How Las Vegas Hospitals Responded to Nation\u2019s Deadliest Mass Shooting.pdf<\/strong><\/a><\/p>\n

Las Vegas Mass Shootings.pdf<\/strong><\/a> \u00a0<\/p>\n

How did the hospitals adjust their emergency response plans during this event? Where they effective?<\/strong><\/p>\n

Did previous mass casualty training help the Valley Health System effectively manage this event? if so, How?<\/strong><\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n
\n
INSIDE\n<\/p>\n
Financial Disclosure: Physician Editor Robert Bitterman, Author Dorothy Brooks, Editor Jonathan Springston, Relias Manager of
\nAccreditations\/Director of Continuing Education Amy M. Johnson, MSN, RN, CPN, Executive Editor Shelly Morrow Mark, and AHC Media
\nEditorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker\u2019s bureau, research, or other financial relationships with
\ncompanies having ties to this field of study.\n<\/p>\n
NOW AVAILABLE ONLINE! VISIT AHCMedia.com or CALL (800) 688-2421\n<\/p>\n
DECEMBER 2017 Vol. 29, No. 12; p. 133-144\n<\/p>\n
Using machine learning,
\ninvestigators at Johns
\nHopkins Hospital have
\ndevised a new method
\nfor triaging patients
\nthat data suggest
\ndifferentiates patients
\nmore effectively . . . . 138\n<\/p>\n
See how a two-stage
\nsepsis alert process
\nhas helped emergency
\nclinicians better identify
\nsepsis without increasing
\nthe incidence of alert
\nfatigue . . . . . . . . . . . . 141\n<\/p>\n
Enclosed in This Issue:\n<\/p>\n
Accreditation Update:
\nRevised standards on
\npain assessment and
\nmanagement reflect
\nconcerns about opioid
\nepidemic\n<\/p>\n
HOSPITALS IN
\nTHE REGION\n<\/p>\n
HAD TO RAMP
\nUP EMERGENCY\n<\/p>\n
OPERATIONS
\nQUICKLY AS\n<\/p>\n
PATIENTS BEGAN
\nARRIVING BY THE\n<\/p>\n
TRUCKLOAD.\n<\/p>\n
How Las Vegas Hospitals
\nResponded to Nation\u2019s
\nDeadliest Mass Shooting
\nPatients continue to present to EDs in the region with PTSD-like
\nsymptoms and anxiety related to the mass shooting\n<\/p>\n
S
\nunday evenings tend to be rela-
\ntively quiet in the ED, but on
\nSunday, Oct. 1, hospitals in Las\n<\/p>\n
Vegas were tasked with responding to
\nthe worst mass shooting in U.S. history
\nwhen a gunman using
\nautomatic weapons
\nopened fire on a
\nlarge crowd attend-
\ning a must festival on
\nthe Las Vegas Strip.
\nFifty-nine people were
\nkilled and more than
\n500 injured, many
\nof them with severe
\ngunshot wounds.\n<\/p>\n
At first unclear on
\nthe extent of the in-
\njuries, hospitals in the
\nregion had to ramp up
\nemergency operations quickly as patients
\nbegan arriving by the truckload, many
\nof them in private vehicles. Sunrise
\nHospital and Medical Center, a level II
\ntrauma center located just a few miles\n<\/p>\n
from the festival, first received notice of
\na mass casualty event at 10:20 p.m.\n<\/p>\n
\u201cOnce our incident command was
\nstood up, we mobilized staff and sup-
\nplies within the ED, operating room,\n<\/p>\n
inpatient units, and in
\n[our] pharmacy and
\nsupply warehouse,\u201d
\nexplains Jeff Mu-
\nrawsky, MD, FACP,
\nthe hospital\u2019s chief
\nmedical officer. \u201cWe
\nalso used the incident
\ncommand structure
\nto ensure protocols
\nwere enacted for
\nmanaging security,
\nvisitors, and family of
\nthose impacted by the\n<\/p>\n
tragedy.\u201d
\nWith such close proximity to the\n<\/p>\n
event, Sunrise Hospital received 180 pa-
\ntients, more than any other hospital in
\nthe region, 124 of whom had sustained
\ngunshot wounds. Dozens of physicians, <\/p>\n<\/p>\n<\/div>\n
\n
134 | ED MANAGEMENT\u00ae \/ December 2017\n<\/p>\n
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AUTHOR: Dorothy Brooks
\nEDITOR: Jonathan Springston
\nEXECUTIVE EDITOR: Shelly Morrow Mark
\nAHC MEDIA EDITORIAL GROUP MANAGER: Terrey L .
