When Seconds Count

Today’s emergency rooms are prepared for the worst with advanced technology, procedures and training.

Susan Jenks

Most of the 75 beds in the emergency room at Orlando Regional Medical Center filled up quickly during the one man terrorist attack at the Pulse nightclub on June 12th. Normally, those beds serve patients with vastly different injuries from simple bone breaks to far more severe compound fractures, as well as life-threatening heart attacks and strokes.

But, on that morning, everything normal was off the table, says Dr. David Cassidy, the assistant director/quality officer in the department of emergency medicine at ORMC, where first responders took almost all of the gunshot victims after the shooting rampage by Omar Mateen.

Although hospital staff is trained to be prepared for anything, Cassidy says, “Who would have thought there would be an attack one block away from our hospital?”

In terms of survival, the Orlando hospital’s proximity to the unfolding tragedy certainly played a role for many of those sustaining the worst injuries. But ORMC’s status in Florida as one of just 10 Level 1 trauma centers, where highly trained trauma teams provide round-the-clock medical care, also worked in victims’ favor.

So, too, did advances in emergency medicine over the past 15 years since the 9/11 terror attacks, from pre-training simulation drills in preparation for mass casualty events to technological advances that mean more accurate diagnoses and a better chance of saving those at life’s fragile edges.

Patients facing life-threatening bleeding from bullet wounds, for example, have much quicker access to blood transfusions and resuscitation than in the past, says Dr.Chadwick Smith, vice chairman in ORMC’s department of surgery and the trauma surgeon on call when the Pulse massacre occurred. From wars in the Middle East and elsewhere, he says, “we’ve learned patients bleed blood, not salt solutions,” so packed red blood cells are rapidly infused into the body to restore oxygen to vital organs and tissues, while other blood components improve clotting time to stem massive hemorrhaging.

“And, yes, we stockpile it,’’ Smith says, referring to an array of blood products, which the hospital stores in advance of emergencies, including, most recently, Hurricane Matthew as the storm raced up Florida’s coast.

Within the first 24 hours of the Pulse shooting, Smith says, the hospital used over 441 units of blood, a massive amount equivalent to the same number of pints, according to the National Brookhaven Laboratory on Long Island. The average patient purportedly requires about 4.5 units of blood after serious injury.

By the early morning hours of June 12, hospital officials say, 13 Pulse victims already had undergone surgery, while 15 more surgeries took place before the end of the day.Altogether, ORMC staff performed 76 operations—all but 9 of 44 patients surviving and released as of early September. Another 11 patients with less severe injuries were treated in the emergency department at Florida Hospital Orlando and released.