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The Virginia Tech Shooting Lessons from a Multi-Casualty Event

The Virginia Tech Shooting Lessons from a Multi-Casualty Event . Sydney J. Vail, MD, FACS Medical Director Trauma Services Medical Director Tactical Medicine Services, Arizona DPS and MCSO SWAT The Trauma Center at Maricopa Medical Center Department of Surgery

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The Virginia Tech Shooting Lessons from a Multi-Casualty Event

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  1. The Virginia Tech ShootingLessons from a Multi-Casualty Event Sydney J. Vail, MD, FACS Medical Director Trauma Services Medical Director Tactical Medicine Services, Arizona DPS and MCSO SWAT The Trauma Center at Maricopa Medical Center Department of Surgery Div. of Burns, Trauma, Surgical Critical Care Phoenix, Arizona

  2. Disclosures • I have no real or perceived conflicts of interest or financial relationships with any product or company that is involved the practice of medicine or delivery of health care services • Just let my attorneys speak for me

  3. We Got No PhinancialDesclosures, ain’t that right? Yeah, right We poor, broke, not soup-orted by anybody or any dowg Hey ya’ll know he came from Virginia

  4. Objectives • Reveal strengths and weaknesses in a “mature” trauma system • Learn the limitations of the ‘best laid’ plans • Murphy’s Take on them • Understand what we did right and less right • Prevent the mistakes we made • What I would do differently next time

  5. April 16, 2007, AMJust Another Day in Trauma • GSW to head patient being transferred from Level III Trauma ctr. • Domestic issue in Virginia Tech dorm…by report • 2 victims • GSW to head, cardiopulmonary arrest on scene • GSW to head, alive and critical to Level III, 7:44am • Transferred to Level 1, arrive 8:30am • Local EMS called for our helicopter at 7:48am • 50-60 mph wind gusts grounded all helicopters

  6. THE Day: April 16, 2007 • 9:42 am: Norris Hall shooting call went out over police dispatch • WINDY: 40-65mph gusts recorded • 2 helicopters grounded • Bell 412 = 4 patient capability, EC-145 = 1 patient capable • Ground transportation slowed by gusts on highway • Two Level III centers instituted “disaster plans” • Opened their Emergency Operations Center (EOC) • Level I center utilized an internal plan to increase personnel and resources • Scene information was obtained from several sources • Most of it INACCURATE!!!! • 10:58am, report of 3rd shooting incident!!!!!

  7. THE Day: April 16, 2007 • Communication • Scene tactical medic and police • Scene EMS / cell phone and/or radio • Regional Hospital Coordinating Center • News Media • Level I had an EM physician and Trauma Surgeon coordinating cooperatively • Resources available in ≤ 30 minutes • 2-60 + potential victims reported • 2 ‘waves’ of victims reported (? 2nd shooter)

  8. Level I Internal Plan • 765 bed tertiary care facility • Available Surgeons • 5 trauma • 2 general • 2 vascular • 2 cardiothoracic • 2 neurosurgeons • 1 ENT • 9 surgical residents • 4 EM attendings • 4 operating rooms now • 4 more in 30 min. • 4 ICU and 12 PACU beds • 2 TRA resuscitation bays, 12 E.D. beds • 2 resupply personnel • 4 rads techs, 2 portables • Blood bank contacts regional Red Cross

  9. Triage • Initial at scene • FIRST: tactical medics inside Norris Hall • SECOND: EMS outer perimeter • THIRD: staging area • Secondary at two Level III centers • Supposed to be ‘filtered through’ the Level I • Check our capacity/capabilities before WE instruct to triage to non-Trauma designated facilities • This did not happen

  10. What You Saw

  11. What We SawNorris Hall #1

  12. Norris Hall Transfer #2

  13. Over-Triage • Critical mortality: patients who are admitted who are critically ill who go on to die • Critical mortality is directly related to proportion of overtriage • Did the ‘system’ react appropriately?

  14. Critical Mortality and Overtriage Frykberg: J Trauma 2001

  15. Overall Triage

  16. Good News • Importance of establishing and developing formal and informal relationships prior to event • Training • Funding • Capacity – without going to another level (region) another 50 patients could have been handled immediately • Timing of incident was optimal

  17. Bad News • Should have initiated FORMAL disaster plan • This gets us real time communication with RHCC and status reports from Web EOC • Regional communication: police/EMS depts. very difficult • Somehow patients ended up at non-trauma center without our knowledge • We had capacity and capability to spare • Mis-identified injured patients • Transferring facility told a family we had their daughter • We didn’t….. I spent 20 minutes figuring this out • No university personnel at our (any?) hospital

  18. Bad News • Failure to “lock-down” • Media played us • Could not communicate with other facilities • Offer advice, transfer acceptance, etc. • After on-scene triage, lack of regional coordination

  19. VA Governors Report • Chapter IX: EMS Response, page 110 • Hospital Response • “ The most significant challenge early on was the lack of credible information about the number of patients each expected to receive. The E.D.’s did NOT have a single official information source about patient flow. Likely explanations for this were -An EOC was not opened at the university -The Regional Hosp. Coordinating Ctr. did not receive complete information that it should have under the MCI plan.”

  20. What Did We Learn • Our regional disaster system worked ‘well’ • We can handle a multi-casualty event • Adverse weather conditions • Practice made it go right • We were not perfect • Our Incident Command system initiation would have helped • DEBRIEF and run it all again with more contingencies that are practical

  21. What Did We Learn • Figure out regional communications: ASAP • Scene intel or triage area communication • Web EOC • Tactical medics • Incorporate into your local L.E./EMS response system • save lives before regular EMS can get to patient • On scene accurate information • True medical/trauma perspective

  22. The News Always Gets it Right!

  23. My Personal Perspective • Have an internal triage system • Practice for ‘worst case scenerio (s)’ • Know your capacity and capabilities medically/surgically…NOT administratively • work out these details ahead of time…cooperatively!! • Minimize paper • Have a predetermined order sheet • Have an internal triage system that is reliable

  24. My Personal Perspective • Know, understand, and UPDATE your • Internal/external disaster polices & procedures • Activation of Incident Command System • Medical & ancillary Emergency/Disaster Credentialing/Privileging policy • Triage training & policies • Perform disaster/MCI drills !!!!!!!! • tomorrow would be soon enough

  25. My Personal Perspective • Don’t let ego, pride or your last successful disaster drill cloud your judgment of actual preparedness • We always default/fall to our lowest level of ‘excellence’ based on training during stressful times • ALWAYS think and practice for worst case scenerio

  26. My Personal Perspective

  27. The End Questions?

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