\nHatcher
\nSENIOR ACCREDITATIONS OFFICER: Lee Landenberger\n<\/p>\n
Copyright\u00a9 2017 by AHC Media, a Relias Learning company .
\nED Management\u00ae is a registered trademark of AHC Media, a
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nurses, and support staff were called
\nin to manage the influx, and staff
\nessentially tripled the size of the ED,
\nexplains Scott Scherr, MD, FACEP,
\nSunrise\u2019s medical director of emer-
\ngency medicine.\n<\/p>\n
To organize care, arriving patients
\nwere tagged to go to designated areas.
\n\u201cWe used the Sunrise Children\u2019s
\nHospital pediatric ED for the \u2018green\u2019-
\ntagged patients, the chest pain obser-
\nvation area for \u2018green- and yellow-\u2019
\n[tagged patients], and the PACU
\n[post-anesthesia care unit] for \u2018yellow\u2019
\npatients,\u201d Scherr notes. \u201cI was able
\nto assign one to two providers per
\nstation with a scribe. We moved all
\n\u2018red\u2019 patients to the trauma bays and
\nstation one.\u201d\n<\/p>\n
Prepare for\n<\/p>\n
Non-local Patients\n<\/p>\n
When yellow-tagged patients
\nbegan to decompensate, they were
\nmoved to the trauma bay or station
\none, Scherr explains. \u201cSince we had
\nfour neurosurgeons in house on
\nSunday night, we sent all isolated
\ngunshot wounds directly to the neuro
\nICU. Orthopedic surgeons were fol-
\nlowing patients on the PACS [pic-
\nture archiving and communications
\nsystem] machines and admitting
\nisolated surgical patients,\u201d he says.\n<\/p>\n
A radiologist followed patients
\nwith a portable X-ray machine to
\ngive clinicians instant \u201cwet\u201d reads,
\nScherr observes. In addition, trans-
\nporters were assigned to each station
\nso they could help move injured
\npatients to radiology for CT scans,
\nupstairs to the ICU, or to the operat-
\ning room, he says.\n<\/p>\n
With so many patient arrivals, the
\nhospital quickly bypassed standard
\nregistration processes, moving instead
\nto a system it uses in mass casualty
\nsituations to capture an alias on every\n<\/p>\n
patient treated. \u201cAfter the emergent
\nstabilization was completed, we
\nwere able to establish and verify the
\nidentity of every patient who was
\nevaluated and treated,\u201d Murawsky
\nnotes. \u201cThose who were treated and
\nreleased did not necessarily complete
\nthe evaluation process.\u201d\n<\/p>\n
Because Las Vegas is a prominent
\ntourist area, it is not unusual for
\nthe hospital to treat patients from
\nother regions, and this often requires
\ncoordinating with hospitals in other
\nstates. However, Murawsky notes
\nthat this was an added challenge in
\nthe wake of the mass shooting be-
\ncause so many patients were not lo-
\ncal. Nonetheless, Murawsky explains
\nthat the hospital regularly practices
\nfor mass casualty events that may
\ninvolve a large number of tourists.\n<\/p>\n
\u201cWe do both table top prepared-
\nness exercises on MCI [mass casualty
\nincidents], simulating a large [num-
\nber of ] casualties, and also annually
\nplan for and execute a New Year\u2019s Eve
\nemergency preparedness response to
\nmeet the influx of emergency issues
\namong revelers each year,\u201d he says.\n<\/p>\n
Murawsky anticipates that there
\nwill be many lessons to incorporate
\ninto these exercises from the mas-
\nsive response to this unprecedented
\nevent, but that will take some time.
