No individual ambulance service or hospital in the Kansas City metro area could handle the aftermath of a mass shooting on the scale of what happened in Las Vegas Sunday night, where more than 50 people were killed and more than 500 were injured.
Getting all of the victims the care they need would require coordinated help from all of them.
“Five-hundred patients, plus, unfortunately, the number of fatalities, would be pretty much an all-hands response,” said Jay Reich, the medical director of the Kansas City Emergency Medical Services office.
An Associated Press report from Las Vegas described “mass panic” at the scene of the shooting, with dozens of ambulances deployed and emergency rooms “jammed with the wounded.”
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The Mid-America Regional Council, or MARC, has been working on plans to mobilize a response to this kind of incident for decades.
MARC’s Emergency Rescue Committee developed its first “regional mass casualty incident plan” in the 1970s. The current plan, published in April 2015, includes 39 emergency medical services agencies with ambulances, fire trucks and helicopters, and 30 major hospitals across 10 counties: Jackson, Cass, Clay, Platte and Ray in Missouri, and Wyandotte, Johnson, Leavenworth, Miami and Douglas in Kansas.
Erin Lynch, MARC’s emergency services and homeland security program director, said the hospitals drilled for a mass casualty event within the last two weeks.
Derek Collins, the Missouri co-chairman of MARC’s hospital committee, said the hospitals have drilled for scenarios with similar or even higher casualty numbers than in Las Vegas, but it would still be a challenge.
“I think any health system across the nation would be taxed,” Collins said.
MARC’s mass casualty plan has five tiers. Any incident with more than 100 potential patients is considered Level 1, the most serious.
In a Level 1 event, dispatchers would issue an alert to all of the hospitals in the MARC region and conduct a “bed poll” to determine how many patients at different levels of severity each hospital could take.
First responders would use that information to determine where to take people.
Still, for those arriving at the scene of an event with hundreds of casualties, evaluating injuries and deciding who needs to go where would be an immense challenge.
“You can never really prepare for an incident of this size and scope,” Reich said. “But you fall back on your training and experience to handle it the best you can.”
Reich said his agency has 35 ambulances, but could call up a total of about 100 “in a relatively short amount of time” with help from neighboring agencies.
But all of them can’t be used at once.
“Obviously you’d have to maintain a supply of ambulances to handle your regular emergencies because they don’t stop in a disaster,” Reich said.
The same would be true of hospital beds.
The most severely injured would likely be sent to the five hospitals in the area with state-certified Level 1 trauma units: the University of Kansas Hospital, St. Luke’s Hospital, Truman Medical Center, Research Medical Center and Children’s Mercy Hospital.
Combined they have more than 2,200 beds, but their capacity would depend on how many of those beds are already vacant or could be cleared quickly.
Collins said in a Level 1 mass casualty incident, the region’s hospitals would activate internal plans to discharge patients who can leave safely, call in more staff and prep more operating rooms.
Collins said one thing that complicates even the best coordination in a mass casualty event like what happened in Las Vegas is the number of people who take themselves to the hospital, rather than waiting on EMS.
Research Medical Center and other HCA Midwest hospitals offer trauma first aid training through a U.S. Department of Homeland Security program called Stop the Bleed.
But Justin Green, the chief of trauma, critical care and acute care strategy at KU Hospital, said well-meaning bystanders who show up at the hospital to help can interfere with a facility’s disaster plan, even if they have medical training.
Green, who runs the largest trauma center in the region and the only one designated Level 1 by the American College of Surgeons as well as the state, has served in military combat zones with the U.S. Army, Air Force and Marine Corps. He said the casualty levels in Las Vegas were comparable to what would occur on a battlefield or from a natural disaster.
“The sheer volume of folks and the need can be overwhelming,” Green said. “When you have that many badly injured folks or even that many folks who may not be gravely injured but still require care, it can be overwhelming — unless you have an infrastructure, unless you’ve practiced.”
Green said trauma centers across the country are practicing for it regularly because of international terrorism and mass shootings at places like Virginia Tech University, the Pulse nightclub in Orlando and now the Mandalay Bay hotel and casino in Las Vegas.
“The last several decades have demonstrated to us that even in the U.S., it’s not a matter of if, it’s when we’re going to be exposed to a mass casualty event,” Green said, “either through a natural disaster or a senseless act of random violence or terrorism.”