When Disaster Strikes: University of Colorado Hospital’s Response to the July 20, 2012, Aurora...
Preview:
Citation preview
- Slide 1
- Slide 2
- When Disaster Strikes: University of Colorado Hospitals
Response to the July 20, 2012, Aurora Shooting Patrick M. Conroy,
EMT-P, MS, ACHE
- Slide 3
- No matter what lessons we ultimately learn from this tragedy,
it is absolutely clear that the overall response from the entire
University of Colorado Hospital family was nothing less than
extraordinary.
- Slide 4
- Facility Information Current facility is Level 2 Trauma center
Currently licensed for 551 beds (407 beds on July 20 th, 2012)
Additional 14-story tower opened this year Entirely new Emergency
Department is now open 34 rooms plus hall beds to 77 rooms 23,000
square feet to 56,000 square feet
- Slide 5
- UCH Overview Only academic medical center in the region 27,000
+ annual admissions and growing 800,000 + outpatient encounters and
growing 73,000 annual ED visits ADC of 20 inpatients daily (On
7/20) Over 6,000 staff and faculty Magnet status for 10 years 2011
and 2012 UHC Quality Award winner #1 hospital in Denver US News
& World Report Part of UCHealth PVHS/ Memorial
- Slide 6
- Facility Information UCH is a quasi-governmental hospital
authority UCH is co-located on the Anschutz Medical Campus with the
University of Colorado Denver Campus and Children's Hospital
Colorado School of Medicine School of Nursing School of Dentistry
School of Pharmacy
- Slide 7
- The University of Colorado Hospital Emergency Department July
20, 2012 1 STARR room with two beds 34 rooms (red, green, yellow)
10 regular hall beds 1 ENT room 2 minor casualty rooms
- Slide 8
- The State of the Department July 20, 2012 49 patients in the
emergency department 25 patients currently admitted without an
available bed in the hospital (boarders) 11 patients in the waiting
room 2 patients ESI level 2 8 patients ESI level 3 1 patient ESI
level 4 On divert (placed on divert at 1900 on 7/19/12)
- Slide 9
- Brief Pre-Hospital Course 0030 0039: First 911 call 00400100
0054: Request to transport victims by police car 0049: First
patients to Aurora South 0050 0055: Request notification of all
hospitals 0041: First officers on scene Full emergency department
with a full waiting room 0056: Notified of 3-5 GS victims likely to
ED 0101: First patient arrives at University Hospital
- Slide 10
- Incident Timeline 01:01First patient is taken from private car
Patient describes to staff the scene in Theater 9: gas canisters
black clad gunman shooting screaming Patients arrived as war
casualties instead of usual ambulance condition 13 by APD 3 by EMS
7 by private vehicle or other
- Slide 11
- Organized Chaos
- Slide 12
- MCI preparation begins: -Call for blood -Prep STARR rooms -Call
by Dr. Kim to general surgery of possible MCI -Dr. Kim (R2) to
STARR B -Dr. Mackenzie (R1) to STARR A -Dr. Johnson (R3) to doorway
of STARR rooms MCI preparation begins: -Call for blood -Prep STARR
rooms -Call by Dr. Kim to general surgery of possible MCI -Dr. Kim
(R2) to STARR B -Dr. Mackenzie (R1) to STARR A -Dr. Johnson (R3) to
doorway of STARR rooms Emergency Department Course 0100011001300120
20sF, private vehicle, GSW ext, hall 1 4mM, private vehicle,
dropped, hall 1 Teenage M, police, GSW to head, STARR A 30sM,
police, GSW to torso ext, STARR B Teenage F, police, GSW head, hall
2 20s F, police, eviscerated abdomen, STARR A2 20s F, police, GSW
bil ext and face, hall 6 18F, police, GSW LLE, hall 3b 20s F, ran,
GSW ext triage Unknown Age F, police, GSW head 20sM, police, GSW to
head, disaster area Teenage F, police, GSW to neck, disaster area
Teenage M, police, GSW torso/ abdomen, STARR B1 14 M, EMS, GSW
lumbar back, hall at room 15 40s F, police, GSW upper and low ext,
