Controlled chaos

November 13, 2017 11:17 AM

215 gunshot victims, arriving four to a car, in one night, in one ER. A Nevada emergency doc tells how he managed the ER on the night of the worst mass shooting in US history. (Warning: contains descriptions of injured people and trauma medicine).
posted by stillmoving (33 comments total)

Yet another suspect for a Stealth Goon.
posted by Samizdata at 11:25 AM on November 13, 2017 [2 favorites]

I wish Paddock was captured alive and made to read harrowing things like this every day.

I wish every NRA executive and their enablers in Congress could have their faces rubbed in the blood and viscera Menes et al had to see that night.
posted by ryanshepard at 11:45 AM on November 13, 2017 [26 favorites]

I can only imagine one would need any little bit of humour or levity to keep sane in such a situation:

Then I took every nurse that was free—at that point we had a lot of extra staff—and told them that all the people who needed CAT scans needed to be lined up in the ambulance hallway outside of CAT scan. We placed monitors on them, and nurses watched them. Then the nurses assisted getting each patient on and off the CT, and then back over to Stations 2 and 4. I called it the CT Conga Line.
posted by mannequito at 11:55 AM on November 13, 2017 [2 favorites]

Fascinating article, thanks for posting this. Those doctors and nurses sound like an amazing team that really pulled together when it mattered most.
posted by machinecraig at 11:58 AM on November 13, 2017 [2 favorites]

Fascinating and infuriating. Thanks.
posted by jeff-o-matic at 12:05 PM on November 13, 2017

The doctor's reference to having rehearsed this scenario in his head reminds me, again, of Unthinkable! Who Survives When Disaster Strikes and Why.

This was a fascinating article and I'm glad he thought carefully about it, was able to execute the plan, and has shared the experience. I wish it never happens again.
posted by crush at 12:10 PM on November 13, 2017 [6 favorites]

Amazing. Sounds like the ED team was basically running the entire hospital for 24 hours.
posted by demiurge at 12:12 PM on November 13, 2017 [1 favorite]

I learned a lot from looking up some of the terms in this article. Red tag, sux, and crump can join my previous stash of O2 sats and gorked so I can get some real information from a medical professional next time my wife or I have to take a white taxi ride.

Maybe "texasshooting" isn't the right tag for this post about a Nevada ER?
posted by infinitewindow at 12:16 PM on November 13, 2017 [1 favorite]

infinitewindow, thanks, I've unfortunately had too many shootings on my mind. Will ping the mods to adjust the tag.
posted by stillmoving at 12:18 PM on November 13, 2017

Mod note: fixed
posted by cortex (staff) at 12:20 PM on November 13, 2017 [1 favorite]

fucking hero

heroism is planning. relentless planning and practice. asking hard questions and thinking of the answers BEFOREHAND.

heroism is not relying on rank. (note the quick promotions of nurses)

heroism is adjusting to empirical evidence

fucking hero.
posted by lalochezia at 12:42 PM on November 13, 2017 [29 favorites]

Stuff like this fascinates me. Not the event itself, of course, but how professional people do their best to deal with it and minimize the lives lost. I'd love to see a documentary on a MCI in an ER, though of course that would require another MCI (don't want) and for a crew to be in the right place at the right time.

I work at a hospital that received a lot of patients after the Boston Marathon bombing and one of our ER docs gave a talk about the event, using (de-identified) data from our ED dashboard as a visualization of how patients moved in and out of the ER that day. it of course wasn't on the scale that this one was, and the injuries were quite different, but it was a similar situation with patients of varying levels of severity going to different rooms, regular patients not involved in the MCI being moved out of the ER (if possible) and even (non serious) walk-ins who basically had to wait until the event had ended before receiving treatment.

Humans constantly do terrible things so I love hearing stories about humans doing their best under terrible circumstances.
posted by bondcliff at 12:55 PM on November 13, 2017

Order vs. chaos - so good. I especially liked how he stopped caring about being sued when he could save lives instead, three times by my count before he even started getting his hands into patients. And that's only counting the violations he doesn't mind admitting.
posted by flamewise at 1:27 PM on November 13, 2017 [2 favorites]

This was incredibly moving. Working in a hospital, I can picture the scene clearly. Make every NRA staff person and every state and federal rep who opposes gun control sit down with this doc for half an hour and hear his story.

For some reason this part made me cry:

They brought them all towards me, and I was at the head of multiple beds, spiraling out like flower petals around its center
posted by latkes at 1:31 PM on November 13, 2017 [10 favorites]

Buh buh buh good guy with a gun buh buh
posted by GallonOfAlan at 1:39 PM on November 13, 2017 [2 favorites]

Looks like we should add time spent by medical staff dealing with victims, and the often extensive recovery period (lasting decades in many cases) to the hundreds of billions of dollars the US spends on completely avoidable gun violence.
posted by zombieflanders at 2:13 PM on November 13, 2017 [3 favorites]

Hell of a story. Well done to those medical personnel, who actually should never have had a night like that outside of a foreign army invading.
posted by turbid dahlia at 2:47 PM on November 13, 2017 [9 favorites]

As someone who works in emergency medicine my jaw is on the floor. That is the most incredible MCI story I’ve ever heard.
posted by not_the_water at 6:39 PM on November 13, 2017 [8 favorites]

I have no medical knowledge but that was a fascinating read. You can pick up most of it from context.