\n\u201cAt present, we are focused on the
\nhealing of our patients and staff,\u201d
\nhe says. \u201cA structured review will be
\ncompleted and coordinated across
\nthe community to ensure that others
\nbenefit from our experience.\u201d\n<\/p>\n
Consider Geographic,\n<\/p>\n
Travel Challenges\n<\/p>\n
University Medical Center of
\nSouthern Nevada (UMCSN), the
\nstate\u2019s only level I trauma center,
\nreceived 104 patients the night of the
\nshooting, creating multiple challenges <\/p>\n<\/p>\n
\n mailto:[email\u00a0protected]<\/span><\/a>\n<\/div>\n
\n mailto:[email\u00a0protected]<\/span><\/a>\n<\/div>\n<\/div>\n
\n
134 | ED MANAGEMENT\u00ae \/ December 2017 ED MANAGEMENT\u00ae \/ December 2017 | 135\n<\/p>\n
EXECUTIVE SUMMARY\n<\/p>\n
Hospitals in Las Vegas scrambled to respond to the deadliest mass shooting\n<\/p>\n
in U .S . history after a gunman opened fire on a large crowd attending a music\n<\/p>\n
festival on Oct . 1, which left 59 people dead and more than 500 injured .\n<\/p>\n
\u2022 Sunrise Hospital and Medical Center received 180 patients, including 124\n<\/p>\n
with gunshot sounds . The incident command structure was used to mobilize\n<\/p>\n
staff and supplies and to ensure protocols were enacted to manage security as\n<\/p>\n
well as the visitors and family affected by the tragedy .\n<\/p>\n
\u2022 With so many patient arrivals, the hospital quickly bypassed standard\n<\/p>\n
registration processes, moving instead to a system it uses in mass casualty\n<\/p>\n
situations to capture an alias on every patient treated .\n<\/p>\n
\u2022 University Medical Center of Southern Nevada (UMCSN), the state\u2019s only\n<\/p>\n
level I trauma center, received 104 patients from the shooting, creating\n<\/p>\n
multiple challenges for staff . The hospital maintains a separate, freestanding\n<\/p>\n
trauma center, which offers advantages in expediting care to critically injured\n<\/p>\n
patients . However, patients arriving by private vehicle presented to both\n<\/p>\n
the trauma center and the adult ED, necessitating triage operations in both\n<\/p>\n
locations as well as continuous travel between the two buildings as patients\n<\/p>\n
were transferred to the appropriate location .\n<\/p>\n
\u2022 Providers rushing to work to care for victims of the shooting ran into\n<\/p>\n
roadblocks set up by law enforcement, in some cases delaying their arrival to\n<\/p>\n
UMCSN .\n<\/p>\n
\u2022 Providers emphasize the importance of developing a versatile emergency\n<\/p>\n
response process that can be deployed in any type of mass casualty event .\n<\/p>\n
for staff. For instance, David Obert,
\nDO, the assistant medical director of
\nthe ED, immediately headed to work
\nwhen he heard about the shooting by
\nphone from a colleague, but he ran
\ninto obstacles related to law enforce-
\nment\u2019s response to the incident.\n<\/p>\n
\u201cThe biggest issue was that they
\nwere setting up roadblocks through-
\nout the city, so it was actually very
\ndifficult for me to get to the hospi-
\ntal,\u201d he recalls. \u201cI had to go through
\nseveral roadblocks, show them my ID
\nand tell them where I was going, and
\nI was able to get through.\u201d However,
\ntraveling to the hospital took extra
\ntime, and other staff faced similar
\nchallenges, Obert notes.\n<\/p>\n
Other difficulties stemmed from
\nthe unique organizational layout at
\nUMCSN. \u201cWe have a freestanding
\ntrauma center, which is in a com-
\npletely separate building,\u201d Obert
\nexplains. \u201cIt has 11 trauma bays, and
\nthen attached to that is a CT scanner,
\nan angio suite, three operating rooms,
\nand then the trauma ICU.\u201d\n<\/p>\n
Separate from the trauma center
\nis an adult ED with 55 beds. Three
\nfloors up is a pediatric ED. Although
\nthe resources are plentiful and state of
\nthe art, the layout was confusing to
\narriving patients, many of whom had
\nto be transferred between the trauma
\ncenter and the ED, depending on
\nwhat their needs were.\n<\/p>\n
\u201cThe medics know where to go,
\nbut it is different for people coming
\nin private vehicles,\u201d Obert observes.
