List Archives

Fri Aug 31 14:52:34 BST 2007

I read this account yesterday and was furious that it was reported "things
could have been done better".

As it is said, hindsight is 20/15 (NOT 20/20, IMO!!) and yes-- as in all bad
results, there are a series of problems. Let's not buy into culpability when
all are punished. Perhaps with this sentinel event, things will change. THAT
is the true test.

C M Morris

On 8/31/07, Jeffrey Hammond <hammond at umdnj.edu> wrote:
>
> The formal report from the State of Virginal on the shooting at Virginia
> Tech has been released. At 260 pages it is a bit much to read but the EMS,
> Hospital, and Emergency Management responses were investigated and outlined
> from page 100 to page 122. I've copied the key findings and recommendations
> below.
> The report should be commended for not concentrating solely on EMS and
> pre-hospital issues. There are a few gaps (e.g. what role did the surgeons
> gaining emergency credentialing play at other hospitlas; what pre-event
> training did the hospitalists have, etc), and some of the operational
> details are sparse, but in general I found the report sound and a good
> example of what we should endeavor to do in future events. "Lessons learned"
> are still those we haven't learned yet from previous events, i.e.
> communications disconnects, failure to effectively use HICS, delays in
> opening an EOC, questionable value of triage tags, obstacles to patient
> tracking and dissonance between healthcare and police disaster plans for
> example. Nevertheless, it seems clear that pre-event coordination,
> planning and exercises paid handsome dividends.
>
>  Two "medical" aspects of the report bear special attention I think:
> 1) The discussion of post-event psychological support for healthcare
> personnel is directed at pre-hospitl providers and ignores the needs of
> hospital staff; 2) The recommendation to include hospitalists more
> prominantly in a disaster response plan is a good one. Hospitalist and house
> physician staff are not generally target groups for disaster training or
> involved in disaster drills (especially at facilities which are resident
> heavy), and in my experience an often overlooked resource.
>
> I suspect this report will be the subject of discussion and debate in the
> near future as new aspects and insights emerge.
>
> The full report can also be seen at:
> http://www.governor.Virginia.gov/TempContent/techPanelReport.cfm<http://www.governor.virginia.gov/TempContent/techPanelReport.cfm>
>
> *
>
> KEY FINDINGS
>
> Positive Lessons
> *
> The EMS responses to the West Ambler Johnston residence hall and Norris
> Hall occurred in a timely manner. Initial triage by the two tactical
> medics accompanying
> the police was appropriate in identifying patient viability.
>
> The application of a tourniquet to control a severe femoral artery bleed
> was likely a lifesaving event.
>
> Patients were correctly triaged and transported to appropriate medical
> facilities.
>
> The incident was managed in a safe manner, with no rescuer injuries
> reported.
>
> Local hospitals were ready for the patient surge and employed their NIMS
> ICS plans and managed patients well.
>
> All of the patients who were alive after the Norris Hall shooting survived
> through discharge from the hospitals.
>
> Quick assessment by a hospitalist of emergency department patients waiting
> for disposition helped with preparedness and patient flow at one hospital.
>
> The overall EMS response was excellent, and the lives of many were saved.
>
> EMS agencies demonstrated an exceptional working relationship, likely an
> outcome of interagency training and drills.
>
> *Areas for Improvement*
> **
> All EMS units were initially dispatched by the Montgomery County
> Communications Center to respond to the scene; this was contrary to the
> request.
>
> There was a 4-minute delay between VTRS monitoring the incident (9:42 a.m.)
> on the police radio and its being dispatched by police (9:46
> a.m.).
>
> Virginia Tech police and the Montgomery County Communications Center
> issued separate dispatches. This can lead to confusion in an EMS response.
>
> BVRS was initially unaware that VTRS had already set up an EMS command
> post. This could have caused a duplication of efforts and further
> organizational challenges. Participants interviewed noted that once a BVRS
> officer reported to the EMS command post, communications between EMS
> providers on the scene improved.
>
> Because BVRS and VTRS are on separate primary radio frequencies, BVRS
> reportedly did not know where to stage their units. In addition, BVRS
> units were reportedly unaware of when the police cleared the building for
> entry.
>
> Standard triage tags were used on some patients but not on all. The tags
> are part of the Western Virginia EMS Trauma Triage Protocol. Their use
> could have assisted the hospitals with patient tracking and record
> management. Some patients were identified by room number in the emergency
> department and their records became difficult to track.
>
> The police order to transport the deceased under emergency conditions from
> Norris Hall to the medical examiners office in Roanoke was inappropriate.
>
> The lack of a local EOC and fully functioning RHCC may lead to
> communications and operational issues such as hospital liaisons being sent to
> the scene. If each hospital sent a liaison to the scene, the command post
> would have been overcrowded.
>
> A unified command post should have been established and operated based on
> the NIMS ICS model.
>
> Failure to open an EOC immediately led to communications and coordination
> issues during the incident.
>
> Communications issues and barriers appeared to be frustrating during the
> incident.
>
> *RECOMMENDATIONS*
>
> *IX-1 Montgomery County, VA should* *develop a countywide emergency
> medical **services, fire, and law enforcement communications **center to
> address the issues of **interoperability and economies of scale.*
> *IX-2 A unified command post should be established and operated based on
> the** **National Incident Management System **Incident Command System
> model. *For this incident, law enforcement would have been the lead
> agency.
> **
> *IX-3 Emergency personnel should use the **National Incident Management
> System **procedures for nomenclature, resource typing **and utilization,
> communications, **interoperability, and unified command.*
> **
> *IX-4 An emergency operations center must **be activated early during a
> mass casualty **incident.*
> **
> *IX-5 Regional disaster drills should be **held on an annual basis. *The
> drills should include hospitals, the Regional Hospital Coordinating
> Center, all appropriate public safety and state agencies, and the medical
> examiner's office. They should be followed by a formal postincident
> evaluation.
> **
> *IX-6 To improve multi-casualty incident **management, the Western
> Virginia Emergency **Medical Services Council should **review/revise the
> Multi-Casualty Incident **Medical Control and the Regional Hospital **Coordinating
> Center functions. *
> **
> *IX-7 Triage tags, patient care reports, or standardized Incident Command
> System forms must be completed accurately and retained after a
> multi-casualty incident.* They are instrumental in evaluating each
> component of a multi-casualty incident.
>
> *IX-8 Hospitalists, when available, should **assist with emergency
> department patient **dispositions in preparing for a multicasualty*
> *incident patient surge.*
> **
> *IX-9 Under no circumstances should the **deceased be transported under
> emergency **conditions. *It benefits no one and increases the
> likelihood of hurting others.
> **
> *IX-10 Critical incident stress management **and psychological services
> should continue **to be available to EMS providers as needed.*
>
> **
> **
> * Jeffrey Hammond MD, MPH
> Chief, Trauma/Surgical Critical Care
> Robert Wood Johnson Medical School
> New Brunswick, NJ
> *
>
> * *
>
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

List Archives

For your convenience, find the Trauma List Archive Below

Va Tech disaster recommendations