Fort Hood Shooting: A Cautionary Tale for Tucson

    I don’t care how many special news reports I see or read on the shootings in Tucson, I’m convinced we won’t fully understand what happened there for months, if ever. What we can be certain of is that more mass casualties will occur and that there will be missteps by both medical and journalism professionals.

I say this because of a recent post-mortem I heard on the November 2009 shootings at Fort Hood, where in a span of roughly 10 minutes, 32 people were injured and 10 died. Ultimately, 13 individuals lost their lives in that tragedy.

In the rush to report the news, two news helicopters hovered over the Scott & White Hospital, located 30 miles from Fort Hood, and the only level I trauma center in the area. The FAA was called in to clear the airspace, but not before the helicopters interfered with the transport of patients.

Back in Atlanta, CNN broadcast the Scott & White command center referral line, and over a 1-hour period, the hospital received 1,300 phone calls, which “essentially crippled our phone systems,” Dr. Jeff Wild, a surgical resident at that hospital, told his colleagues at the Western Surgical Association meeting.

The overload meant that Darnall Army Hospital in Fort Hood and nearby Metroplex Hospital, both of which were receiving shooting victims, couldn’t reach staff. Communication problems ultimately led to the transfer of two patients from Metroplex to an out-of-region hospital.

Triage was minimally organized and patients were maldistributed, with the closer facilities becoming saturated with shooting victims, he said. Darnall Army Hospital, a level III hospital, evaluated 27 patients and performed five operations on 4 patients, with one death. Scott & White prepared 6 trauma bays, made 16 of its 24 ORs available and posted one trauma surgeon in the OR and another in the ED, which proved invaluable in triaging patients, noted Dr. Wild. Over roughly a 2-hour period, they received 10 patients, of which five were taken urgently to the OR. Metroplex, which had only one emergency department physician and two general surgeons in the level IV facility at the time, received seven patients, including a civilian police officer who helped take down the perpetrator, and had no deaths. “I think we’re quite lucky that none of the patients transferred here had any adverse events,” he said.

I was beginning to squirm in my seat at this point, until Dr. Wild acknowledged the hospitals had alternative means of communication. The only problem was that personnel didn’t know how to properly work the radios and Web-based computer program.

Security was also an issue for the hospital. The alleged perpetrator, psychiatrist Maj. Nidal Hasan, was in the same ICU as six of his shooting victims and their families. The hospital elected to move Hasan to an isolated OR that served as his ICU until he was transported out of the hospital.

Since the shootings, Scott & White has hosted several disaster drills that included the army hospital, which had not been done before, Dr. Wild reported on behalf of senior author Dr. Randall Smith, Scott & White interim chief of trauma, critical and acute care surgery. Staff has been educated on various communication pathways, and twice a month, all the hospitals and EMS agencies in the area talk on the radios to make sure they’re working properly and that staff knows how to use them.

“Scott and White hospital has taken part in four mass casualty events in the past 25 years and, although these are considered somewhat a rarity, they seem to be more commonplace,” Dr. Wild said. “And if you haven’t already, it’s very likely a lot of you will take part in one of these events over your careers.”

From my own perspective, I just hope everyone knows the drill, including my colleagues at the mic.

  Patrice Wendling (on Twitter @pwendl)

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Filed under Emergency Medicine, Hospital and Critical Care Medicine, IMNG, Surgery, Thoracic Surgery

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