While I’m sure the event was gruesome, I didn’t find the article emotionally stressful. YMMV of course.
posted by pmurray63 at 7:25 PM on November 13, 2017

I'm just in awe. Incredible, staggering competence. Thank fucking god or whatever that we have such people in the world.
posted by rodlymight at 7:51 PM on November 13, 2017 [3 favorites]

That was amazing. The other night I was at a happy hour with several oncology med students. It was really interesting to be able to ask them questions in a context that wasn’t guarded like it would be if I or a loved one were a cancer patient. I’m adding epmonthly to my regular reads list.
posted by bendy at 8:35 PM on November 13, 2017

I work in this ER, in one of the roles mentioned in this article. Dr Menes absolutely saved lives that night- we all did. I have never been so proud of my profession and so humbled to be a part of this team. It has absolutely changed the way we view ourselves and our community- we are stronger, more compassionate, more capable, more loving than we knew we could be.

Senator Dean Heller visited the ER two days after the incident and I interrupted the conversation he was having with the CEO to beg him for common sense gun control legislation. I'm sure it didn't have any effect on him, but I had to speak my mind when I had the chance.

Witnessing this sort of thing changes you. We are still reeling, we are still crying, we still don't understand how one person can cause so much pain. We never will. I'm sorry, I think I'm rambling now.
posted by pupperduck at 10:35 PM on November 13, 2017 [62 favorites]

crumping

ATTN: music video directors - I have an idea.
posted by atoxyl at 12:43 AM on November 14, 2017

(Not to make light of the actual event or response - this is incredible to read. )
posted by atoxyl at 12:50 AM on November 14, 2017

After the Utøya, Norway shooting in 2011 a tiny local hospital faced having to give aid to around 35 gunshot victims despite not even having a proper trauma centre. They managed to adapt and improvise, and actually stabilised all incoming victims before dispatching them to larger regional hospitals for further treatment. It got them noticed internationally, and the lessons they drew seem to be some of the same from TFA. Here's a snippet from the research report I linked:

As Brandrud et al demonstrate, an important element is context. The crisis response was not conjured out of thin air. A culture of resilience existed, embedded in a favourable institutional and general context. The Ringerike hospital was able to implement the rationale of a national trauma system with national guidelines, shared triage rules, quality standards and evaluation, in association with a national Trauma Registry. The hospital administration provided doctrine, mission, objectives and necessary means, but refrained from micromanagement and a top-down approach and lent autonomy to front-line actors and teams to accomplish their mission. The principle of subsidiarity was respected; actors were empowered within a shared model and framework.

I.e. people had been training beforehand, they had a sensible system in place with a high level of buy-in from the staff, management actually trusted the people on the ground to do the right things and the people trusted each other.

There was an excellent article in a major newspaper about this, but in addition to being in Norwegian, it's sadly behind the paywall now.
posted by Harald74 at 1:06 AM on November 14, 2017 [5 favorites]

This was an incredible, harrowing, infuriating read. Thanks for posting it.

Just:

Don’t have enough ventilators? Pair patients of similar size, double the tidal volume, and use Y tubing to ventilate two patients on one vent.

A civilian ER doctor in the fucking First World has to think of how to handle this scenario, that a major trauma hospital in a city could conceivably run out of ventilators due to the sudden influx of mass casualties. Depraved.

I'm glad we have incredibly competent, dedicated doctors and nurses who can save lives in these mass shootings. They fucking shouldn't have to.
posted by RedOrGreen at 9:09 AM on November 14, 2017 [2 favorites]

Thank you for your service, pupperduck.
posted by mosessis at 9:22 AM on November 14, 2017 [7 favorites]

I know nothing about ER yet the imagery of this piece is really very vivid. I can almost see it playing in my head like a movie. Without wanting to derail I see this kind of story as a stronger argument for gun control than most other reporting. I don't care about the kind of gun, or why he did it, but just look at the tragic consequences.

(And seconding mosessis, thank you pupperduck for the work you did that day and every day).
posted by ianso at 1:23 PM on November 14, 2017 [1 favorite]

Pupperduck, thank you. All of you. The whole team for executing in the middle of it all, and then *telling us about it*.
posted by DigDoug at 6:38 AM on November 15, 2017 [2 favorites]

Pupperduck, my heart goes out to you. I spent a few years in a large urban ER and we had loads of GSWs pretty much every day, including drive-bys and gun battles with multiple casualties, but never an MCI of this scale. The pain and sadness never leave your heart. Hope you can take time to cry and grieve and heal a bit, and many many thanks to you and your team for your incredible work.
posted by stillmoving at 12:01 AM on November 16, 2017 [1 favorite]

What a great article, thanks for posting.
posted by theora55 at 6:00 AM on November 20, 2017

States, cities shame Congress by banning rapid-fire ‘bump stocks’

States and cities are taking the lead when it comes to banning rapid-fire "bump stocks" for guns after Congress has done nothing on the issue.

Proposals to ban bump stocks — devices that turn a semi-automatic rifle into one that fires like a fully automatic weapon by using its forceful recoil to quickly re-engage the trigger mechanism — caught fire in Washington after reports that the shooter in the Las Vegas massacre had used them in his attack.

Politicians from both parties, including Republicans often opposed to gun restrictions, said banning their sale should be seriously looked at. But nearly two months after Reps. Carlos Curbelo, R-Fla., and Seth Moulton, D-Mass., introduced a bipartisan bill to outlaw bump stocks nothing has happened.

posted by homunculus at 4:07 PM on November 23, 2017

Tens of thousands with outstanding warrants purged from background check database for gun purchases
posted by homunculus at 4:08 PM on November 23, 2017 [1 favorite]