SCCM Resource Library-50 Shades Darker: Lessons Learned From 50 Years of Mass Casualty Events

Video Transcription

Hello, and thank you for joining us for 50 Shades Darker, Lessons Learned from 50 Years of Mass Casualty Events. I am Dr. Marilyn Bullock, and I am the moderator for this session.  Our first presentation is presented by Dr. Babak Sarani. It is entitled Experiences the Worst Teacher, History and Epidemiology of Mass Casualty Events.  Dr. Sarani is a professor of surgery and emergency medicine and is the chief of trauma surgery at the George Washington University School of Medicine.  He graduated from George Washington University School of Medicine and Health Sciences in 1997. He then completed his training in general surgery at George Washington in 2004.  And following this, he completed a fellowship training in trauma and critical care surgery at the University of Pittsburgh.  He began his career as an assistant professor of surgery in the division of trauma, emergency surgery and critical care surgery at the University of Pennsylvania.  He was recruited back to George Washington in 2011, where he is the founder and director of the Center for Trauma and Critical Care at the George Washington University Hospital.  His research interests include measurement of coagulopathy following injury, chest wall injury and reconstruction and processes to mitigate the risk of death following penetrating  trauma. So join me in welcoming Dr. Sarani. Hello. I'd like to begin by thanking the Society of Critical Care Medicine and the program  committee for the opportunity to speak on this topic. My topic will be the history and epidemiology of mass casualty events, focusing in really on mass shooting events.  By way of disclosure, I contribute to the Brady United Against Gun Violence and Every  Town for Gun Safety political action committees, and I am the chair of the Washington DC Regional Leadership Council for Brady United Against Gun Violence.  The objectives of my talk today will be to define public mass shooting, which you'll find actually does not have a uniformly agreed upon definition, discuss the incidence of  public mass shootings in the United States over the last 50 to 60 years, discuss briefly the characteristics of the shooter, him or herself, and lastly, spend a good amount of  time talking about the victims of mass casualty shootings, their wounding patterns and opportunities for rescue, and where do we come in as clinicians.  So what is a mass shooting event? Well, come to find out, there really is no universally agreed upon definition of what a mass shooting event is.  Generally speaking, when you look at the various different definitions that are used, they basically have these characteristics in common.  Three to four people shot in one location, not including the shooter, him or herself. Some people, some definitions state that it should be three to four killed, not three  to four shot. So you have to be a little bit careful when you look at the literature as far as how was that event defined, what were the inclusion criteria.  The purpose has to be killing alone. In other words, it cannot be secondarily due to a gang-related event, a botched robbery, et cetera.  It has to be killing for the purpose of killing itself. And then some definitions state that it has to be in a public location, like a mall or a public venue.  Other places remove that. The reason they stipulate that it has to be in a public location is to try to get away  from domestic violence, where maybe some individual kills his or her entire family and then kills him or himself or herself as well.  So the definition that is commonly used is four or more dead, not including the shooter, in a public location, and the purpose of the killing is killing itself, not a secondary  gang. When you look at the types of events that occur by number, what you find is prior to  1960, there really were no mass casualty events as we just defined them in the United States. One to two events per decade was kind of the norm.  However, starting around 1960, as you can see in this table, the number of events started to increase significantly, and with that, so too did the number of people killed, to  the point where by the 1980s, 1990s, there were a significant number of events. There was more than one a month, upwards of two and a half or so a month, and that number  dropped off in the early 2000s, only to then come back again, significantly so, over the last five or six years, and of course, in the last five or six years, we now have the  24-hour news cycle, where these types of events really became foremost in people's minds, and you could argue that unto itself led to copycat type events.  You could argue that this brought forth a public health epidemic that had always been there to some degree or another, but you can see that this has become kind of a common  event in the United States in the last few years, dropping off significantly once COVID-19 hit and social distancing was put into place.  Let's talk a little bit about the characteristics of the shooter. Well, firstly, they are almost always males. Very few have females.  When there are females involved, frequently they are accessory to a male partner. The majority are in their 20s, 30s, some in their 40s, and I think the last point is worth  mentioning. Whereas many in various venues have suggested this is mostly a Middle East Muslim problem, the simple truth is it is not.  The simple truth is, in the United States, the majority of mass casualty shootings occur by Caucasians.  There are others of other races and ethnicities, true, but the majority of the shootings occur by Caucasians. Now, let's spend some time talking about the victims.  The study that we did looking at autopsy reports, we started off with 61 public mass shooting events over the time period seen there, 534 victims.  