One critically injured young man made it to the operating room at University Health Kansas City within minutes after being hit. Had he not been triaged at the scene and rushed to the Level 1 trauma center, he would be dead, said Dustin Neel, medical director of the hospital’s trauma program.
Crews also prioritized rushing a woman, the second to arrive at University Health with a penetrating gunshot wound, to make sure she got immediate surgery.
Both patients remain in critical condition at the hospital, formerly known as Truman Medical Center, but doctors said both are improving.
“I’m not surprised our care went the way it did,” Neel told reporters at a Thursday afternoon press conference, “because of the way we train for it.”
The shooting that erupted at the end of Wednesday’s Chiefs parade and rally tested a disaster plan that meshed together multiple hospital systems, first-responder agencies and public health departments.
Under the umbrella of the Kansas City region’s Health Care Coalition, people at the scene rushed to sort out who needed to get to an operating room most quickly. Minutes and seconds mattered.
Then ambulances whisked the wounded to the care of surgeons who’ve refined their skills for these situations partly from dealing with Kansas City’s steady drumbeat of gun violence. Similarly, disaster response plans across the country have become more formal and rigorous in recent years in response to the seeming regularity of mass shootings.
Just as they had been at last year’s Super Bowl celebration, at the NFL Draft festivities and at other large public gatherings, parts of the coalition stood at the ready all day as Chiefs fans and players celebrated. They watched and waited, prepared to act if the worst happened.
“You hope it doesn’t,” said Carolyn Wells, chair of the Regional Homeland Security Coordinating Council for Hospitals. “But all of that planning and training clicked into place.”
Action at the scene of parade shooting
When word came that shots had been fired on the west side of Union Station, first responders flew into action. They treated and triaged patients at the scene while hospitals triggered plans to get patients treated.
The Kansas City Fire Department had paramedics at the scene — some within 40 feet of the shooting — who treated victims and had them on ambulances headed to hospitals within 10 minutes.
University Health, the closest Level 1 trauma center, got the first two patients who had life-threatening injuries, six others with gunshot wounds and four others with non-gunshot injuries.
Other victims were taken to three of the area’s other Level 1 trauma centers: Children’s Mercy Kansas City, which took care of 11 children, 6 to 15 years old; University of Kansas Medical Center; and St. Luke’s Health System.
Avery B. Nathens, medical director of trauma quality programs with the American College of Surgeons, said hospitals plan for incidents like this by drilling and trying to plan for nightmares.
Hospitals hold drills where staff members across the hospital — and often throughout a region — simulate mass-casualty events. And they conduct “tabletop” exercises where they talk through various events and how they might be handled. Behind all that, Nathens said, are policies and procedures that ensure the lessons learned through the drills are put into action when an event actually happens.
Even a trauma center like University Health that has lots of experience treating victims of gun violence would not be prepared for a mass event if they didn’t plan for it, Nathens said.
“It is quite different than a typical Friday or Saturday night,” he said. “(Then) you might experience multiple gunshot wounds coming in, but they don’t come in all at once. It’s the number of patients per minute. … It’s not so difficult from a medical perspective. But just making sure the team is ready and able to act in a very short timeline is what matters.”
Every practice run and planning discussion — and certainly real events like Wednesday’s shooting — will give hospitals a chance to refine their plans, he said.
Hospitals typically have an incident command where the cascade of events necessary to handle a mass trauma begins, Nathens said. Once word hits that a large number of patients are coming, hospitals need to make sure enough surgeons, nurses, anesthesiologists and radiologists are on duty.
Then they need to be ready to triage the incoming patients — quickly. And planned operations need to be called off to make way for trauma victims.
The crush of patients often comes amid a fog of unreliable information.
“We don’t really know what’s happening,” said Nathens, a professor of surgery at the University of Toronto and medical director at Sunnybrook Health Sciences Centre in Toronto. “So we prepare for the worst.”
