​Patients arrived “nonstop" in a “a very chaotic scene" that “looked like a disaster zone" at Nevada's only Level 1 trauma center after the deadliest mass shooting in modern U.S. history, according to an October 2, 2017, article in the New York Times. University Medical Center is one of the country's few freestanding trauma units and is fully staffed with surgeons and trauma nurses at all times to handle injuries and mass casualties, the article said. This made it uniquely prepared to treat victims of the mass shooting at a Las Vegas concert, which killed at least 59 people and injured more than 520. Still, the trauma center, which has 11 trauma bays, three operating rooms, a computed tomography (CT) scanner, a trauma intensive care unit, and a pediatric intensive care unit, had never faced such a ceaseless deluge of patients. The radio frequencies were frequently overloaded, so paramedics called patients in by phones. Some patients arrived in the beds of pickup trucks. Because the day had been busy, many day shift workers were still present when the shooting occurred, and they stayed to work alongside the night shift. With all the pagers beeping and patients crowding in, one hospital staffer noted that “we couldn't hear ourselves talk." Gurneys and wheelchairs were moved outside so as not to take up space inside, which is a lesson learned from the Orlando nightclub shooting in 2016. (See HRC Alerts, June 22, 2016: Orlando News Roundup: Was HIPAA Waiver Needed? How Can Hospitals Prepare for Tragedy?) A separate area was set up for patients whose injuries were deadly, so they could receive comfort care until they died, the article said. Patients were constantly reassessed, and when they were deemed to no longer be critical, they were moved to make room for other patients. The trauma unit ran out of supplies, which it “begged, borrowed and stole" from other parts of the hospital, the article said. In the middle of all of the chaos, the unit cared for other patients, treating a burn victim and a pedestrian hit by a motorcycle. A nurse who worked on the scene said the advice she would give to other hospitals is to “be prepared and practice." The chief executive officer at Sunrise Hospital, which is the closest trauma unit to the Las Vegas strip and treated 180 people, said in a statement that hospital staff did “an amazing job." He noted that the hospital's entire trauma staff was on hand the morning after the incident, and that most had stayed throughout the night. Because there was no declaration of public emergency, hospitals still must follow the Health Insurance Portability and Accountability Act Privacy Act (HIPAA), according to an October 2, 2017, article in Modern Healthcare. HIPAA waivers are not usually issued in the wake of man-made disasters such as mass shootings, the article said. The American Hospital Association issued a message of support for Las Vegas, noting that programs like its Hospitals against Violence action program "are needed now more than ever to help address violence and the toll it takes on our communities and hospital colleagues."

HRC Recommends: Healthcare organizations must be prepared to respond to mass casualty and active shooter events that may occur in the community as well as those that may occur on their own campuses. Organizations should examine how effectively their own all-hazards emergency plans might respond to such events, develop an appendix for these particular events if they do not already have one, and consider their potential role in educating and training the public. Risk managers may wish to review the Hartford Consensus III and Hartford Consensus IV reports, which discuss strategies to aid preparation for active shooter and intentional mass casualty events.