On 1 October, a recent mass shooting occurred in Las Vegas, leaving 59 people dead and another 527 injured. Medical services in the state are now wrestling to overcome the sudden and insurmountable number of patients that needed to be managed.

More than 24 hours after the incident, the worst has yet to pass for the trauma teams in Las Vegas hospitals many are still in unstable conditions. If anything, the Las Vegas shooting reaffirmed that acts of mass violence can occur anywhere, at any time. For trauma doctors and nurses, being ready, trained and prepared is the only way to stay one step ahead of the curve.

Preparing for the worst

Aside from ensuring that the 24-hour trauma unit of a hospital is fully staffed, trauma nurses and doctors often prepare for such incidents of mass casualty by carrying out drills. For instance, Palmetto Health Richland Hospital in Columbia, South Carolina, US, is doing just that by ensuring it is always ready in the event of a mass casualty – whether it be the result of an act of terror, natural disaster or accident.

“We have drills on a regular basis,” asserted Palmetto Health Richland Hospital trauma surgeon Dr. Phillip J. Prest. “We have mass casualty drills, we have active shooting drills. Once every month or two, we do some version of a simulation where we try to picture the worst-case scenario and do our best to work through those evaluations.” Back in September, Dr Prest’s trauma team at Palmetto Health Richland put the drills to the test, when nine patients were admitted due to a mass shooting at Columbia’s Vista. Because of their prior training and drills, the team were able to handle the influx of patients, relying only upon the regular staff without the need of any backup aide.

Another big part of Dr Prest’s success lies in the well-equipped trauma bays which allow the team to diagnose and stabilise patients before they are transferred for other modalities of treatment. By carrying out drills, the team could familiarise themselves with the scenario and the equipment that to save patients’ lives.

“Decisions have to be made rapidly,” added Prest. “We can try to assess a patient and make a determination as to their survivability options versus how severe or stable they are in a matter of seconds.”

Reduced fatalities thanks to military medical advancements

In America, patients are more likely to survive gunshot wounds compared to 15 years ago. Since 2002, gun fatalities have been stable despite the rise in gun violence and overall rate of non-fatal gunshot injuries.

Apart from the regular drills, trauma doctors have medical advancements developed by military doctors in American wars to thank for.

“During the height of the wars,” said Colonel Todd Rasmussen, a medical doctor and professor of surgery who served in the Iraq and Afghanistan wars, “we were treating injury patterns at a rate that was 10 to 100 times [that which] you would treat in any given city.”

This translated into instructive medical research, researchers say, making gun fatalities more survivable over the long run. These researches include the practice of using tourniquets on gunshot wound victims, performing “damage control surgery” and giving blood transfusions immediately.

However, during mass casualty events, hospital blood banks and drug caches often run dry, bottlenecking much of the treatment that patients receive. As part of the relief effort, hospitals in Las Vegas are currently calling upon blood donations from the public.

Hospitals can be prepared and still experience unforeseen hurdles

Despite these advancements in trauma care, hospitals can still be presented with unforeseen hurdles. As seen in the tragedy in Orlando – the largest mass shooting in recent US history until Las Vegas – the hospital was turned into a “war scene” where “patient after patient after patient” overwhelmed the hospital staff.

Less familiar injuries are also encountered, making it more challenging to treat.

“We saw the gamut of wounds – from wounds to the extremities, the chest, abdomen, and pelvis area – as if they were shot from below… something we’re not used to seeing,” said Joseph Ibrahim, the trauma medical director at Orlando Regional Medical Centre.

As such, the scientific community urged to close the gap between military and civilian worlds. The National Academies of Sciences released a report in 2016 detailing “how military advances can be sustained and translated to the civilian sector.” For now, with the growing outbreak of mass violence, each becoming more devastating than the one before, hospitals can only keep running drills and keep up with military medical advancements to be prepared. MIMS

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