KK: Did you do any initial triage outside of the emergency department, or did you bring everybody inside to do that?
Explore This IssueACEP Now: Vol 37 – No 02 – February 2018
SS: Everybody was brought inside. We were fortunate that this was a Sunday night in Las Vegas. The ED volume was not like it would be on a Monday or Tuesday night, so we were able to put our active patients in certain areas to make room for the patients that were coming in. Initially, the MCI [mass casualty incident] triage was done by a physician. However, we needed physicians in the back to take care of the sicker patients, so we passed that on to one of the nurses out there to coordinate the MCI triage. A lot of things that I’m going to learn, I’m going to learn from Jeannine, from the patient’s perspective.
Station 1 was the area where we took care of all our “red” patients. Those were our most unstable patients with the most life-threatening injuries. Station 2 and Station 4 were for what we call our “yellow” or our “immediate” patients to resuscitate them and stabilize them there. Then we utilized our ambulatory care areas, our pediatric emergency department, and our PAC-U [post-anesthesia care unit] space [as Station 3] for what we call our “green” patients, which is kind of our “walking wounded.” We had that pretty well dialed in when the first patients started to arrive.
KK: Can you give us a sense of the spectrum of injuries that you saw?
SS: Most severe were gunshot wounds to the chest, abdomen, and also to the head.
KK: I have to credit you and others for your disaster preparedness plan and making sure everybody was ready to go. Do you think that plan was adequate?
SS: It was from an organizational standpoint, but there were a lot of lessons learned. We’ve practiced MCIs and even had a few MCIs, but nothing to this scale, so there are certain things that we ran out of. We ran out chest tubes and laryngoscopes. We ran out of ventilators at one point. We ended up having to put two patients on the same ventilator at one point. Sunrise is part of a three-hospital system, so we were able to commandeer level 1 transfusers, chest tubes, laryngoscopes, and blood products from our area hospitals in a matter of minutes.