Downtown Hospital Prepares for the Worst
LA Downtown News
By Eddie Kim
November 20, 2017

DTLA – The United States has seen hundreds of mass shootings, usually defined by the government as indiscriminate killings of four or more people, over the past decade.

Perhaps even more alarming is that three of the five deadliest shootings in American history have come within the past 18 months, including the Las Vegas attack that left 58 people dead at a concert on Oct. 1.

The incidents have been marked by chaos not just for victims, but also for first responders and local hospitals, which can be inundated in minutes by people who need immediate, and serious, care.

Downtown Los Angeles has never experienced a mass attack, but last Thursday morning, the Dignity Health California Hospital Medical Center in South Park prepared for just such a tragedy. During a two-hour exercise, a stream of people — some able to walk, many more battered and bleeding, others dead — lined the emergency department entrance. Some were rushed directly into the ER, while others waited in a blow-up triage tent, confused and in pain.

One woman lay quietly on a stretcher, murmuring at the plastic roof of the tent. A man in blue scrubs appeared at her side, introducing himself with a smile.

“So you got hit in the head?” he asked, gently.

No response.

“Do you know who the president is?”

Soft murmurs.

“Okay. Your lungs sound good and your tummy feels okay,” he said with a nod, before turning to two nurses: “She has head trauma with repetitive questioning. Let’s yellow-tag her.”

The staffers tore a tab off a placard hanging around the woman’s neck, leaving the one designating her as “delayed.” Other victims wore tabs showing “minor” (in green) or “immediate” (in red). A woman with fake bullet wounds in her forehead and jaw lay still and silent with a black tag: “Morgue.”

The Nov. 16 drill involved 25 “victims” of an attack on commuters during the morning rush on the 10 Freeway. That nobody seemed to know exactly how the attack unfolded was by design; the medical staff tried to piece together what happened while speaking with victims.

One patient said he heard an explosion, with a nurse speculating that his wounds came from shrapnel. Others clearly had been “shot.”

Each victim also wore a card displaying their age, sex and initial symptoms — a sort of riddle for the ER workers, who barked orders for drugs and immediate tactics as more people flowed in. Approximately 60 hospital doctors, nurses and other staffers participated in the drill.

“We’ve learned lessons in this industry, unfortunately, from a lot of incidents in the past,” said Patrick Caster, chief operating officer of California Hospital Medical Center.

Caster noted the hospital has trained employees to be flexible in receiving patients at the ER not just from ambulances, but from random vehicles such as Uber and Lyft cars (as in the Las Vegas shooting), which arrive with no communication. Best practices have changed with regard to emptying ER beds of low-priority patients to make room for attack victims, and even using social media to glean information about an incident, he said.

California Hospital Medical Center is Downtown L.A.’s only “level two” trauma center (of five levels, “one” being the highest). That means it would be the front line for treating victims with the kinds of injuries seen in mass shootings or terrorist attacks.

The sheer volume of patients can lead to miscommunication amid a harried response, which is why the hospital conducts a drill every year, said Dr. Joe Kim, chief medical officer for California Hospital Medical Center.

“It’s not just hospital staff that’s being trained, though. Even the public is being taught to respond in such events, like with the national Stop the Bleed campaign,” Kim said. “Learning to put on a tourniquet, for instance. It’s like learning CPR.”

Kim was pleased with how the drill unfolded and the staff responded, but added that several nurses and doctors at CHMC had actually treated victims of mass shootings — a reminder of how quickly a simulation can become reality.

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