What happens immediately after a shooting can determine whether a patient survives, Nathens said. Ideally, crews triage patients at the scene, so that those with with the most severe injuries get whisked away by ambulance soonest to the closest trauma hospital.
That’s what happened at Wednesday’s parade shooting, with Kansas City Fire Department EMS already on the scene and volunteer doctors on hand at a nearby medical tent.
“The way those kids came to us triaged, beautifully packaged, allowed us to treat every single one of them in a manner that nobody else can do,” Children’s Mercy’s Chief Nursing Officer Stephanie Meyer said. “The tragedy in this community was met with strength, compassion and absolute preparedness.”
The American College of Surgeons verifies that Level 1 trauma centers have met established standards, and in Missouri, the Department of Health and Senior Services designates them as Level 1 centers. University Health just completed the process to renew its Level 1 designation in December.
The impact across health care
The ACS placed extra emphasis on preparing for mass-casualty events when it updated its standards in 2022.
“Compared to a decade ago, centers have really, really improved their ability to respond,” said Nathens. “I would say it’s in part because of experience, and it’s in part because of the focus on this. It could happen anywhere, anytime.”
With gunshot deaths at record high levels, doctors need to know how to deal with gunshot victims. The U.S. Centers for Disease Control and Prevention says that 2022 averaged almost 54 firearm homicides a day in the country.
Dr. Allan Philp first treated gunshot wounds as a medical resident in Knoxville, Tennessee. A few years later, he entered the Air Force as a combat surgeon in Iraq and Afghanistan and got a lot of practice with gunshot wounds and even more severe injuries, such as those caused by rocket-propelled grenades.
“That volume that you see in the military is many times what you’d ever see in the civilian sector,” he said.
Philp, now the chief medical officer at Allegheny Health Network in Pittsburgh, said the medical field does a better job of treating gunshot wounds even before patients show up at the hospital than when he started in 2001.
Much of that, said Philp, is due to Stop the Bleed, a campaign from the American College of Surgeons to train first responders and the general population on how to control severe bleeding. Two of the tools come straight from the military — tourniquets and hemostatic gauze, which contains clotting agents.
But just as important as the tools is speed. The campaign first targeted law enforcement officers, who might arrive at a scene before emergency medical technicians, and later expanded to teachers, librarians and the general public.
Once an ambulance arrives, gunshot survival rates have improved because victims are now generally taken to Level I trauma centers instead of the nearest emergency room.
“You play like you practice. The team is comfortable with it,” Philp said. “You know this is Step One through 20 when we get a gunshot wound victim, as opposed to saying we only get these twice a year, someone get the book out and see what the steps are.”
Decades of trauma treatment have revealed new tactics. Surgeons know more about fixing veins and arteries damaged by gunfire and to give a trauma patient whole blood rather than products broken down into its component parts.
“There’s a military saying, ‘What you’re bleeding is blood,’” Philp said.
A mass-casualty event with so many children can present a challenge. For one, kids are small. A nurse trained to insert an adult IV will likely struggle finding a vein on a 3-year old, Philp said. The average emergency room doctor is unlikely to know the correct dosage for a 25-pound 2-year-old or a 90-pound 11-year-old by memory, like they would for an adult. Instead, they would need to look it up, wasting precious time. In this case, Children’s Mercy was close at hand.
Hospitals learn every time they go through an event like the one that happened Wednesday in Kansas City about how they could have responded differently. That helps inform their ongoing plan.
When members of the Health Care Coalition held a debriefing Thursday to talk over how the response had gone, most agreed it had gone as best as it could have, said John Whitaker, public health emergency response coordinator with Missouri’s Office of Emergency Coordination, in the Department of Health and Senior Services.
“The response itself went very well,” he said. “You can’t always prevent these things from happening, but when they do if the teams can react quickly (it will help) … There were a lot of injuries that were critical that, you know, the teams that were there jumped right into action and prevented any further death.”
This story was originally published on the Kansas City Beacon , a fellow member of the KC Media Collective.
