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Local Tragedies and the Impact on Hospitals

Local Tragedies and the Impact on Hospitals

Friends and colleagues, 

The tragedy in Las Vegas hit close to home for me, both personally and professionally. As most of you know, I live in Las Vegas. My family is there. We drive past the Mandalay Bay Hotel several times a week. My daughter is a country music fan who usually goes to the festival that was attacked. Thankfully, she wasn’t there that night, but several of her friends were, and one was shot in the arm. Like everyone across the country, I grieve for those who were killed and injured, and I am thankful for those who were saved by the dedicated staff at area hospitals.

Earlier in my career, as a hospital CEO, I led the planning process for setting up trauma centers. I know from experience that planners consider how many trauma centers are needed in an area to meet Level I, Level II, and Level III standards. They consider staffing levels – the number and types of surgeons needed, how many doctors and nurses need to be on site and on call at any given time. They consider how many ambulances are needed, how many EMTs, and how many helicopters can be landed at once. They try to balance the cost of providing services at a moment’s notice against the need and arrive at a model that services the public good at a reasonable cost. 

Planners try to prepare for a large-scale incident with many casualties, such as a 30 car pileup on the highway or a plane crash. But who could envision a mass shooting with 500 victims?  

According to MSN, these are some of the challenges Las Vegas hospitals faced:

  

  • • University Medical Center’s Level I trauma center saw over 100 patients, most with gunshot wounds. Thirty were in critical condition. All but one survived.
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  • • Nearby Sunrise Hospital treated over 200 patients in 3 hours, more than they usually see in a day. 
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  • • Patients needed to be triaged – red tags for the most critical, green tags for those who were stable. Patients waited on gurneys, shared beds, even sat on the floor.  
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  • • Victims were brought to the hospital by ambulance, SUV, and pickup truck. They kept coming for hours.
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  • • The trauma center was fortune to be able to call on four visiting Air Force trauma surgeons to treat bullet wounds typical of combat situations.
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  • • Surgeons conducted as many as five operations at once. Anesthesiologists were involved in two dozen surgeries or more before the crisis had passed.  
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  • • Pediatric trauma surgeons operated on adults. Obstetricians tended to gunshot victims.
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  • • Doctors and nurses spoke of slipping on bloody floors, and the smell of iron in the air.
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  • • There weren’t enough X-ray machines. The hospital ran out of chest tubes and had to call another hospital to resupply them.
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Gunshot wounds from a high powered rifle are devastating and exceptionally difficult to treat. Even a small entry wound can shatter bones or shred internal organs. That there were only 58 deaths in this mass shooting is a tribute to the great work of the Las Vegas community, which came together to care for the wounded, and the medical professionals who worked tirelessly and in difficult conditions to make sure everyone got the best care they could deliver. 

The lesson hospitals should take from this tragedy is that it is important to be prepared for the worst, and have a Plan B, Plan C, and even a Plan D. Prepare for what can be imagined, and what cannot be imagined. Know what resources are available within the hospital and beyond, within the community and the region. Unfortunately, we cannot prevent every tragedy, but as the people of Las Vegas showed us, we can rise to any challenge and deliver life-saving medical care in the most difficult of circumstances.

Sincerely, 

Bob Erra  
 

Bob Erra

Bob Erra joined Integrated Healthcare Strategies, a division of Gallagher Benefit Services, Inc., in 1993 and served as managing director of the Physician Services practice for 10 years.  He became President of Gallagher MSA in 2003, and was appointed President of Gallagher Integrated in 2007.  Mr. Erra has also served as Chief Financial Officer and later appointed Senior Vice President and Chief Operating Officer and member of the board of governors at Scripps Clinic and ...

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