I’ve participated in probably a few dozen disaster drills and mock disasters, as well as commanded the hospital side of five MCIs with up to 20 patients over the years, and after listening to the tapes of the fire response from the Aurora incident Thursday, I don’t believe we as a medical system in the US are adequately prepared to handle those incidents effectively. It sounds like the FD and the hospitals in that area did a fantastic job, but from listening to the tape, it wasn’t until the Battalion Chief arrived at the theater that any semblance of ICS was instituted. Fire depts have a great system to insure that trained Chief officers are available 24/7, hospitals, not so much. For a center like ours, which is the only trauma center for at least 50 miles in all directions, we would have to handle almost all the red priority patients. The trauma surgeon on call is likely not trained in ICS, and may be a year or two out of fellowship. I have confidence the processes for an MCI will work, but that may not necessarily handle this sort of incident effectively.

With an active shooter, the most important hospital resources are OR’s, surgeons, and OR teams (anesthesiologists and nurses/techs). We would also need blood, ICU nurses, and a lot of other help to take care of everyone else in the hospital while we’re dealing with this. Most disaster plans treat an MD as an MD, for this type of situation, general/thoracic/and vascular surgeons and anesthesiologists are the highest resource. After that, we cant do anything without an OR and and OR team. While in most disasters, EM physicians and ED staff are the most important, they cant take a patient to the OR and stop bleeding. Every trauma center (and hospital in a populous area) needs to learn more about and create an active shooter MCI protocol that specifically addresses these key resources.

For those readers (especially those overseas) who have been through these types of incidents, or people who have created these types of protocols, please add your comments so we can learn from your experience. Our hearts go out to all the victims and families affected by this tragedy.