Unpredictability is the norm for emergency departments across the country. It is true, the managed chaos of a day in emergency medicine becomes familiar over the course of years on the job. But far too many of my colleagues know that a mass casualty response is unlike any other day in the ED.
The impact these incidents have on the medical community, particularly emergency physicians, is often overlooked.
Indelible images of neighbors at risk and in pain stay with you long after the shift ends. The enormous weight of loss: A mother who loses her son. A friend forever gone. The efforts of heroic first responders and courageous acts of bystanders—it all stays with you.
Emergency physicians train for this and most institutions conduct extensive training for these events. When an ED fills with severely injured patients, adrenaline and expertise kick in. Still, physicians may feel overwhelmed, stressed and out of their comfort zone. In these moments, it is imperative to trust the training and personal experience.
There will come a time when a physician confronts situations well outside the bounds of the usual practice patterns and there is no one-size-fits-all response to these tragedies. That is when it is most important to trust instincts, abilities, and most of all, each other.
There is no textbook to dictate the best way that each person processes the toll exacted by the mental, physical and emotional energy required to respond to these incidents. Physicians learn that they must trust and accept their decisions. Even the most experienced physicians need constructive outlets for the stress and the roller coaster of thoughts and emotions that become part of the job. While it may get easier, it never gets easy.
What happened in Dayton, El Paso, Las Vegas, Newtown, Orlando and countless other communities can happen anywhere. Physicians can learn strategies for communicating tough news to friends and families of victims, but these conversations are hard, every single time.
From dispatchers and responders to the all-hands response while beds or staff or medicines run short, every role is important and effective emergency response takes a village. Accordingly, it is too much to ask for anyone to be left to process these events alone.
We must care for the caregivers. Post-incident support and counseling for the entire team inside and outside the hospital, including physicians, is crucial for healthy recovery. It can be incredibly helpful to seek the advice of others who have experienced such events. Physicians, staff and administrators must not underestimate or downplay the lasting impact these horrific, senseless tragedies have on the entire staff and community.
The American College of Emergency Physicians strongly believes that firearm injuries—accidental or otherwise—should be addressed as a public health epidemic. Let’s make sure that we push for constructive solutions every day, not just in the immediate aftermath of a shooting. The frequency of these tragedies is a uniquely American problem.
The ACEP supports legislative, regulatory and public health efforts that can help end the epidemic of gun violence. This includes expanding access to mental health services, universal background checks and restricting the sale or ownership of weapons, munitions and large capacity magazines designed for military or law enforcement use. A significant increase in public and private funding for research is needed to expand firearm safety and injury prevention research.
There is one common thread emerging from these events—they each seem to leave more questions than answers in their wake. Unfortunately, the simple questions seem to be the hardest for Congress to answer. Perhaps we can start there. Emergency physicians will continue to ask policymakers: Is it finally time to do something?
