA Bridge, I don't know if y'all are familiar with that, just to get the physicians involved in that home network of communication.
So when the event actually happened, the first alert came in at about 10:53 and it was just an active shooter with the address, unknown number of victims. So once in a while we hear about active shooters. So you go through the phases of the shock and denial, then our trauma medical director texted the CEO and myself that this was real and we still didn't know the exact number of patients. The fire chief from the scene, and I promised myself I wasn't going to cry, and the fire chief got to the scene and radioed in our ED charge nurse and said that there were at least 10 victims.
So within three minutes of that radio call, we received our first patient as a walk-in and he was escorted by an off-duty police officer. Three minutes later, another level I activation, just another level I activation. So within the first 11 minutes, we received six patients–pediatric and adults. Then, 11:23 is when we decided to activate the HICs, which is hospital incident command. And with events with an active shooter, we know from the scene police, it's usually over rapidly within five minute or so. So we didn't know how many exact number of patients. We didn't know if there were multiple shooters. So HICs was activated. We had 30 minutes to respond. By the time we got to the hospital, we had already received 14 patients by 11:36, so there was a huge surge and five of them, six, excuse me, needed to go urgently to the operating room. During this time frame, my battery power went from 85% down to about 30% because it was just nonstop, the communication.
So arriving to the hospital, there was security at all the hospital doors. We didn't think that we were necessarily in danger, but we need to traffic control. We had a golf cart with security offering rides to people to the emergency department. So I get up to the HICs command, and we had a debriefing. Again, didn't know if there were other shooters involved because the rumors start, and we have the social media.
So we had our first debriefing and we knew how many patients were in the operating room, how many patients were having to go to the ICU. Arturo here, very key role, he was one of the administrators on duty that really facilitated our ability to keep track of these patients on where they were going, from the ED, to the OR, to the ICU, or up onto the floor.
Also, patients they were walking in through the ED. All in all, we received 14 patients; 10 by ambulance and 4 walk-ins. We had a next debriefing at about one o'clock. Surgeons came up, and at that time we had a more definitive list of the patients that came in. About a quarter till three, the physicians were coming to me. I ended up serving as incident command, not by choice. They were just emotionally drained. We had the news up on in the HICs area, and it was difficult to concentrate on what was happening, the true events, because of the nonsense, the noise of the news that was going on, and then social media.
So, really having to focus on what resources do we have available, what do we need next, and how do we recover if another resurge of patients happen to come into our hospital. So we essentially deactivated HICs quarter after three and had our press conference at 4 o'clock. Then thereafter were definite lessons learned with the amount of news media that came in. And it was just amazing to see the donations that we received. By 4 o'clock, we had Chick-fil-A, pizza, Mexican food, people were just coming in and offering food for us.
Arturo: Just to touch a little bit on what Sandra said, as far as, as I said earlier, we only had five beds at that time right before the incident. At time of, when the patients were already coming out of OR, it was amazing to see how many beds had opened up and I know throughout these sessions, we talk about getting discharges out by 11 o'clock. So we started getting so many beds available when we had our after meeting, charge nurses actually brought to us that patients were voluntarily wanting to leave because they heard about the situation. So not only were patients, you know we heard about the community helping that externally, but even internally, the community was wanting, saying, "I don't need this bed, give it to someone who does need it.". So we were able to have so many available beds. So everyone that came out of the OR and the ER that day did not have to wait for a bed. Everyone was ready to move and assigned a bed within minutes.
Then to touch as far as on the preparedness, I know we do drills. Most of the time, you've probably all gone through it, people don't take it seriously, think it's a game. On that day it was so impressive to see everyone come through. We had transporters doing housekeeping. We had charge nurses all going down to ER helping with IVs and whatever was necessary, and other ones stepping up to do the charge nurse role. So it's just awesome to see the whole hospital come together, and the community.
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