\n\u201cThey just see an ED and don\u2019t differ-
\nentiate because most places don\u2019t have
\ntheir own separate trauma center.\u201d\n<\/p>\n
Familiarize Staff\n<\/p>\n
With Resources\n<\/p>\n
The night of the shooting, the ini-
\ntial patients were triaged through the
\nadult ED, and then if needed, trauma\n<\/p>\n
then was alerted. However, it wasn\u2019t
\nlong before truckloads of people be-
\ngan arriving at the trauma center. To
\nmanage the influx, there needed to be
\nan immediate operative intervention
\non both ends to ensure that patients
\nwere directed to the right facility for
\ntheir needs, Obert explains. \u201cPatients
\nwere crisscrossing back and forth,
\nand, unfortunately, there is some
\ngeographic distance between these
\ndepartments.\u201d\n<\/p>\n
Patients with local extremity
\nwounds showed up to the trauma
\ncenter, and the majority of these
\npatients would get transferred to the
\nadult ED.\n<\/p>\n
\u201cWe set up a receiving area in
\nthe PACU to do secondary triage
\non people who just showed up on
\nthe doorstep so that we could find
\nout who needed to go straight to\n<\/p>\n
the operating room and who could
\nbe delayed and then transferred [to
\nthe adult ED] and get an extremity
\nevaluation and management,\u201d Obert
\nexplains.\n<\/p>\n
When Obert arrived at the hos-
\npital at 11:15 p.m., he went to the
\ntrauma center.\n<\/p>\n
\u201cAt that point, a car load of four or
\nfive patients showed up. They all had
\nextremity wounds, so I basically fol-
\nlowed all of those patients, went over
\nto the adult ED with them, and then
\nassisted in the care of all of them,\u201d he
\nexplains. \u201cI then found another eight
\npatients who had extremity wounds
\nthat I helped to manage [in the adult
\nED].\u201d\n<\/p>\n
Another challenge of operating
\nseparate trauma and ED buildings is
\nthat staff members tend to be familiar
\nwith one area or another, but not <\/p>\n<\/p>\n<\/div>\n
\n
136 | ED MANAGEMENT\u00ae \/ December 2017\n<\/p>\n
FURTHER, IN THE
\nMIDST OF THE
\nCRISIS, IT WAS
\nUNCLEAR HOW
\nMANY PATIENTS\n<\/p>\n
WOULD BE
\nARRIVING, WHICH
\nMADE DECISIONS\n<\/p>\n
ON HOW TO
\nREGISTER
\nPATIENTS\n<\/p>\n
DIFFICULT.\n<\/p>\n
necessarily with all areas. This became
\nevident the night of the shooting.\n<\/p>\n
\u201cWe had an onslaught of help,
\nbut there was a lack of familiarity
\nwith where resources were,\u201d Obert
\nobserves. \u201cThere is not much cross-
\nover between the nurses that work in
\npediatrics or work in the adult ED or
\nwork in trauma. They typically focus
\non one of those three areas.\u201d\n<\/p>\n
As a result, when clinicians ran
\nout of chest tubes or other needed
\nsupplies, staff didn\u2019t necessarily know
\nwhere those resources were stored,
\nso it would take added time to track
\nthem down.\n<\/p>\n
\u201cThat was a bit of an issue because
\nwe had a lot of people to help, but
\nthey didn\u2019t have familiarity with what
\nwas there.\u201d\n<\/p>\n
Take Advantage\n<\/p>\n
of Military Training\n<\/p>\n
Another issue that arose was a lack
\nof some basic supplies such as tour-
\nniquets and chest seals, things that
\ntypically are not used in the ED. \u201cIt
\nis very rare that we put a tourniquet
\non in the department. We will put a
\nblood pressure cuff on, but when you
\nhave 20 people with arterial extremity
\nwounds that are all heavily bleeding,
\nyou don\u2019t have 20 blood pressure
\ncuffs,\u201d Obert notes.\n<\/p>\n
Consequently, a lot of the equip-
\nment emergency staff members were
\nusing was coming from first respond-
