When 23 severely injured patients arrived at University of Colorado Hospital in 2012 after a gunman opened fire on the moviegoers, the trauma team immediately jumped into action.
The team implemented its protocols for mass casualty events. Extra staff was called in to help and patients were triaged to ensure the most critically wounded were cared for quickly. The Level 2 trauma center constantly performed drills to make sure it was prepared for any mass casualty scenario like the one that happened in 2012.
"The one thing about a mass shooting is it's sudden," said Dr. Richard Zane, UCHealth executive director of emergency services. "The injuries are immediately life-threatening and time-dependent, so there has to be provisions to be able to mobilize mass quantities of blood, operations and resuscitations."
Las Vegas hospitals have likely implemented similar emergency preparedness protocols as they treat the roughly 515 people who were wounded Sunday night in the deadliest mass shooting in U.S. history, which has left 59 people dead as of Monday afternoon.
University Medical Center, the only Level 1 trauma center in Nevada, has treated 104 individuals who were wounded when a lone gunman opened fire on a concert crowd on the Las Vegas strip. More than 30 patients were treated in the free-standing trauma center approximately 6 miles from the country music festival's location. Four patients were pronounced dead at the facility, UMC spokeswoman Danita Cohen told the media.
Sunrise Hospital and Medical Center, a Level 2 trauma center also about 6 miles from the shooting, has treated 180 victims and performed about 30 surgeries as of Monday afternoon, according to a statement. Fourteen patients have died at the hospital.
"Our trauma center physicians and hospital staff have done an amazing job," said Todd Sklamberg, CEO of the hospital, in a statement. "Our trauma team and all supporting nursing units, critical-care areas and ancillary services are all at work this morning in the aftermath of this tragedy—and most stayed throughout the night—to help the victims and to assist their loved ones."
The trauma centers were likely well-prepared to treat the victims, as they conduct drills all year that are meant to mimic real-life scenarios, according to Dr. Joseph Ibrahim, trauma medical director and trauma surgeon at Orlando Health, a Level 1 trauma center that treated victims of the Pulse nightclub shooting in June 2016.
For instance, Orlando Health had completed a drill that simulated a mass shooting at a local school just before the nightclub shooting.
"We're always prepared for your worst moment of your life. That's our average day," Dr. Douglas Fraser, a surgeon at UMC, told the Associated Press in July 2016.
Zane at University of Colorado added that since the Columbine High School shootings in 1999, hospitals now prepare to treat victims with high-velocity gunshot wounds.
To prepare for the influx of patients in a mass casualty situation, patients in the ER are often moved to other areas of the hospital to open beds up quickly. Patients that arrive at the ER are then triaged to ensure the victims in need of the most critical care can be treated immediately upon arrival.
"Every disaster is really a supply-and-demand mismatch," Zane said. "It's important to augment supply."
Gunshot wounds often require emergency surgery, Ibrahim said. Eight patients were taken immediately to UMC's operating rooms, Cohen told media.
As hospitals move beyond the immediate aftermath, many will turn to offer grief counseling to patients and their families, Ibrahim said. Orlando Health provided such services after the Pulse nightclub shooting. "It is very likely that (patients') loved ones and friends were injured or killed," he said.
Treating victims of mass casualty events is also emotionally draining for the medical teams, Ibrahim said. After the commotion slows down, doctors and nurses are going "to be hit with the gravity of what has happened," and it is essential that caregivers receive access to grief counseling as well, he said.