We ultimately ended up doing a study that included 19 of these events with 213 victims involved.  When we looked at the autopsy results of these patients to ask the question, where were they  shot externally, head, chest, abdomen, where were they shot internally, liver, lung, heart,  and how many of them might have survived had they been taken to a trauma center expeditiously  as opposed to waiting until the scene is secured to allow the EMS providers to penetrate. What we find in this study is the vast majority of shootings occur to the extremity and to  the chest, with the second area being the head. Now, why is that? Partly because the victim, I'm sorry, the shooter is close to the victims.  The shooter's intent, as we already said, is killing. So he or she is going to go for shooting to center mass. They're going to try to aim for the head, chest, abdomen, the torso.  But of course, they may not be very great shots, and they're firing quite a few rounds, so the extremities are oftentimes hit.  But importantly, even though the extremities are the most common area shot, they are the least frequent source of death.  The majority of extremity woundings are to soft tissue or to bone. It is rare to have a shooting to a named vessel that could not be controlled.  On the other hand, when you look at the internal autopsy and you say, okay, what organs were  injured that might have resulted in survival if the person had been extricated expeditiously, you find by far the majority are the lung.  And these people died essentially of a pneumothorax. On autopsy, there was a wounding to the lung without concomitant significant hemothorax.  So one can only speculate that these patients died of a pneumothorax because they were left on scene and not extricated because the scene had to be secured first.  The poster child for this would be the Pulse nightclub shooting, where there were a number of people injured, but EMS was not allowed to enter the nightclub because of the shooter's  presence. And we're going to talk about maybe an opportunity for rescue with changes in EMS response paradigm in just a few slides. Let's look at the survivors.  What about the survivors? We just recently published a study. This study has now been accepted for publication in the Journal of Trauma and Acute Care Surgery.  We looked at 31 events, including 191 survivors of public mass shootings. And when we look at this, what we find is the organs injured by and large are skeletal.  And this is congruent with what we just mentioned about people who died from a public mass shooting event.  You'll recall the deaths were mostly due to gunshots to the head and to the chest.  That would be irreversible injury to the brain or mediastinal structures. You'll recall in that slide, the majority of injuries to the extremity were not fatal.  So similarly, when we look at the other side of the coin and we ask, okay, of the people who survived, where were they shot?  Not surprisingly, the majority were shot in the appendicular skeleton, i.e. the bones. And certainly those are not going to be fatal wounds.  The next up area was the chest, when the EMS was able to get to them fast enough to resolve essentially a pneumothorax.  And in this slide, we've broken it out by the Route 91 shooting, as opposed to the all other shootings, because the Route 91 event was such a huge event, it acts as an outlier  if you put the events together, Route 91 being the Las Vegas Mandalay Bay shooting a few years ago.  What if we now take the same thing we asked the question, do we need to have specific response paradigms only for mass shooting events?  Or can we just apply this knowledge across the board to all shooting events in the United States?  We did an autopsy-based study looking at people who died of urban-related violence, non-mass Cal shootings, in Washington, D.C. over a two-year time period, and we compared those  people to the autopsies we had from mass casualty shootings. So urban violence is dead in Washington, D.C. from everyday homicide, CPMS is dead from public mass shootings.  And what you find is there's very little difference, very little difference, in terms of the location of the shooting between these two venues. But why is that?  Because the shooter wants to kill the intended target, that's why, because the shooter was close enough, oftentimes almost always with a handgun, to aim for center mass.  So you see a lot of shootings to the head, a lot of shootings to the chest. There was a statistically significant difference in terms of the number of shootings to the  chest in public mass shooting events than in chest events. But clinically speaking, we're talking about the same thing, shootings to the head, shootings to the chest.  And so when we discuss opportunities for rescue, there really is no reason to have a different response paradigm for urban events as we do for public mass shootings.  And again, same methodology, looking at autopsy reports of the urban killed versus the public  mass shootings killed, and you see that the internal autopsy reports are essentially the same thing.  The majority of dead are due to gunshots to the head, gunshots to the chest, heart, liver, so on and so forth.  So the point being, most deaths in either environment, public mass shooting or urban, are instant. There's very little opportunity to rescue these people.  At least half, if not more, will die on scene no matter what. The people who do survive tend to survive because they're not that severely injured,  particularly in the public mass shooting events when we found that the injury severity score overall was reasonably low.  And so if we can get to these patients quickly, there's a good chance that they will be saved. I did not have the time to show you, but if you were to look at the publications, this  one was in the Journal of the American College of Surgeons by our group. We actually did a subset analysis of the type of weapon involved as stipulated on the autopsy report.  