No U.S. hospital in recent history has cared for more gunshot victims at one time than Las Vegas’ Sunrise Hospital & Medical Center on the night of Oct. 1, 2017. For its physicians, clinical and nonclinical team members, first responders, and the entire Las Vegas community, the tragedy that night was beyond all comprehension. A culture of preparedness would serve the organization well, one it draws upon today during the global COVID-19 pandemic.
Sunrise Hospital & Medical Center is the largest acute care facility in Nevada. A 762-bed adult and children’s hospital, it is a regional center for tertiary care and features a Level II trauma center. It is the closest hospital to the Las Vegas Strip.
On Oct. 1, 2017, Sunrise Hospital’s senior leaders and staff received a page shortly after 10 p.m. during the Las Vegas Route 91 Harvest festival advising of a mass casualty. The number of victims and extent of injuries from the incident at Mandalay Bay Resort and Casino, just 4.8 miles from Sunrise Hospital, were unknown at the time. What followed tested the mettle of the Sunrise Hospital team, but they were prepared to rise to the occasion.
Ambulances, cars, pickup trucks and taxis flooded the Sunrise Hospital ambulance bay. Over 100 physicians and more than 200 nurses responded to assist over 240 patients arriving at Sunrise Hospital for care in a span of two hours. Over 80 surgeries were performed during the first five days (58 of those in the first 24 hours), 516 blood products were administered and 50 crash carts were deployed within one hour.
How does Sunrise Hospital bring order and stability in times of chaos and uncertainty? Strength, perseverance and hope. At every turn during its response, Sunrise Hospital staff displays these traits, benefiting its teams, patients and their families.
Communicating in a Sea of Fear and Uncertainty
Sunrise Hospital prioritized the flow of structured communication to families from the onset of the crisis. CEOs, physicians and nurses are empathetic leaders who are well-trained to share the most difficult of messages with families. The majority of the organization’s everyday family interactions are tight and contained. There are certainties: We know the identity of the patient and whether the EHR is accessible. Hospital and health system staff members are prepared with appropriate responses to family in the event of an escalating situation, yet 99.99% of those fall into the category of certainty.
Imagine, however, the uncertainty the shooting victims’ families experienced when they arrived at Sunrise Hospital desperately searching for answers, with no idea if their loved ones were at Sunrise Hospital or elsewhere in Las Vegas. Were their loved ones even still alive? Compounding the situation was the fact that many were unfamiliar with the city, its healthcare system or Sunrise Hospital.
To alleviate this uncertainty, the hospital organized ongoing updates for the families every 30 minutes, starting at midnight on Oct. 2. It shared information from its CEO and attempted to give families some sense of hope that their loved ones were alive and would be provided the best medical and traumatic care available.
Initially, 92 of the victims had no identification because clutches, purses and wallets were displaced during the attack. Our Incident Command Center team found answers using an old-fashioned approach: comparing families’ descriptions and photos to our team’s own visual descriptors. This process accelerated patient identification, with tattoos, piercings and even boots becoming definitive identifiers.
The Right Team at the Right Time at the Right Place
There are similarities between Sunrise Hospital’s response to Oct. 1 and COVID-19. Oct. 1 was a single point in time. One page and an hour later, 250 patients flooded the ED with an immediate crisis managed over an extended period. The global pandemic provided advanced notice of what we might be facing and the ability to plan for various scenarios spanning months.
Communicating and connecting with the Sunrise Hospital team throughout both events has been of paramount importance. Expressing gratitude to our team for being there at the right time is always mission critical. As the pandemic continues, we see a stress on the global supply chain, so ensuring our team has a safe and healthy work environment with appropriate personal protective equipment is a top priority.
Sunrise Hospital had the right team at the right time at the right place for Oct. 1. It all started with the hospital initially establishing a triage process in the ED that was similar to combat triage, enabling the hospital to provide immediate, lifesaving care for an unprecedented patient volume in the following ways:
- A physician experienced in tactical situations made an early decision to designate areas in the ED for specific care.
- ED and trauma physician leaders developed a strategy for stabilizing patients in the ED before immediately transferring them to other areas in the hospital per primary injury category. The hospital dispatched subspecialists to units housing patients requiring their expertise.
- ED and trauma physicians took the lead on the immediate triage of victims, directing them to appropriate areas.
- A trauma physician took the lead on surgical triage and directed surgical strategy.
- ED nurses rapidly reprioritized patients and initially engaged in the resuscitation of multiple patients until additional staff arrived.
- Leaders took a pause in care to organize a system response, a critical factor in maintaining control during the crisis.
- Paramedics and flight crews on-site supported Sunrise Hospital staff. The Sunrise care team used intraosseous infusion to more effectively and efficiently place IVs.
- Clinical staff self-dispatched to support the anticipated need at Sunrise Hospital and upon arrival, took on the role or task needed at that time.
- Pulmonary and critical care staff were available and engaged in ongoing care needs to leverage trauma team capabilities.
Sunrise Hospital also demonstrated many nonclinical strengths throughout the crisis:
- An experienced hospital team led the Incident Command Structure.
- Early in the crisis, the hospital established a family staging area to separate families from the clinical unit, allowing staff to ensure care for a large volume of patients.
- Ongoing updates at regular times helped manage families’ anxiety and expectations.
- CEO-led updates assured families that the top leader was addressing their concerns.
From the New York City Emergency Preparedness team to local EMS, the Federal Emergency Management Agency and multiple organizations, we have shared our crisis response best practices with the hope of helping others be crisis-ready. Sunrise Hospital recently opened a new, state-of-the-art tower, including a new, expanded trauma and adult ED and ambulance bay designed with many of the lessons learned from Oct. 1.
Today, we are seeing the same, unparalleled perseverance of our entire organization as on Oct. 1. The hope for our team, patients, community and our nation still runs deep in Sunrise Hospital’s veins. After a month or two following Oct. 1, the vast majority of our patients were discharged and the healing process began for our patients, staff and community. In contrast, we must prepare for the pandemic as an ultramarathon. We will be working with our patients and the clinical need for months, if not longer. The runway for recovery will be months or years for our nation and Las Vegas.
As of June 5, we discharged our 134th COVID-19 patient with more to come. Like Oct. 1, strength, perseverance and hope have served our team well. We remain forever #SunriseStrong.
Todd P. Sklamberg is CEO, Sunrise Hospital & Medical Center and Sunrise Children’s Hospital, Las Vegas, and an ACHE Member (Todd. Sklamberg@hcahealthcare.com).