Acting on Instinct

By David Thill

Solid preparation helped Orlando Regional Medical Center respond to the nation’s deadliest shooting. Supply chain played a key role.

At 1:57 a.m. on Sunday, June 12, 2016, in Orlando, Fla., the first shots were fired in what would become the deadliest mass shooting in U.S. history. It would leave 49 people dead and more than 50 others injured.

Thanks to plenty of training on how to respond to such events, the staff at Orlando Regional Medical Center (ORMC) – Central Florida’s only Level One Trauma Center, located just half a mile from Pulse nightclub, the site of the shooting – navigated through the emergency efficiently and effectively, its leaders report.

“The good news is, we found we did more things right than wrong,” says Randy Hayas, chief supply chain officer at Orlando Health (ORMC’s parent network), following a review of the night’s events.

‘People were carrying patients in’
Because of the medical center’s proximity to the club, patients arrived not only in ambulances, but in patrons’ vehicles as well. “People were carrying patients in,” says Hayas, noting that staff had almost no notice.

The first patient arrived at the hospital at 2:14 a.m., less than 20 minutes after the shooting began. Just after 3 a.m., a wave of 36 patients arrived, prompting ORMC President Mark Jones to put into effect the Hospital Incident Command System – that is, its procedure for mass casualties greater than 20 traumas. Around 5:15 a.m., 11 more patients arrived.

In total, says Hayas, ORMC treated 44 victims. Three remaining victims with less traumatic injuries were treated at sister hospitals. (Nine of those 47 patients died.) By 11:30 a.m. on June 12, six patients had been discharged, and surgeons were performing operations on the remaining ones, several of whom were in serious to grave condition.

The importance of drilling
“It’s about being prepared,” says Hayas, who emphasizes the importance of conducting hospital-wide drills to prepare for mass casualty situations. He says, “We hate the guy who makes us do the drill – but we really appreciate now that he made us do that, because we could react on instinct. We knew what to do.”

Orlando Health conducted its first mass casualty drill in 2010; its most recent one was in March 2016, three months prior to the June shooting. Hayas says that the administration and staff take these drills very seriously. “We actually do them,” – not just discuss them. Each drill lasts about eight hours: two hours prior to go over the procedure, four hours to run the procedure itself, and two hours afterward to review the drill.

Even then, he notes, every real-life situation is unique. In the case of the Pulse shooting, almost all the patients were treated at ORMC, whereas in the drill scenarios, patients are treated and transferred between hospitals across Central Florida.

On top of that, ORMC is so close to the club that emergency vehicles and hospital staff arriving at the hospital had to maneuver roads closed due to police response. In the chaos of the situation, families were coming to the hospital for loved ones who were still at the club. For those patients at the hospital, staff had to be careful about violating privacy laws while trying to connect them with their loved ones. What’s more, Pulse had hosted a “Latin Night” that night, meaning many of the families spoke Spanish, creating a language barrier.

But even with those unpredictable factors, says Hayas, the drills were vital in executing an appropriate response. “We knew what had to be done. Not only were we prepared, but we knew how to react.”

He notes several other factors that contributed to the overall smooth response on the morning of June 12. Chief among them is the fact that ORMC is a trauma facility, so “we’re geared up … better on the supply chain side.”

ORMC’s central supply department is located 50 paces from the trauma center, he says, and is staffed 24 hours a day, so staff could respond to emergency and surgical supply needs immediately. The supply department is continuously stocked and restocked in order to be prepared for trauma events, and orders from the nearby consolidated services center arrive at night. For those reasons, the trauma center was freshly stocked at the time of the shooting.

Dealing in the aftermath
Even with the preparation that Orlando Health had, dealing with trauma of this magnitude takes its toll. Hayas describes driving to the hospital that night and calling colleagues to inform them of the situation. Many checked their televisions to make sure what they were hearing was true.

“These calls were coming in the middle of the night to people, and they weren’t sure if they were dreaming – if this was a nightmare or if this was reality.”

Staff already onsite had to deal with a stream of incoming victims. Because it was an evolving situation, they didn’t know how many victims would arrive, nor did they have the usual advance warning that comes with shooting incidents.

“These people were three blocks away. They were showing up at the door,” Hayas explains. “You don’t have that five to 10 minutes to process what’s happening.” As a trauma center, ORMC staff are used to seeing gunshot wounds, “but we’re not used to seeing them in this quantity.”

The hospital enlisted its chaplain counseling services to counsel staff for the remainder of that day, but quickly realized they would need additional support for a much longer period of time. In all, says Hayas, 1,200 team members used counseling services in the aftermath of the shooting. Those individuals ranged from first responders and surgeons onsite at the time of the event, to those with connections to victims and families, to those who felt guilty because they were unable to be present at the time.

Hayas says the impact on staff cannot be understated, adding that Orlando Health Chief Executive Officer David Strong waived the out-of-pocket medical expenses for victims treated at the health system’s hospitals. (Daryl Tol, president and CEO of Florida Hospital in Orlando – where 12 other club patrons were treated – did the same for patients at that facility. Together, the two organizations waived an estimated $5.5 million in medical expenses.)

Even at press time, six months after the shooting, Hayas says, “people are still dealing with it.”

‘It’s not just about having a manual’
After the event, the Orlando Health administration agreed that staff had responded quickly to the situation, says Hayas. “Our planning was spot on.”

Speaking at a news conference, one of ORMC’s surgeons said that every time he needed supplies, they were available and ready. Hayas attributes this strong performance by supply chain staff to proper preparation and drilling prior to the event.

“It’s not just about having a manual,” he says. “You want all of your team to do this by instinct.

“It’s not just the manager of the department. It’s the people onsite, because the manager of the department is not going to be there at 2:00 a.m. on Sunday morning ….You need the individual who is onsite at that moment to be totally engaged, totally prepared, and dedicated.”