Natural disasters, like Hurricane Harvey, and human-made ones, like the Las Vegas massacre, have long prompted hospitals to evaluate their preparedness and ability to handle hundreds of patients in a crisis.
“From the perspective of mass shooting, it’s unfortunate but we’ve learned a lot, mostly around the types of injuries because these are military-grade weapons that are being used and they are incredibly high-energy and destructive,” said Dr. Richard Zane, chairman of emergency medicine at the University of Colorado School of Medicine.
Dr. Zane was part of the team at UCHealth University of Colorado Hospital that treated patients in the immediate aftermath of the 2012 theater shooting in Aurora, Colorado, when a shooter killed 12 people and wounded 70 others.
Sunday night’s assault on concert-goers in Las Vegas has tallied at least 59 dead and 527 wounded — the deadliest shooting in U.S. history.
The two hospitals closest to the scene prepared to receive gunshot victims — University Medical Center of Southern Nevada and Sunrise Medical Center — are Level I and Level II trauma centers, respectively.
A Level I center can provide care for every aspect of an injury from prevention through rehabilitation, and a Level II facility can initiate care for injured patients, according to the American Trauma Society (ATS). The society advocates for trauma care and prevention programs.
ATS Executive Director Ian Weston said that his organization has been working to increase high-level trauma centers in the central-western U.S., which has fewer compared to other major metropolitan areas and regions.
“Nevada is an area that is not heavily resourced with trauma services. Las Vegas only has two trauma centers, and your next closest you’re going to is California and some other surrounding states,” Mr. Weston said.
“It’s unfortunate that Las Vegas suffered this critical incident without having more than two or three facilities that are appropriately capable of treating gun shot victims or serious penetrating trauma,” he said, adding that issues like staffing, reimbursement and general capacity are hurdles in establishing more trauma centers.
The trauma centers are equipped to handle high-volume and complex injuries, of which gunshots are among the most unpredictable. According to the Centers for Disease Control and Prevention, more than 33,000 people died from injuries sustained from firearms in 2014.
“The general nature of gunshot wounds is that it’s probably one of the most complex types of injuries to treat, primarily because to some extent, without opening a patient up, they truly don’t know the true extent of the damage a bullet causes,” Mr. Weston said.
Last week, House Majority Whip Steve Scalise returned to Congress after having been shot 2 1/2 months earlier by a sniper at baseball practice in Alexandria, Virginia. Mr. Scalise told CBS’ “60 Minutes” that the bullet shattered his femur and damaged his hip and pelvis. He had lost 50 pounds and had to relearn to walk.
“Depending on where that bullet enters and the direction it travels, it can be an easy repair to many multiple, hour surgeries,” Mr. Weston said. “We’ve seen gunshot wounds that go through arms that are patched with a couple of sutures and they’re ready to go the next day.”
He said hospitals and emergency personnel have been evaluating preparedness for hundreds of patients, rather than dozens, in the aftermath of the 2103 Boston Marathon bombing, the 2016 Orlando nightclub shooting and this year’s hurricanes — Harvey, Irma and Maria.
“I think that’s a conversation that’s already occurring. Regardless of what transpired this morning, it’s something the hurricanes prompted and even before that. As we continue to look at these reports and continue to evaluate our own internal plans in cities and facilities those capacity numbers are going to have to be questioned or reevaluated,” he said.
But equally important to having personnel and resources ready to react to an emergency is long-term follow-up and in particular, psychiatric and mental health care. Dr. Zane said that this is one of the important lessons they gleaned from Aurora.
“The important part is realizing that what you just went through is not normal and there isn’t an expectation that you can simply forget what you just saw,” he said. “If you think you need help, and then it’s our job to be able to provide different types of help, because different people need different things.”
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