\ners. \u201cOur physicians who support the
\npolice department have actually built
\nkits for [first responders] to use on
\nscene, so we ended up using a bunch
\nof those kits,\u201d Obert recalls. It is one
\nissue that definitely will be addressed
\nin the post-event analysis, he adds.\n<\/p>\n
Given the fact that patients were
\ntriaged to two separate buildings,
\ngood communication between
\nthe ED and the trauma unit was\n<\/p>\n
important. In fact, the hospital\u2019s
\nemergency planning calls for the
\navailability of two-way radios, but
\nthis aspect did not go as smoothly as
\nintended, Obert observes.\n<\/p>\n
\u201cOnce they set up the incident
\ncommand center and started going
\nthrough the equipment, they dis-
\ncovered some technical issues,\u201d he
\nexplains. \u201cThe equipment is checked
\nevery once in a while, but some of it
\nwas not properly charged.\u201d\n<\/p>\n
Clinicians were able to work
\naround the problem by using tele-
\nphone communications, but it is an
\narea that clearly can be improved,
\nObert adds.\n<\/p>\n
While the distinct geography of
\nthe trauma center presented some
\nobstacles, Obert stresses that the cen-
\nter is uniquely designed to respond
\nquickly to patients with severe inju-
\nries, which certainly proved advanta-
\ngeous for the seriously wounded the
\nnight of the shooting.\n<\/p>\n
\u201cYou have proximity to a CT
\nscanner, you have proximity to an
\nangio suite and to the operating
\nrooms,\u201d he says. \u201cSomeone can\n<\/p>\n
be offloaded from a rig, get an
\nevaluation, and get to the operating
\nroom within a few minutes, which is
\na pretty phenomenal process.\u201d\n<\/p>\n
As is often the case, military train-
\ning proved invaluable in the hospital\u2019s
\nemergency response. In particular, a
\nphysician assistant\u2019s military instincts
\nkicked in and he took charge of the
\ntriage process, labeling patients with
\ntheir injuries when they arrived. The
\napproach deviated a bit from the hos-
\npital\u2019s mass casualty training process,
\nbut it worked, Obert notes.\n<\/p>\n
\u201cHe actually did probably 90%
\nof the triage and he was phenomenal
\nbecause he was just very focused,\u201d he
\nsays. \u201cHe was the one directing who
\nwas going to stay in trauma if they
\nwere shot in the chest or the belly or
\nhad a significant wound that required
\ntourniquets and things of that sort. If
\nnot, he was directing patients to the
\nadult ED or the PACU.\u201d\n<\/p>\n
Consider Paper\n<\/p>\n
Registration\n<\/p>\n
While mass casualty practice drills
\ncertainly make a difference when the
\nneed arises to activate emergency
\nplans, the magnitude of this event was
\noverwhelming, Obert notes.\n<\/p>\n
\u201cYou can drill for anything, but
\nit is not the same when it is real time
\nand there is real emotion and stress,\u201d
\nhe says. \u201cAnd of course it happened
\nwhen [we were] not expecting it \u2014
\n10:30 on a Sunday night, which isn\u2019t
\ncharacteristically a big trauma night.\u201d\n<\/p>\n
Further, in the midst of the crisis,
\nit was unclear how many patients
\nwould be arriving, which made
\ndecisions on how to register patients
\ndifficult.\n<\/p>\n
In the end, staff used electronic
\nmedical records (EMRs) to register
\npatients throughout the night, which
\nwasn\u2019t necessarily the best option.<\/p>\n<\/p>\n<\/div>\n
\n
136 | ED MANAGEMENT\u00ae \/ December 2017 ED MANAGEMENT\u00ae \/ December 2017 | 137\n<\/p>\n
\u201cThey didn\u2019t know how many
\npatients to expect, so they went from