So if the autopsy report said it was a rifle, it was a rifle, handgun, handgun, shotgun, shotgun.  And what we found was the probability of death actually is highest, highest for people with a handgun as compared to an assault weapon.  And the reason being, the person with a handgun is close enough to be able to hit its intended target several times.  The assault weapon person is far away, the bullet by the time it makes impact has less velocity, and the probability of being hit multiple times actually was significantly  lower with an assault weapon than with a handgun. So if the assault weapon dies close to you, absolutely you're going to die.  But oftentimes they're not that close to you because they can't conceal their weapon.  And so the handgun person actually has a higher chance in total of killing the intended victims.  When we discussed opportunity for rescue, it's not just about putting on a tourniquet. In fact, the tourniquet will probably have less of an impact on mortality than other  interventions, including interventions on the chest, chest seals, intervention on the airway, turning the person on their side, opening their airway, routine BLS type interventions  than would an extremity intervention. Because as I said to you, there are very few deaths related to extremity wounds from gunshot  wounds as well, there are very few opportunities for rescue because there's very few deaths to begin with.  Thus rapid extrication of the victim may ultimately represent a better strategy and really should  be studied to change EMS response paradigm such that EMS is able to penetrate the scene more expeditiously and pull patients out very, very quickly.  And there's no reason to have a different response paradigm between public mass shooting events and urban events.  Now, there are some challenges to firearm-related research, and I put this up there. These are actual quotes that we received as we're trying to do our research.  One was, many states consider an autopsy report part of the medical record, and therefore they will not release it for research unless you have a valid court order, which is a  very, very high standard to set, particularly for research that's not funded. The second one was ourselves, though.  If you look at that second paragraph, that is a response we got from a major, major university in the United States that basically said, hey, I want to help you as a PI, while my  university is saying I can't because there is, quote, no direct benefit to my university. In other words, you don't pay me money, I'm not going to do it.  You don't want to put my name on it, I'm not going to do it. And the IRB in that university said, we can't put our name on it because of the political  nature of this thing, and because it's not funded, the university opted out. I think that is a real shame.  I think it's a real travesty that we are carrying as a medical profession, and this one is in our control. So with that, I will end.  I'd like to acknowledge the multiple people who have helped with all these studies. First and foremost, Dr. Reed Smith, who's an emergency medicine physician and a professor  at George Washington University, as well as Mr. Joff Shapiro, who is a paramedic and director of our emergency medicine operational program at George Washington.  They're the brain children of, they're the ones who came up with this. This is their brainchild.  And so as much as I have helped move the project forward, it really belongs to Joff and to Reed. Roger Mitchell is the medical examiner for Washington DC.  Our autopsy studies would have simply been impossible without his help. I'd like to publicly acknowledge his particular help as the chief medical examiner for Washington DC.  And then the multitude of GW residents and medical students who really did the lion's share of reading through all of these various records and helping us abstract and organize  them. And of course, for all the multiple multi-center studies that I mentioned, these would not  have been possible without the hard work and cooperation of my colleagues throughout the United States. I'd like to thank them as well. I will stop there.  And once again, thank the Society of Critical Care Medicine for the opportunity to present. Thank you.  Our last session, Roles of the Interdisciplinary Team and Resource Allocation during Mass Casualty Events will be given by Melissa Hockaday.  Melissa is the vice president and chief nursing officer for Indiana University Health in Indianapolis, Indiana.  Melissa has over 20 years of nursing experience in emergency medicine, trauma surgery, and surgical critical care.  She is also a practicing and board certified acute care nurse practitioner for the past 14 years.  During her two decades of healthcare experience, she has served in numerous leadership roles to advance the field of nursing, advanced practice providers, and trauma care.  Her previous leadership role focused on trauma system development and operational excellence for a large academic healthcare system.  Melissa obtained her baccalaureate and master's degree in nursing from Indiana University, and she's an active member of numerous state and national trauma nursing organizations  that focus on professional development, mentorship, and advocacy for nursing. She has served two terms as the past president for the Indiana Trauma Network for the state  of Indiana, as well as the Society of Trauma Nurses Board as the director-at-large for leadership for two terms.  She has published in Leadership, Geriatric Trauma Care, and Reducing Burnout in Trauma Centers. So, join me in welcoming Melissa. Hello, everybody. My name is Missy Hockaday.  