department. Eventually the incoming-patient overflow
also extended into the post-anesthesia care unit, where
orthopedic injuries were addressed.
“Our pediatric ER docs actually were taking adult
patients with extremity injuries over there,” Dr. Scherr
says. “In the ER, we had pediatric surgeons doing
emergency surgeries on adult patients. Pediatric
cardiothoracic surgeons were doing thoracotomies on
adult patients. Then of course our seven trauma
doctors were constantly running the ORs. We ended
up doing 27 emergent surgeries that evening; five
emergent surgeries within the first hour and then 83
total during the first 24 hours.”
Rapid mobilization key
to successful intake
More than 100 physicians
rushed to Sunrise to
assist, as well as more
than 200 nurses,
clinicians, and support
staff. Matching the frantic
pace of patient care
taking place in the ER
and adjacent areas, the
rest of the hospital also
was highly active. In addition to the activity around new
patient care, staff was working to discharge those
patients who could be processed out in order to make
room for the influx. Thanks to around 100 discharges,
there was a bed for every incoming patient who
needed one; no shooting victims were diverted to
other facilities.
In short, everyone who could be there, was there—
and playing a vital role.
“How did we get that response? There was a mass
text, and phone calls were sent out to all people
in the medical staff,” Dr. Scherr explains. “That got
anesthesiologists, ICU doctors, hospitalist medicine,
and emergency medicine docs to arrive.”
And even though it was late in the evening, it was still
early enough to mobilize a fair number of people more
22
quickly than would have been likely in the early-
morning hours, he says. “If it was 2 a.m., it would have
been difficult to mobilize the number of physicians and
physician extenders as we did. All the nursing leaders
called their staff members to bring them in. Some of
them were at home watching the news and they didn’t
even wait for a phone call—they just came in.”
Similarly, the Sunday-night time window also meant
that the busy ER area wasn’t full to capacity, which
meant there was room to maneuver the initial wave
of patients while triage areas were being created for
the additional ones arriving every minute.
“If it was a Monday or a Tuesday afternoon where the
PACU space and both ERs would be completely full of
medical patients or surgical patients, we wouldn’t have
been able to expand the footprint of the ER,” Dr. Scherr
says. “Basically, we expanded the footprint of the ER
about four times. We quadrupled the space of the ER
within 60 minutes.”
While the Sunrise team wasn’t anticipating having
to care for more than 200 patients in an hour, it
nonetheless was ready for the unexpected. Multiple
Casualty Incident (MCI) drills are conducted
throughout the year, and past real-life responses
have included a British Airways fire at McCarran
International Airport, where more than 35 patients
were treated.
“Every year, we actually have a planned surge model for
New Year’s Eve because we’re the destination of choice
for the paramedics on New Year’s Eve,” Dr. Scherr
adds. “We’ve utilized the PACU space before, so we
had all necessary office equipment and supplies over
there to help us take care of those patients. But have
we practiced taking care of 215 patients like we saw?
No, but it’s just the Sunrise ‘next man up’ mentality to
help our patients that really showed that night.”
Incorporating crisis lessons into
everyday procedures
In the days and weeks following the shooting and its
response, the Sunrise team also worked together to
review that evening’s patient care to see where regular,