\na few patients to 50 patients within
\nan hour,\u201d Obert relates. \u201cThey actu-
\nally pulled in registration people from
\nall over the place, and they were out
\nthere meeting patients on the curb
\nand were doing bedside registration as
\nsoon as the patients arrived.\u201d\n<\/p>\n
Switching to paper registration
\nmight have been more expedient, Ob-
\nert observes. The hospital maintains
\npreprinted packets for this purpose,
\nbut it was not prepared to intake 50
\npatients at once.\n<\/p>\n
\u201cWe use paper registration for peo-
\nple who are suffering from a stroke or
\na heart attack, so some of our post-
\nevent [analysis] is that we need to
\nhave at least 100 pre-printed labels,
\ntags, and charts,\u201d he says. \u201cTo me
\nthe biggest issue was the fact that we
\nwere bouncing patients from depart-
\nment to department and having them
\nfollowed. And, unfortunately, EMRs
\naren\u2019t that user friendly, so no mat-
\nter how good they are, when we have
\nthree separate locations, it becomes a
\nchallenge of patient tracking.\u201d\n<\/p>\n
Despite all the challenges, Obert
\ngives the staff high marks for their
\nemergency response.\n<\/p>\n
\u201cThey handled the incident very
\nwell,\u201d he says. \u201cI felt comfortable
\nleaving at 3:30 a.m. because most of
\n[the patients] had already been there,
\npeople were taken care of, and we
\nwere discharging a lot of people,\u201d he
\nsays. \u201cThe patients that needed to
\nbe there emergently were there, and
\nthe rest had already been admitted or
\nseen by consultants.\u201d\n<\/p>\n
However, even a day or two after
\nthe incident, patients from the inci-
\ndent continued to present to the ED.\n<\/p>\n
\u201cWe were getting transfers later
\non, and people eventually turned
\nup who had injuries sustained from
\nthe stampede,\u201d Obert notes. \u201cPeople
\nwere stomped on and people hit their\n<\/p>\n
heads and had skull fractures, so there
\nwere some secondary effects from [the
\nmass shooting]. And then we started
\ngetting influxes of people with degrees
\nof PTSD [post-traumatic stress disor-
\nder] and anxiety.\u201d\n<\/p>\n
Even people who were not at the
\nfestival where the mass shooting oc-
\ncurred were developing symptoms,
\nObert explains.\n<\/p>\n
\u201cWe are still seeing people who
\nare extremely traumatized by some
\nrelation to the event, the location or
\nsomething else that happened in their
\nlife. This has reactivated something,\u201d
\nhe says. \u201cWe are seeing those kinds
\nof patients all over [Las Vegas] Valley
\nnow.\u201d\n<\/p>\n
Develop a\n<\/p>\n
Versatile Process\n<\/p>\n
Some members of the hospital
\nstaff are experiencing a degree of
\nemotional fallout from the event.\n<\/p>\n
\u201cWe still have counselors [on site],
\nand there are some people where
\nthere has been more of a delayed
\nimpact,\u201d Obert explains. \u201cWe see
\nthings on the news all the time about
\npatients that we have taken care
\nof, but this has been of such great\n<\/p>\n
magnitude that it is overwhelming.\u201d
\nHowever, the gratitude shown by the
\ncommunity has been a huge positive,
\nObert stresses.\n<\/p>\n
\u201cWe are getting deliveries of food
\nand gifts every single day still,\u201d he
\nsays. \u201cI have been in Las Vegas for
\n12 years, and I have never seen an
\noutpouring from the community like
\nanything close to this, so it\u2019s pretty
\nphenomenal. They have done a lot to
\nsupport the nurses and the physicians
\nand the first responders throughout
\nthe city.\u201d\n<\/p>\n
While the shooting event on Oct.
