SALT LAKE CITY — Utah health care executives on Monday learned the importance of preparation from the CEO of a hospital that faced a historic patient burden after the October shooting in Las Vegas that killed 58 and injured hundreds.
Todd Sklamberg, CEO of Sunrise Hospital and Medical Center in the Las Vegas Valley, told members of the Utah Hospital Association that health facilities and their partners in public health and law enforcement must coordinate extensively ahead of time for the possibility of a mass-casualty event.
"The question is not if this is going to happen again, but when and where," Sklamberg told the Deseret News following his lecture at the University Park Marriott hotel in Salt Lake City. "Be it a shooting, national disaster or some other attack."
Sunrise Hospital saw 214 patients who were hurt in some way in the Oct. 1 Las Vegas shooting, where people attending the Route 91 Harvest Music Festival were targeted by a gunman on the 32nd floor of the nearby Mandalay Bay hotel.
Those patients at Sklamberg's hospital included 124 with gunshot wounds, which he said was the largest group of such victims any hospital has ever treated from a single incident in U.S. history.
Sklamberg said the ordeal, despite the hospital's imperfect response, proved to him that hyperrealistic emergency training for hospitals, police agencies and others ultimately pays off.
"Part of it (is) communitywide drills," Sklamberg said. "When you drill, drill like it's the real thing."
He said that in communities throughout the country, there is always a risk that states and counties wrestling with budget constraints will be tempted to skimp on, or totally cut out, interagency emergency preparedness training. Local governments should never give into that impulse, Sklamberg told the Deseret News.
"It's just (about) maintaining the heightened awareness that this can happen anywhere and anytime … and we need to be diligent in our preparation activities," Sklamberg said. "We cannot shortchange funding of emergency preparation in our communities, because lives are at stake."
Sklamberg addressed Sunrise Hospital's efforts to ensure blood supplies got to where they were needed and to obtain additional supplies from other hospitals. The presentation also described the work of "environmental services" crews who kept the facility clean amid the chaos.
"It's ever so critical to enhance coordination of care," he said.
One unpredictable challenge encountered in the response to the mass shooting, Sklamberg said, was the sheer number of patients who had no identification with them. All 16 patients who were deceased at Sunrise Hospital — 10 of which were dead on arrival — had no identification with them.
"We had 92 patients without any identification at all," he said.
Jan Buttrey, disaster preparedness coordinator for the Utah Hospital Association, explained that many of the concertgoers didn't have their wallet or purse because they had wristbands that served as a catch-all device that could be scanned to buy things at the event.
The number of unidentified patients required a large effort by hospital staff to obtain as thorough a description as possible of each person.
"We then went through an identifying process with family members asking for physical identifiers," Sklamberg said.
Because medical gear was frequently covering much of the patient's face, staff in many cases relied on locating tattoos or body piercings in order to get some certainty, he said.
"At times it's hard to recognize facial features," Sklamberg said.
"It was important to the families" that staff be able to quickly and reliably determine whether or not any of the victims at the facility was their loved one, he said.
Sunrise Hospital performed 58 surgeries on patients within 24 hours and used 516 units of blood. Thirty-one patients were admitted to intensive care units.
Kirsten Mills, emergency management program coordinator at Intermountain Medical Center, said the presentation gave providers a lot to think about in terms of how to best communicate in a large-scale emergency.
One group that could benefit from improved methods of instantaneous communication, she said, is the general public in the area of the emergency. For example, Mills said, many people simply took injured loved ones, friends or strangers to the first hospital they could find directions for, rather than the ones best-suited for traumatic care or with the most availability to take on more patients.Comment on this story
"The (directions) apps on your smartphone aren't taking you to (trauma) centers or asking you about your injuries," Mills said.
She said the confusion those people experienced raises important questions for public health departments and provider organizations about how to rapidly disseminate those important details.
Rachelle Rhodes, director of intensive medicine at Intermountain Medical Center, said that what Sklamberg described to providers Monday "hits very close to home."
"This is a wake-up call to make sure everyone knows how to respond, what to do," Rhodes said.