People Killing People: Frequency of tragic events spurs mass-casualty healthcare mindset

ACTIVE SHOOTER: HonorHealth partnered in early August with multiple law enforcement agencies, emergency medical services, and other organizations to coordinate the largest full-scale emergency response drill in the healthcare provider’s history. (Independent Newsmedia/Arianna Grainey)

At some point over the next four months it is likely an active-shooter situation occurs on American soil — as in the first week of August — it has been widely reported there have been about 250 mass-shootings nationwide.

American places of worship, retail commerce and public education have become some of the most dangerous ground on planet Earth. However, the chances of a school shooting are 1 in 6.4 million and there is no need to be alarmed, experts contend, but emotionally, the statistics mean nothing.

The proliferation of mass-casualty events is spurring training in both the first-responder community — but now hospitals, local theaters and schools routinely participate in drills to prepare for the worst. (Independent Newsmedia/Arianna Grainey)

As of press time, there have been more mass-shootings than days in calendar year 2019. In all, since the most recent horrific events in Texas, Ohio and California, 62 human beings have lost their lives to a mass-shooting event so far this year.

Definable mass-shooting events appear to have started 37 years ago, according to Time Magazine, defining the event as an occurrence where at least three people are killed by gunfire on civilian ground during one period of time.

The seminal American periodical offers a 1982 incident in Florida where junior high school teacher Carl Robert Brown killed eight people inside a welding shop as its first data point.

Since then, thousands have been injured, hundreds of lives lost; and here in Arizona, public safety officials and medical professionals are finding ways to cope with horrendous realities.

Addressing the unimaginable

HonorHealth, a local community hospital and healthcare system serving 1.6 million people in the Phoenix metropolitan area, partnered in early August with multiple law enforcement agencies, emergency medical services, and other organizations to coordinate the largest full-scale emergency response drill in the healthcare provider’s history.

With more than 80 participants, volunteers, and support personnel, the comprehensive training exercise was held across all five HonorHealth Hospitals, including the Level 1 Trauma Center at the Scottsdale Osborn Medical Center, 7400 E. Osborn Road. The exercise tested active-response capabilities, coordination, and communications during mass-shooting emergency situations.

A Scottsdale police officer works through the mock carnage of a mass-casualty event resulting from an active-shooter situation. (Independent Newsmedia/Arianna Grainey)

“I came into healthcare from a career in law enforcement. I was on duty in Scottsdale, the day of the Columbine incident — that, for a lot of us, was a real awakening of a mass-shooter situation,” said Todd Larson, HonorHealth associate vice president of workplace and public safety.

“That is what put active-shooter awareness and training at the forefront of law enforcement duties.”

An employee of HonorHealth for just over four years, Mr. Larson comes from both a law enforcement and military background and is spearheading innovative private-practice solutions to handling the aftermath of a mass-casualty event.

“When you look at battlefield medicine, much of the medical injuries and or deaths are similar to those of a mass-shooting event. Extremity hemorrhage is a very common form of injury and cause of death in the military and the expansion of tourniquet use has saved lives,” he said.

— Todd Larson, HonorHealth associate vice president of workplace and public safety

Since 2015, the Scottsdale Police Department has outfitted its officers with tourniquets, which are devices designed to allow compression to Stop the Bleed while not halting blood flow.

“If a citizen is shot in the arm or leg, and if an officer can Stop the Bleed, that is critical in mass-casualty situations in the saving of lives,” Mr. Larson said of the national Stop the Bleed effort focused on educating and equipping first responders and citizens with tourniquets.

“Through our medical trauma training — and through the HonorHealth Military Partnership — we have learned battlefield medicine can apply to mass-casualty events. In the battlefield, medics will do these things under pressure and move people to the next level of care.”

It’s that next level of care, HonorHealth officials aim to improve.

“Unfortunately, these things are happening in our world and in the meantime, we are doing everything we can to prepare — the first responder community is prepared and is trained. But we should be educating and preparing our community,” Mr. Larson pointed out.

“Many times in a mass-casualty event most patients come into the Hospital in an abnormal way.”

Mr. Larson points out much of modern medicine hinges upon practices and procedures that move a patient from intake to service — in an emergency situation or not. But when a mass-casualty event occurs, those processes and procedures are quickly overwhelmed.

“A typical patient is hooked up to a monitor, may have medication on-board if they are in pain, or perhaps a splint or a bandage to Stop the Bleed and hospitals are used to receiving patients who are ready to be delivered to the next level of care,” he said. “But during a mass-casualty event many of the patients are coming in via patrol cars, the back of a pick-up truck like in Las Vegas — people are being quickly transported to the hospital.”

— Todd Larson, HonorHealth associate vice president of workplace and public safety.

The issue: At one time more than 15 patients could appear in emergency rooms seeking immediate care.

“No triage, no assessment and now the hospital — that creates a different level of problems,” Mr. Larson contends.

“When you have patients who don’t have an ambulance. We have to prepare for the surge of patients who are not coming in through standard procedure. When you are surged with 15 shooting victims and the hospital staff is not prepared, they are not ready to receive those patients.”

About 60 volunteers took part as victims in the August mock mass-shooting scenario. The “victims” were treated by various EMS entities and transported to five Valley HonorHealth hospitals, where hospital staff, nurses and doctors engaged in high-stress simulations that included multiple patient surges, blood shortages and the presence of possible toxic chemical agents.