\n1 was unprecedented in scope, mass
\ncasualty events are not uncommon in
\nLas Vegas, Obert says. He recalls one
\nrecent incident in which a woman
\nwho apparently had some type of
\npsychiatric issue drove down the side
\nof the street, running over several
\npeople.\n<\/p>\n
There also have been several
\ndeadly fires in recent years. Hospital
\nstaff members know they need to be
\nprepared.\n<\/p>\n
\u201cUnfortunately, something like
\nthis is going to happen again in Las
\nVegas. We just don\u2019t know to what
\ndegree, and that is the challenge,\u201d
\nObert laments. \u201cIt is a matter of
\npreparing for a process that is going
\nto work in any circumstance, and not
\njust mass casualty shootings.\u201d n\n<\/p>\n
SOURCES
\n\u2022 David Obert, DO, Assistant Medi-\n<\/p>\n
cal Director, Emergency Depart-\n<\/p>\n
ment, University Medical Center of\n<\/p>\n
Southern Nevada, Las Vegas . Email:\n<\/p>\n
[email\u00a0protected]<\/a> .com .\n<\/p>\n
\u2022 Scott Scherr, MD, FACEP, Medi-\n<\/p>\n
cal Director, Emergency Medicine,\n<\/p>\n
Sunrise Hospital and Medical Center,\n<\/p>\n
Las Vegas . Phone: (702) 383-1958 .\n<\/p>\n
\u2022 Jeff Murawsky, MD, FACP, Chief\n<\/p>\n
Medical Officer, Sunrise Hospital and\n<\/p>\n
Medical Center, Las Vegas . Phone:\n<\/p>\n
(702) 881-8887 .\n<\/p>\n
\u201cIT IS A MAT TER
\nOF PREPARING\n<\/p>\n
FOR A PROCESS
\nTHAT IS GOING\n<\/p>\n
TO WORK IN ANY
\nCIRCUMSTANCE,
\nAND NOT JUST\n<\/p>\n
MASS CASUALT Y
\nSHOOTINGS.\u201d<\/p>\n<\/p>\n
\n mailto:[email\u00a0protected]<\/span><\/a>\n<\/div>\n<\/div>\n
\n
Copyright of ED Management is the property of AHC Media LLC and its content may not be
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\nexpress written permission. However, users may print, download, or email articles for
\nindividual use.<\/p>\n<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
How Las Vegas Hospitals Responded to Nation\u2019s Deadliest Mass Shooting.pdf Las Vegas Mass Shootings.pdf \u00a0 How did the hospitals adjust their emergency response plans during this event? Where they effective? Did previous mass casualty training help the Valley Health System effectively manage this event? if so, How? INSIDE Financial Disclosure: Physician Editor Robert Bitterman, Author […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_joinchat":[]},"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/posts\/155599"}],"collection":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/comments?post=155599"}],"version-history":[{"count":0,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/posts\/155599\/revisions"}],"wp:attachment":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/media?parent=155599"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/categories?post=155599"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/tags?post=155599"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}