Mass Casualty Incidents

Lessons Learned from EMS Response to the Orlando Pulse Nightclub Shooting

Chris Hunter, MD, PhD, FACEP, Director of the Health Services Department for Orange County, Fla., spoke to the audience at the National Association of EMS Physicians (NAEMSP) annual meeting in New Orleans about the lessons his department learned during the Pulse Nightclub Shooting, which occurred in the early hours of June 12, 2016, when an attacker entered the Orlando nightclub and began shooting.

This response included dozens of first responders from multiple agencies on scene, activation of emergency intake plans at Orlando area hospitals, coordination with several local, state, and federal law enforcement agencies, and collaboration with elected leadership from across the region. Hunter presented the lessons learned regarding Orlando’s approach to mass shootings, hostage situations, mass fatality events and crisis assistance.

The attack and subsequent hostage situation lasted over three hours and resulted in more than 100 victims, including 49 fatalities. Dr. Hunter discussed the response from the Orange County EMS System, from the initial encounter through the mass casualty incident.

The incident occurred about 600 yards from the ED entrance of Orlando Regional Medical Center (ORMC) and across the street from an Orlando fire station. The initial shooting stopped in minutes, but then continued on for three hours until the shooter was engaged and killed.

There were actually three MCIs involved in this incident as the scene progressed: The first wave of victims; the second wave of victims; and the survivor and family unification after the incident. Triage tags were not used on the first wave of victims, but some were used during the second wave.

ORMC went into a Code Black status, stopping receipt of all patients other than those from the Pulse Nightclub incident. Civilians who were involved did not leave; they stayed and assisted in the carrying, care and transfer of patients at the scene.

The police transported 30% of the casualties using pick-up trucks during the early phases of the incident because they were there in mass early and better protected than EMS personnel.

The amazing thing about this incident, which is a great testimony to the care provided by the first responders and ORMC staff, was that every patient who survived to ED admission is still alive today.

Lessons Learned:

  1. It is difficult to tag and track patients during a fast-moving, volatile incident.
  2. Systems (both prehospital and hospitals) should use Disaster Medical Assistance Teams (DMATs) to help manage the mass fatalities.
  3. Despite the importance of tourniquets, this shooting involved mostly head and chest wounds, and the average number of wounds per patient was one to four.
  4. Family reunification must be addressed early into an incident because family members (and the media) will begin to swarm the ED/hospital(s) and must be housed/accommodated and managed.
  5. Many support functions are needed; such as clean-up of blood, prophylaxis inoculation and decontamination of rescuers.
  6. Just when you think it’s over, community vigils begin and have to be staffed and supported. In addition, people will be available and want to donate blood to replace depleted blood supplies.
  7. Preparedness is important, and drills and planning are essential.

To continue the conversation about MCI preparedness and training, JEMS is hosting a series of super-sessions at EMS Today 2017 in Salt Lake City, Utah. On Feb. 23, join us from 8:00–10:00 a.m. for Lessons Learned From the San Bernardino Active Shooter Incident, and on Feb. 24, from 8:00–10:00 a.m. for The Orlando Fire Department Response to the Pulse Nightclub Terror Attack.

For more information on the rapid removal, assignment and tracking of patients, read Duck vs. Bus Complex MCI on Seattle’s Aurora Bridge in the November 2016 issue of JEMS.