“The Osborn Trauma Center was quickly surged with 20 patients. What we found that with the hospital’s electronic records system we overloaded the Internet in the ED because we didn’t have the infrastructure in place to handle simultaneous registration of all of those patients,” Mr. Larson said of a major takeaway.

The coordinated efforts of the multi-agency emergency response exercise brought together 11 public safety entities spanning much of Phoenix metropolitan area.

“The hospital end of mass casualty training is not as advanced as law enforcement,” Mr. Larson said of a key understanding gained from the August exercise. “I think the medical world is realizing how critical it is to partner with the first responder community.”

But Mr. Larson explains new procedures are being established in the event of a local mass-shooting scenario and every exercise operation improves readiness.

“I would say the input has already improved,” he said of positive outcomes. “This is the reason we do this. In a situation like this, how do we become more prepared?”

Scottsdale Mayor Jim Lane says, for him, the most important piece of public knowledge when talking about active-shooter scenarios is understanding how the law enforcement community will react to help alleviate the situation.

Knowledge is power

Scottsdale Mayor Jim Lane says the most important thing for him regarding active-shooter situations is what civilians are supposed to do.

“What would be good to know is how police and fire are going to react,” he said. “There have been at least one change in tactics because of some of things that have occurred most recently.

Scottsdale Police Chief Alan Rodbell says tactics are constantly changing.

“Unfortunately, in today’s climate our officers need to be prepared to respond to the unimaginable,” he said of the constant state of readiness achieved at the police department. “As a department, we are committed to providing them with the most timely and realistic training possible. That commitment carries over to the community we serve with training, programs and informational sessions to prepare them as well.”

Scottsdale Police Officer Kevin Watts reports training helps to ensure public safety.

“Training is paramount to the successful delivery of police services by any law enforcement agency,” he said.

“The Scottsdale Police Department is no exception, and we are committed to providing our officers with the most timely and relevant training possible. It goes beyond active shooter scenarios. As a department, we are continually reviewing and evaluating events and police responses to ensure that we are utilizing best practice in our delivery of all police services.”

The recent HonorHealth training was invaluable, Mr. Watts contends.

“First, it provided the opportunity for the multiple agencies and disciplines to work together in response to a potential real-world problem in the safety of a training environment,” he said.

“Lessons learned and working relations that were established will better prepare us all if we have to responded to such an event in the future. It also provided information to the public on what an event like this would look like and how police respond. Additionally, reality based trainings like this provide our officers with a level of stress inoculation not available in traditional training environments.”

A volunteer runs through the mock active-shooter exercise held recently in Scottsdale. (Independent Newsmedia/Arianna Grainey)

School safety top of mind

In February 2018, Northeast Valley News Editor Melissa Rosequist reported new Scottsdale Unified School District safety provisions contemplated in the wake of a six-minute massacre on a Florida school campus killing 17 children.

Then, there were about 23,000 students attending one of SUSD’s 29 campuses, and the priority of classroom safety was a topic of conversation at an early 2018 Scottsdale Unified School District Governing Board meeting.

In early 2018, the Governing Board approved several new security measures, including a button that would make the lockdown processes easier for employees and students in case of an emergency.

The safety of the American public school campus remains a point of debate.

An ongoing Washington Post analysis has found that more than 150,000 students attending at least 170 primary or secondary schools have experienced a school shooting on campus since the Columbine High School massacre in 1999, according to the Washington Post.

Coronado High School and three other Scottsdale schools will receive front office security upgrades. (Independent Newsmedia/Arianna Grainey)

The figure, which comes from a review of online archives, state and federal enrollment figures and news stories, is a conservative calculation and does not include dozens of suicides, accidents and after-school assaults that have also exposed youths to gunfire, the Post states.

“Our highest priority is student safety. We take this responsibility very seriously,” said Amy Bolton, a spokeswoman for the district, “We are continuously working to ensure that we safeguard students with the latest training, technology and tactics.”

Ms. Bolton explains security personnel and school resource officers stationed throughout the district are a first line of defense.

“The Scottsdale Unified School District’s chief security officer leads a team of security professionals stationed on our campuses,” she said. “In addition to this team, school resource officers are assigned to each middle and high school. Our partners in the school resource officer program are the Scottsdale and Phoenix police departments. We also work with the Town of Paradise Valley Police Department to ensure safety at our schools within its jurisdiction.”

On a site-by-site basis, Ms. Bolton says safety plans are in place.

“In addition to having a robust, all-hazards plan in place, each school has a site-specific security plan to cover any situation it may face,” she said also noting the digital webpages with general information available at the district website.

“Schools also regularly practice fire and lockdown drills to ensure that students, staff and campus visitors know what to do should an event occur. The schools are equipped with technology that assists school administration with conducting a lockdown and securing the campus.”

— Amy Bolton, Scottsdale Schools spokeswoman

Ms. Bolton says safety is woven into the daily fiber of all aspects of the Scottsdale Unified School District.

“From the moment students, staff and visitors walk onto campus, they are reminded of safety in various ways, including visitor identification and sign-in, access control, behavior standards and signage,” she said.

“Prevention and planning are a continuous mindset on our campuses. We constantly look for ways to ensure that we are poised to respond to any hazard. Our Student Services division is our partner in this effort to approach campus and student safety from a holistic perspective, including the social and emotional needs of students before, during and after any event that could be cause for concern.”

Independent Newsmedia Arizona Managing Editor Terrance Thornton can be contacted at tthornton@newszap.com

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