‘It was our finest moment’

Dr. Rodney Rohde

Mass Shooting

Most mass casualty stories are told from the victims’ point of view, or the fi rst responders, doctors, medics, nurses, or police.

This is not that story.

Sunday night (Oct., 1, 2017) began as an ordinary night at Desert Springs Hospital Medical Center (DSH), a 293-bed acute care community hospital in Southeast Las Vegas.

Three miles west on the Las Vegas strip, across the street from Mandalay Bay and the Luxor hotel casino, 20,000 attendees reveled and celebrated one last night of live country music at the Route 91 Harvest Festival. However, everything rapidly changed, where ordinary turned into extraordinary as disaster and tragedy struck, courtesy of a lone shooter.

Shortly thereafter, the crew in the medical laboratory was shaken out of their slow night, as an overhead page announced, “CODE TRIAGE EXTERNAL, CODE LOCKDOWN.”

Every hospital practices, drills, and works on policies and procedures for how to handle disasters. No amount of practice, drilling, or procedure writing will ever prepare someone for the real deal. While we have learned a great deal with the growing number of mass casualty incidents (MCI) in the United States and abroad, we are still learning lessons in the “controlled chaos” of an MCI.

It all happened quickly. Victims with gunshot wounds started pouring into the ER at a rapid pace by every mode of transportation. One ER doctor recalls that it escalated quickly from a trauma to a war zone mentality. Triage, tourniquets and patient ID was critical.

DSH was notified to expect about 50 victims. The final count was over 100 injured not counting dozens handled by the hospital transfer center.

In the laboratory it was not until the ER hit 50 patients that phlebotomist Jennifer Grant stepped into the ER, just on the other side of the door from the lab, to investigate. “They need towels to soak up all the blood!” she announced in horror. Quickly, Jennifer Grant and Noe Huerta, another phlebotomist, had found their task for the crisis: patient care and pre-op!

Two other phlebotomists had a daunting task: they drew blood from every single victim that showed up in the ER. Every patient had a type and screen. Over 100 patients in the ER had blood drawn by AJ Ramos and Shelly Co Yu that night. GSW victims first and AJ even donned a surgical gown to draw the patients in the OR.  The phlebotomy staff paved the way for the medical laboratory science professionals to manage blood supply. Shift lead, Jennifer Patterson called Julia Wiezbicki, a day shift blood banker, back in to help.

The blood bank at DSH was informed the blood supplier had “logistic issues” and the trauma centers would take priority. In other words: DSH was not getting more blood.  Pathology swiftly gave approval to give O positive in lieu of O negative to all male patients and to give O positive to all female patients once the supply of O negative ran out. DSH had a total of 37 units of type O blood on hand and over 100 victims in the ER.

Jennifer coordinated with the ER and OR to only use emergency blood if absolutely needed, and to return it after patient triage and found to be hemodynamically stable. With help from laboratory professionals, Michael Leonardo and Allan Luzon, along with Julia Wierzbicki, all 37 units of type O blood were setup for emergency release.

Julia handled running types and screens while Jennifer handled distribution and inventory of emergency uncrossmatched blood. The angels were watching over us that night, because at 4 a.m., we still had 33 units of type O blood on the shelf, and the crisis was over.  The doctors and nurses were critical by making those critical decisions and follow-up phone calls.

Jennifer recalls one trip to the ER to deliver emergency uncrossmatched blood:

“I wasn’t prepared for what I saw. People, beds, blood everywhere. Men were running around without shirts because their shirts were tourniquets for the victims – total chaos. The hospital badge around my neck made me a target for those needing assistance. That was the hardest part. We are trained from day one that no matter what you are doing you stop and help anyone who needs it.  I had life-saving blood that needed to be delivered and I had to walk by those in need. I had to keep going…it felt horrible….because they had no way of knowing I was on a different mission.”

In the laboratory after dealing with the blood crisis, things were settling down and running smoothly. The blood bank might have gotten the spotlight, but the rest of the medical laboratory still needed to function. Michael and Allan were running the show, taking care of hematology, chemistry, all the daily maintenance, QC, and other required work.

By 4 a.m., the crisis was wrapping up. The Code Lockdown had ended. Of nearly 500 people injured, DSH had received a total of 105, more than any Level 1 Trauma Center in the Valley had received.  Of the 105 victims, only four passed away. The medical laboratory helped save 101 souls.

An (MCI) occurs when “a destructive event causes so many casualties that extraordinary mobilization of medical services is necessary.” During an MCI, it is understood that the emergency department (ED) and all of its personnel must be prepared to handle and prioritize the care for the (usually) massive patient volume that occurs in such a short span of time. Typically, the first 24 hours are critical to saving lives. While it may be known by most that the physicians, nurses, and other front-line responders in the ED are in critical demand during these events,  we must not forget the vital role that the medical laboratory  and its highly trained personnel in laboratory medicine play during an MCI and other emergencies.

Learn more about this lifesaving profession today and share it with everyone. We just might end up saving your life one day!

Click here for the full story. (with permission).

Rodney E. Rohde, PhD, MS, SV/SM/ MB(ASCP)CM received his Bachelor of Science (microbiology) and Masters (Biology, emphasis in virology) degrees from Southwest Texas State University (now Texas State University). Dr. Rohde received his Ph.D. in Education in 2010 (Adult Professional Community Education) with a focus on Methicillin Resistant Staphylococcus aureus (MRSA).

Dr. Rohde is the Program Chair for the CLS Program, and holds the rank of Professor in the College of Health Professions. He also serves as Associate Dean for Research for the College of Health Professions.

San Marcos Daily Record

(512) 392-2458
P.O. Box 1109, San Marcos, TX 78666