no pulse ext, hall room 4 Teenage F, police, triage, mult abrasions
20s M, EMS, GSW upper and lower ext, hall 3a 30s M, EMS, GSW R
chest, hall 6 30s M, EMS, GSW R chest, hall 6
- Slide 13
- Incident Timeline 01:05Administrator on-call, CNO and CEO
notified and en route to hospital 01:25Hospital incident commander
position filled; initial coordination done from the ED 01:30House
manager alerted OR and PACU 01:31Internal call-down lists activated
in OR, PACU, inpatient units and support departments
- Slide 14
- Emergency Department Course 0130014002000150 30s M, private
vehicle, with GSW hand, hip pain, triage Plan-D initiated -internal
disaster command center -departmental call downs begin -additional
nurses called in -ICU and floor nurses to ED -initiation of
admitted patients transported to PACU, floors, hallways Plan-D
initiated -internal disaster command center -departmental call
downs begin -additional nurses called in -ICU and floor nurses to
ED -initiation of admitted patients transported to PACU, floors,
hallways 30s F, private vehicle, GSW to lower ext and lac R
foot
- Slide 15
- Incident Timeline 02:00Plan-D announced overhead and operations
move to the hospital command center 02:10Managers and directors
from all departments begin arriving 02:30Arrangements made to stand
up PACU as inpatient unit; open as many ICU beds as possible
- Slide 16
- Slide 17
- Hospital Priorities Initial Priorities OR/PACU/ICU/ED Staffing
Off-load ED to PACU Augment ED Staffing Medical supplies Patient
families Behavioral Health Security Hot Line
- Slide 18
- Emergency Department Course 0200022003000240 60s M, EMS,
hypoglycemic and altered mental status, hall 5 40s M, private
vehicle, R eye pain, hall 1 20s F, private vehicle, abrasions to
ribs, triage 20s M, private vehicle, 11 seizures throughout day,
not clearing, room 3.
- Slide 19
- Casualties Treated Total Citywide 58 victims treated in local
hospitals (initial wave) 10 dead at scene UCH Of the 23 patients
received: One obvious DOA 10 were treat and release 12 were
hospitalized 8 ICU including 6 trauma surgery 4 Med/Surg
- Slide 20
- Emergency Department Response Staff cooperation was
extraordinary Many people performed duties that were outside of
their normal roles Security, Facilities Best term that can be used
is focused chaos Everyone was assigned a role
- Slide 21
- Hospital Response Nurses came from inpatient units floors to
assist in decompressing ED Many inpatient units doubled
RN-to-patient ratios Clinical and support departments called in
extra personnel The words that is not my job were never heard
- Slide 22
- Hospital Response Medical Staff Within 20 minutes, many
surgeons and anesthesiologists reported from home All available
house staff came to assist ED ED attendings assigned groups of
patients to house staff after triage Within 1 hour, more than 50
directors, managers, staff and physicians physically responded to
the hospital
- Slide 23
- Hospital Response Radiology Patients going to OR required
scans; staff stayed over; radiologists called in to read Teamwork
between ED and Radiology never better 150 images performed in under
1 hour Clinical Lab Supported blood bank, OR lab and core lab 185
units of blood products delivered
- Slide 24
- Hospital Response Hospital switchboard handled all incoming
calls until hotline could be set up The hotline had been in
planning stages Went live this night (Over 1,000 calls) Purpose of
hotline: Answer calls from families and friends searching for
victims Hospital Command Center coordinated with APD in getting the
names of all the victims at all local hospitals
- Slide 25
- Hospital Response Operating Room Difficult pump case in
progress at the time of the event Activated internal call-down list
very rapidly 9 operating rooms stood up in