I'm the VP and Chief Nursing Officer for IU Health Physicians here in Indianapolis, Indiana, and I'm going to be talking briefly about the role of interdisciplinary teams  and resource allocation during mass casualty events.  It's been really hard to think about mass casualty events other than COVID right now, but I'm going to do my best today. And so, I have no disclosures.  Objectives, we're going to apply new knowledge and strategies to optimize the care of critically injured patients as provided by the interdisciplinary teams during a crisis.  We're going to talk about utilization of clinical and non-clinical roles during a surge, and then we're going to talk about different nursing  or care delivery models during times of crisis or patient surges. And so, we all know what mass casualty incidences are.  It's basically when your healthcare system is overwhelmed by the demand of patients and exceeds your local resources, and that can be very different depending  on what environment you're in. If you're serving in a critical access hospital, three patients in the middle of the night with one doc and a nurse might exceed your resources.  If you're down at a level one trauma center, you might be able to handle eight to nine gunshot wounds at once on a Saturday night within a two or three hour period.  And so, it's really important to know what your local resources are, because that really determines if it's a mass casualty incident. It's very locally driven.  So, the types of mass casualty incidences are mass shootings, natural disasters, Indiana State Fair stage collapse is the one that I'm most familiar  with here in Indiana, and then bombings. And so, today we're going to talk about mass shootings in general, or mass killings.  And so, it's three or more people killed in one single event, and there's been two pretty recent events where we've had mass shootings, one in Las Vegas,  and then the Orlando nightclub massacre.  And so, we're going to talk about some of the timeframes here in the United States specifically, and there's been a lot of mass shootings outside of the United States.  But over the last 20 years, you can see all of the mass shootings and the number of people injured from those shootings and killed.  And so, I remember the Columbine High School massacre. I was actually working in the intensive care unit right out of college as a new nurse  when that one occurred, all the way to the Walmart shooting in El Paso, which was in 2019. So, those are some of the historic events who really defined how we respond  to mass casualty events and all the lessons learned that we've had from those incidences. And so, we're going to talk about resource utilization and using multidisciplinary teams  to respond during these events, but there's different types of events, just like we talked about, you know, the demand in your facility may be different depending on your resources.  The type of event really determines what type of resources you need as well. So, if we're talking about a mass shooting, which is mostly we're going to talk about today,  I mean, you have to have resource allocation in minutes, sometimes in seconds, and then sometimes over hours and potentially days depending on missed injuries  or take backs to surgery and things like that. Or we could talk about tornadoes and natural disasters where that could be a response  and needing resources within minutes versus days or a month, depending on the destruction, into what we're experiencing now, a global pandemic, where it started in Indiana in March  and we're still surging in November, and that's really where you have compassion fatigue.  You have difficulty with resource utilization because you've got team members out on quarantine. And so, we all know these events are very different on how we utilize resources,  and so that's really important to look at the different types of events as you're thinking about planning for each of these.  So, some of the big lessons that we've learned for mass casualty incidences or themes that we know are really, really important is leadership is critical.  Leadership needs to be frontline. They need to communicate well. They need to be visible. They need to be well prepared and to be able to adjust very quickly  to the rapid changes during an incident. You need to have alternate locations for surge capacity and planning. Are you going to have tents?  Are you going to expand your ICUs into your PCU areas? Or are you going to take a NICU and make it an adult space for ICU coverage?  So, it's really important to know where those surge locations are. And then staffing resource allocation, which is what we're going to talk about mostly today,  and how do you have people assume nontraditional roles? So, you know, if I'm a typical ICU nurse at the bedside and I need to be utilized  in the emergency room, what are those sort of nontraditional roles that we would use people for today?  And then another key theme that we've had from lessons learned is we have to take care of our staff, both mentally, physically, emotionally.  We have to care for the people who are caring for these patients. And we know that as leaders across the system.  So, now we're going to talk briefly about each type of category of team members and how you can utilize them.  And this is going to be a brief overview to just to give you some ideas when you think about planning for your institution, how you would utilize these team members.  And so, for example, if you are an academic institution, utilizing residents and fellows to serve as team leads, to serve in operating rooms, or be more procedural,  running through the intensive care unit to see who needs ART lines and intubations and central lines, who can identify missed injuries.  So, if you have a mass shooting, you're dealing with emergent life-threatening events. People are going to the operating room.  