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When Disaster Strikes: University of Colorado Hospitals Response to the July 20, 2012, Aurora Shooting Patrick M. Conroy, EMT-P, MS, ACHE

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No matter what lessons we ultimately learn from this tragedy, it is absolutely clear that the overall response from the entire University of Colorado Hospital family was nothing less than extraordinary.

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Facility Information Current facility is Level 2 Trauma center Currently licensed for 551 beds (407 beds on July 20 th, 2012) Additional 14-story tower opened this year Entirely new Emergency Department is now open 34 rooms plus hall beds to 77 rooms 23,000 square feet to 56,000 square feet

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UCH Overview Only academic medical center in the region 27,000 + annual admissions and growing 800,000 + outpatient encounters and growing 73,000 annual ED visits ADC of 20 inpatients daily (On 7/20) Over 6,000 staff and faculty Magnet status for 10 years 2011 and 2012 UHC Quality Award winner #1 hospital in Denver US News & World Report Part of UCHealth PVHS/ Memorial

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Facility Information UCH is a quasi-governmental hospital authority UCH is co-located on the Anschutz Medical Campus with the University of Colorado Denver Campus and Children's Hospital Colorado School of Medicine School of Nursing School of Dentistry School of Pharmacy

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The University of Colorado Hospital Emergency Department July 20, 2012 1 STARR room with two beds 34 rooms (red, green, yellow) 10 regular hall beds 1 ENT room 2 minor casualty rooms

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The State of the Department July 20, 2012 49 patients in the emergency department 25 patients currently admitted without an available bed in the hospital (boarders) 11 patients in the waiting room 2 patients ESI level 2 8 patients ESI level 3 1 patient ESI level 4 On divert (placed on divert at 1900 on 7/19/12)

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Brief Pre-Hospital Course 0030 0039: First 911 call 00400100 0054: Request to transport victims by police car 0049: First patients to Aurora South 0050 0055: Request notification of all hospitals 0041: First officers on scene Full emergency department with a full waiting room 0056: Notified of 3-5 GS victims likely to ED 0101: First patient arrives at University Hospital

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Incident Timeline 01:01First patient is taken from private car Patient describes to staff the scene in Theater 9: gas canisters black clad gunman shooting screaming Patients arrived as war casualties instead of usual ambulance condition 13 by APD 3 by EMS 7 by private vehicle or other

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Organized Chaos

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MCI preparation begins: -Call for blood -Prep STARR rooms -Call by Dr. Kim to general surgery of possible MCI -Dr. Kim (R2) to STARR B -Dr. Mackenzie (R1) to STARR A -Dr. Johnson (R3) to doorway of STARR rooms MCI preparation begins: -Call for blood -Prep STARR rooms -Call by Dr. Kim to general surgery of possible MCI -Dr. Kim (R2) to STARR B -Dr. Mackenzie (R1) to STARR A -Dr. Johnson (R3) to doorway of STARR rooms Emergency Department Course 0100011001300120 20sF, private vehicle, GSW ext, hall 1 4mM, private vehicle, dropped, hall 1 Teenage M, police, GSW to head, STARR A 30sM, police, GSW to torso ext, STARR B Teenage F, police, GSW head, hall 2 20s F, police, eviscerated abdomen, STARR A2 20s F, police, GSW bil ext and face, hall 6 18F, police, GSW LLE, hall 3b 20s F, ran, GSW ext triage Unknown Age F, police, GSW head 20sM, police, GSW to head, disaster area Teenage F, police, GSW to neck, disaster area Teenage M, police, GSW torso/ abdomen, STARR B1 14 M, EMS, GSW lumbar back, hall at room 15 40s F, police, GSW upper and low ext, no pulse ext, hall room 4 Teenage F, police, triage, mult abrasions 20s M, EMS, GSW upper and lower ext, hall 3a 30s M, EMS, GSW R chest, hall 6 30s M, EMS, GSW R chest, hall 6

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Incident Timeline 01:05Administrator on-call, CNO and CEO notified and en route to hospital 01:25Hospital incident commander position filled; initial coordination done from the ED 01:30House manager alerted OR and PACU 01:31Internal call-down lists activated in OR, PACU, inpatient units and support departments

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Emergency Department Course 0130014002000150 30s M, private vehicle, with GSW hand, hip pain, triage Plan-D initiated -internal disaster command center -departmental call downs begin -additional nurses called in -ICU and floor nurses to ED -initiation of admitted patients transported to PACU, floors, hallways Plan-D initiated -internal disaster command center -departmental call downs begin -additional nurses called in -ICU and floor nurses to ED -initiation of admitted patients transported to PACU, floors, hallways 30s F, private vehicle, GSW to lower ext and lac R foot

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Incident Timeline 02:00Plan-D announced overhead and operations move to the hospital command center 02:10Managers and directors from all departments begin arriving 02:30Arrangements made to stand up PACU as inpatient unit; open as many ICU beds as possible

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Hospital Priorities Initial Priorities OR/PACU/ICU/ED Staffing Off-load ED to PACU Augment ED Staffing Medical supplies Patient families Behavioral Health Security Hot Line

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Emergency Department Course 0200022003000240 60s M, EMS, hypoglycemic and altered mental status, hall 5 40s M, private vehicle, R eye pain, hall 1 20s F, private vehicle, abrasions to ribs, triage 20s M, private vehicle, 11 seizures throughout day, not clearing, room 3.

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Casualties Treated Total Citywide 58 victims treated in local hospitals (initial wave) 10 dead at scene UCH Of the 23 patients received: One obvious DOA 10 were treat and release 12 were hospitalized 8 ICU including 6 trauma surgery 4 Med/Surg

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Emergency Department Response Staff cooperation was extraordinary Many people performed duties that were outside of their normal roles Security, Facilities Best term that can be used is focused chaos Everyone was assigned a role

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Hospital Response Nurses came from inpatient units floors to assist in decompressing ED Many inpatient units doubled RN-to-patient ratios Clinical and support departments called in extra personnel The words that is not my job were never heard

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Hospital Response Medical Staff Within 20 minutes, many surgeons and anesthesiologists reported from home All available house staff came to assist ED ED attendings assigned groups of patients to house staff after triage Within 1 hour, more than 50 directors, managers, staff and physicians physically responded to the hospital

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Hospital Response Radiology Patients going to OR required scans; staff stayed over; radiologists called in to read Teamwork between ED and Radiology never better 150 images performed in under 1 hour Clinical Lab Supported blood bank, OR lab and core lab 185 units of blood products delivered

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Hospital Response Hospital switchboard handled all incoming calls until hotline could be set up The hotline had been in planning stages Went live this night (Over 1,000 calls) Purpose of hotline: Answer calls from families and friends searching for victims Hospital Command Center coordinated with APD in getting the names of all the victims at all local hospitals

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Hospital Response Operating Room Difficult pump case in progress at the time of the event Activated internal call-down list very rapidly 9 operating rooms stood up in