A few miles away, staff members at the University of Colorado Hospital (UCH) were attending to a full emergency room and a nearly full waiting room unaware of what had taken place at the Aurora Century 16 Movie Theater — that a gunman had entered a packed showing of the newest Batman movie with intent to kill. In the EMSystem, which is used by all Colorado hospitals to track available beds among other things, UCH was on ER divert. Mentions of a shooting were heard on a fire radio in the hospital, but no details were provided. “There was a sense that something unusual was happening in the community,” Patrick Conroy, manager of support services for UCH, told attendees at Emergency Management’s All-Hazards, All-Stakeholders Summit on Sept. 20 in Denver.
What follows is a look into the University of Colorado Hospital’s response, which earned it Emergency Management’s Disaster Humanitarian Preparedness Award. “The exceptional response by the University of Colorado Hospital and its staff to the emergency illustrates its commitment to preparedness and the community, and for that, Emergency Management is honored to give it the Disaster Humanitarian Preparedness Award,” said Marty Pastula, vice president of emergency management and homeland security for the Emergency Management Media Platform.
Conroy — along with Justin Oeth, associate manager of the emergency department, and Rob Leeret, director of emergency and trauma services — accepted the award.
Pictured from left to right: Rob Leeret, director of emergency and trauma services; Justin Oeth, associate manager of the emergency department; Patrick Conroy, manager of support services; and Marty Pastula of the Emergency Management Media Platform.
Responding to a No-Notice Event
According to police, James Holmes — who was charged with the attack that killed 12 people and injured 58 — entered the movie theater through an emergency exit door at 12:38 a.m. The first 911 call was made at 12:39 a.m., and Holmes was apprehended by officers at about 12:45.
Shortly after 1 a.m., a request for bed counts went out over the EMSystem, which automatically paged several members of the UCH staff, including Conroy. And at 1:01 a.m., the first patients from the shooting, a mother and her four-month-old child, arrived at the University of Colorado Hospital by private vehicle. That was just the beginning. Conroy said that within about five minutes of the first patients’ arrival, police officers began bringing more victims to the hospital for treatment. Within about 15 minutes, nine Aurora Police Department patrol cars each transported between one and three patients to UCH.
“All this happened before an ambulance ever arrived at the hospital with patients,” Conroy said.
In total, UCH received 23 patients from the Aurora massacre. In addition to those brought by private vehicle and patrol cars, three victims arrived by ambulance and another ran from the theater to the hospital.
Although UCH was originally on ER divert, it eventually made no difference, Conroy said. “One of the takeaways that the local EMS providers are looking at is how we do distribution of patients in no-notice events.”
At 1:30 a.m., Conroy assumed the hospital incident commander position under the emergency operations plan. Although staff members were already working from the emergency operations plan, it was formally announced, which triggered internal notifications and call downs.
UCH then began focusing on its initial priorities, including: ensuring there was adequate staff in the ER; offloading patients who were in the emergency department to the post-anesthesia care unit; securing the area; and working with people in the lobby who were inquiring about loved ones.
To help the public, UCH established a hotline within the first 12 hours of the emergency. It received more than 2,000 calls of people looking for loved ones. UCH worked collaboratively with other hospitals and its partner, the Tri-County Health Department, to get each health-care facility’s patient list so family members could be directed to the correct location.
“The downside of that, a lesson learned,” Conroy said, “is if someone is calling for John Smith and John Smith isn’t on any of those lists, we have a pretty good idea that John Smith was still on the scene awaiting the coroner’s response, but what do you tell those family members?”
Reviewing the Response
Other takeaways from UCH’s after-action review include that health-care facilities cannot train, exercise and drill too much, especially for a no-notice event, like the mass shooting in Aurora. “A lot of us in the hospital environment tend to believe we will have some level of notice and control of the number of patients that are coming in the door,” Conroy said. “Certainly that didn’t happen in this event.”
UCH conducts a monthly emergency management activity, such as a policy review, drills, training and table top exercises. Conroy said in 2012 the hospital has completed 34 preparedness activities to date.
Conroy also addressed other implications for health care and emergency management. Unified command is necessary because of the complexities of large health-care organizations. “Unified command in a health-care setting is a reality of our existence,” Conroy said. The liaison officer’s role also proved to be critical during the response. The liaison officer coordinated with other hospitals, the local governments’ EOCs and the Tri-County Health Department. Conroy also said new technologies will help hospitals get a clearer picture of different situations, and more importantly, help filter out what the information means to the organization.
Another takeaway Conroy pointed out is the importance of Emergency Support Function 8 (ESF-8). According to the U.S. Department of Health and Human Services, ESF-8 involves supplemental assistance to state, tribal and jurisdictional governments in identifying and meeting the public health and medical needs of victims of major disasters or public health and medical emergencies. Conroy said that many times, there is an assumption that hospitals will be self-sufficient, but in reality that isn’t necessarily true. He added that all hospitals must have a plan for how they will sustain themselves for 96 hours, and although the plans look great on paper, they can’t be tested in a real-world environment. For example, hospitals relied on local community support during Hurricane Irene and after the tornadoes struck Joplin, Mo., in 2011.
“Unless there is a good ESF8 partnership that is up and running and dialed in and active, something is going to ultimately get lost and unfortunately it might be lives,” Conroy said.
The Aurora tragedy will continue to be studied from all sides of the emergency management community, but it’s important to remember that the response was successful. Conroy said every patient at every hospital survived. (The two fatalities at health-care facilities were deceased before they made it inside a hospital, he said.)
“The bottom line, at least from a hospital perspective, no matter what the lessons we ultimately learned from, we know absolutely without a doubt that internally our response was nothing less than extraordinary,” Conroy said. “The entire health-care community in the entire metro area really deserves the credit for their response and their ability to say … ‘we’ll take care of it.’”