Well, we know that there are missed injuries identified. Maybe that person had some type of blast injury  and we've missed some orthopedic injury prior to managing hemorrhage control.  They can also help with tiered staffing models in your intensive care units. But I think it's really important that as we're using our residents and fellows,  knowing that they don't have a lot of experience with emergency preparedness and disaster response. And so, we really need to provide a lot of social, physical,  and emotional support for these team members. I know in Orlando, they learned that a lot of their team members  and their residents had post-traumatic stress from just the pure volume of patients, the high acuity, and so making sure that we have the right type of support  around those team members is critical. The next is our advanced practice providers. And I'm an acute care nurse practitioner,  and my clinical background was emergency medicine and trauma care. And so, during mass casualty incidents is thinking  about how you can utilize your advanced practice providers to lead teams with residents to really manage vents, to manage drips, to manage massive blood transfusion,  assessing ratios, and making sure that patients are getting the products they need. During this pandemic, we used our anesthetist, CRNAs,  and certified anesthesia assistants to run ventilators and do respiratory treatments because we all know during the pandemic, respiratory therapists were at short.  We were short respiratory therapists. And then serving in non-intensivist roles where you're really letting the APPs help you be the liaison  with families and documentation and order entry, missed injuries and delayed injuries, to really be a leader of a team is really important.  So, utilizing those resources really well, making them part of your planning committee.  You all are very familiar with this, the Society of Critical Care Medicine's tiered staffing strategies, specifically for the pandemic where you've got a trained intensivist  and you've got other non-intensivists who are leading teams to really expand how many patients one intensivist can care for by utilizing advanced practice providers,  residents, fellows, anesthetists, ICU nurses, and non-ICU nurses for care team models  so that you can expand the number of people that you can care for in the ICU as we're expanding the number  of beds where we're putting ICU patients, we have to have the resources to care for them.  And we all know we don't have more intensivists, and so we have to be creative about this model.  And this applies for mass shootings as well as it does for the pandemic that we're going through right now.  I think an area that we really forget, a care team member that we forget to involve in disaster planning is our pharmacist. These individuals are critical.  You know, they are experts for medication administration, delivery of medications, tracking of medications.  I think they can be critical in massive blood transfusion and resuscitation and really keeping track of the ratios that we're giving patients during mass shootings.  And then really thinking about, you know, how do you incorporate the pharmacy residents into our plan  and making sure that they're part of your response so that there is a disaster call tree  so that we can get more resources into the hospital of these critical team members during an event  and having more people in the ICU in the emergency rooms, making sure that we're giving the appropriate medication, helping with airway management, stabilization.  It's just critical when there's a lot of stress having somebody who can just focus on medication administration. So making sure that you're involving these key members on your team.  The last is the nursing response. And, you know, I think a lot about, you know, how do we utilize our nurses?  And we think about, you know, nurse patient ratio and scope of practice and nurses that are ICU nurses staying in the ICU and nurses who are in the ED staying in the ED.  But when you have a mass casualty event, either a mass shooting or a pandemic, you really need to think about utilizing all of your resources.  And so thinking about, you know, administrative nurses. You know, we've used a lot of our clinical informatics team to really be critical in our ICUs right now  to staff our virtual screening hubs. So thinking about who else can we utilize, especially if you have a prolonged period of time where you're going to need a lot of resources.  Centralized staffing pools is really important so that you know what people's clinical experience is and what their availability is.  Putting nurses in specialty pods. So, you know, if you're going to be having people in the intensive care unit during a mass shooting,  you might want to staff everybody in your trauma surgical unit. But if we're talking about a COVID pandemic event, then we have COVID units or respiratory units  where we have specialty pods of nurses who can care for those patients.  Really important, we have to think differently. We can't think like we always do. We can't do things like we always have done during a mass casualty event or a pandemic.  We need to think about what can we do to make sure the patients are safe and reduce work burden for team members.  So we have to look at documentation, reducing documentation burdens. We have to chart by exception.  We have to think about, you know, getting out of our comfort zone and maybe learning a new skill and being able to do things that we haven't done before, which is really important.  You know, the nursing role during a mass casualty event or a mass shooting is really important.  I think decompressing the emergency room, you know, those, our nurses really help with workflow and making sure that we get our ERs decompressed so that we can get new patients,  making sure that our operating rooms are not doing elective cases so that we can be ready to respond  to people who really are in hemorrhagic shock and need to go to the operating room.  We need to hold transfers. You know, I think a nursing leader who's really looking at our transfer center and making sure  that we're not accepting non-critical patients as we're dealing with a mass casualty event,  working with our physicians to rapidly discharge patients either from our ICUs so that we can have beds available or discharge home so that we really have the capacity to handle  an immediate crisis, making sure that our patients are being cared for in the appropriate area.  And then critical is safety and security and restricting visitors during this time  and ensuring we have crisis debriefing after the post-event for all team members, not just nursing.  We talked a lot about the nurse's role and the physician leadership role in managing surge.  Really have to ensure that you have appropriate bed capacity. We have alternate spaces for people and expanding the number of critical care beds  or emergency room beds when we have a mass casualty event. It takes a lot of training, a lot of prepping, a lot of surge planning prior to the event so that you know where  you're going to open up more spaces prior to when the event occurs.  A really important concept and I showed you the model from SCCM is really thinking about tiered pyramid structures and we do this in nursing and we're actually doing this now in  our intensive care units. We only have so many nurses who are ICU nurses and so if we surge  with critical patients, we have to think about how do we go to these tiered nursing models where  we have an ICU nurse lead but we may have a PCU nurse or a med surge nurse or an outpatient nurse  on that care team helping with the non-critical care tasks so you know baths and medication  administration and documentation and family liaison. Why the critical care nurse is really managing the vent, the pathophysiology, ensuring the patient is safe. So really important  concepts and you can see on this slide you know the ICU nurse really focuses on the vent management and then the non-critical care nurses in that secondary role manages non-critical  functions and they work as a team to care for more patients and so really important concept  that has worked for us during this pandemic and really allowed us to care for more patients.  To have flexible care teams, it's really important to ensure that you all have shared goals. The  goal is to care for as many patients as you possibly can. The people understand this is a  pandemic and we have to do things differently or you have a mass shooting and you know that we have  to respond to more patients than what we have normally responded to. You have to have clear  roles and responsibilities and be able to delegate to team members mutual respect, high levels of  communication because you have an interdisciplinary team who have not worked together before so it's critical that you guys are communicating well with each other.  And so the next slide here just emphasizes the role of palliative care.  We all know that this is an important service that's in our inpatient  spaces right now and we need to ensure that we're using this team to help us with patient and family psychological and emotional support, making sure that they're helping us  with aggressive management of symptoms for patients who may succumb to their injuries.  And then chaplain and social workers and I think these guys are most important not only for our  patients and our families but for us. Really helping us establish family assistance centers  where family members can go, we can care for those family members, we can help them with coping,  we can help them with identifying the victims because we know if there's a mass shooting  we may not be able to identify victims, we may not know what hospital they were transported to  and so our chaplains and social workers can run that family assistance center and then ensuring that our team members are cared for with basic needs, water, food, overnight stay,  showers, scrubs, whatever they need so that they can still care for patients.  And then critical to teamwork and collaboration is planning. We all know that we need to plan, we need to debrief our plans, we need to practice our plans, we need to drill,  we need to reflect back after every event and that is root cause, you know, analysis after action reports, trying to figure out what we could do better the next time this occurs,  communicate clearly and manage risk. Really important to ensure high levels of teamwork  and collaboration. So in summary, just some brief key takeaways. The type of event is critical.  You need to know if it's a mass casualty event versus a 12-month pandemic, you're going to need  different types of resources. Knowing what your resources are is important. Preparing and drilling  with a multidisciplinary team and ensuring that everybody is part of that plan, pharmacy, nursing,  physicians, your residents, your social workers, your chaplains. Teach your teams to be flexible  and willing to perform jobs outside of their standard duties. Be creative on identifying  resources, ensure strong backup plans, especially when you know people are going to be out sick,  which is what we're dealing with now or may have been involved in the event if there's a natural  disaster. Team member well-being is critical and then teamwork and collaboration makes an  effective team and that requires drilling after action reports and high levels of communication  to ensure strong collaboration and interdisciplinary teamwork in a mass casualty event.  So thank you very much today. I appreciate your attention to this session. I'd like to thank all  the faculty for their outstanding presentations today and thank you for attending us in this session. We hope you enjoyed it. We look forward to seeing you next time. Goodbye.

Video Summary

In this video transcript, Dr. Babak Sarani presents on the history and epidemiology of mass casualty events, specifically focusing on mass shooting events. He discusses the definition of a mass shooting event and the increase in the number of events and fatalities over the years. He also highlights some characteristics of mass shooters, such as their gender and age. Dr. Sarani then talks about the patterns of injuries seen in mass shooting victims, both externally and internally, and the opportunities for rescue in these situations. He emphasizes the importance of rapid extrication of victims to improve survival rates. Dr. Sarani concludes by discussing the challenges of firearm-related research and the response paradigms for mass shootings and urban events. In the second presentation, Melissa Hockaday discusses the roles of interdisciplinary teams and resource allocation during mass casualty events. She emphasizes the importance of leadership, alternate locations for surge capacity, and taking care of the mental and emotional well-being of healthcare professionals. She also discusses the role of different team members, such as residents, advanced practice providers, pharmacists, and nurses, in responding to mass casualty events. Hockaday highlights the need for tiered staffing strategies and flexible care teams to optimize patient care. She also stresses the importance of planning, drilling, and collaboration among healthcare professionals.

Asset Subtitle

Crisis Management, Trauma, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Compare and contrast methods used to triage multivictim casualties that might exceed available resources
Prioritize resource allocation to optimize outcomes in a mass shooting situation
Discuss comprehensive training and preparation methodologies for ensuring performance and deliberate practice during a mass casualty event

Experience Is the Worst Teacher: History and Epidemiology of Mass Casualty Events
Babak Sarani

Roles of the Interdisciplinary Team in Resource Allocation During Mass Casualty Events
Melissa Hockaday

Meta Tag

Content Type Presentation

Knowledge Area Crisis Management

Knowledge Area Trauma

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Evacuation

Tag Staffing

Tag Resource Allocation

Year 2021

Keywords

mass shooting events

fatalities

mass shooters

patterns of injuries

rapid extrication

healthcare professionals

patient care

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