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All Children’s Hospital is always preparing for the unthinkable

The attack on a Texas school is a sobering reminder to those who have to plan to respond to a mass casualty event in Tampa Bay.
Johns Hopkins All Children's Hospital at 501 Sixth Ave. S in St. Petersburg.
Johns Hopkins All Children's Hospital at 501 Sixth Ave. S in St. Petersburg. [ DIRK SHADD | Times ]
Published May 28|Updated May 31

ST. PETERSBURG — A doctor dedicated to saving children, Meghan Martin shared in the nation’s horror and grief when 19 students and two teachers were shot and killed Tuesday at a Texas elementary school.

But as the pediatric emergency medicine physician for Johns Hopkins All Children’s Hospital, that very scenario has played out in her head dozens of times.

It’s her job to ready the hospital and her colleagues should the unthinkable happen here.

All Children’s Hospital is one of five Florida hospitals designated as pediatric trauma centers. In the event of a school shooting in Pinellas County, it will likely be the primary destination for wounded children.

The hospital runs frequent drills for mass casualty events including chemical spills, biological attacks, hurricanes and active shooter scenarios, Martin said. Emergency plans detail how much emergency medication to have on hand; what surgeons are available and when to call in more; and where to stage temporary morgues and emergency operating tents — and they’re revised after almost every national incident.

It may not be possible for a hospital to ever be completely prepared for a rush of patients with traumatic, life-threatening injuries, Martin said. But the frequency of mass shootings, and Florida’s vulnerability to hurricanes, means the hospital’s planning and drills must be more than just a theoretical exercise.

“It’s not if, but when,” she said. “I want our hospital to be taking care of kids to the best of our ability. If they make it to our hospital, I want them to be survivors.”

‘How many can you take?’

The Tampa Bay region has five designated trauma centers. During normal operations, they offer a specialized and expensive level of care for serious injuries like severe burns and gunshot wounds. They must have a trauma surgeon in the hospital at all times and be able to call in specialists like neurosurgeons and orthopedic surgeons within 30 minutes.

Those trauma centers, such as All Children’s Hospital and Tampa General Hospital, would likely bear the brunt of a sudden influx of seriously injured patients from a mass casualty event.

The call about where to send patients lies with first responders who provide dispatchers with the first reports on casualties. Which hospitals they’ll be sent to depends on the location of the incident and the capability of nearby hospitals.

Meghan Martin, M.D., Johns Hopkins All Children's Hospital
Meghan Martin, M.D., Johns Hopkins All Children's Hospital [ ALLYN DIVITO | Johns Hopkins All Children's Hospital ]

Typically, paramedics responding to a disaster with multiple casualties would triage victims, Martin said.

Patients will be prioritized based on the severity of their injuries and how quickly they need medical care. Red means severe injuries and needs care quickly to survive. Yellow patients need care but could wait an hour or two. Green are the walking wounded — they may have suffered cuts or a broken arm, but they can wait. The same triage procedure is used to care for patients after events like multi-vehicle accidents.

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“They will often give us a call — we have three red patients and 12 green patients — how many can you take?” Martin said.

‘A process in that seeming chaos’

There are lessons in every tragedy.

After the 2017 Las Vegas mass shooting that killed 59 people, it emerged that 90% of the injured were taken to the nearest hospital in pickup trucks and cars by other survivors. Those drivers had no idea whether the hospital could handle that many trauma patients.

The Orlando Regional Medical Center was so close to the Pulse nightclub after the 2016 attack that killed 49 that some of the wounded arrived without any triage taking place. Doctors set up triage in the ambulance bay and arranged for patients to go straight to operating rooms, helping to avoid a bottleneck of victims needing medical treatment.

Findings like that are detailed in so-called “after-action” reports produced by hospitals, first responders and law enforcement that analyze their successes and failures. Martin reads those looking for ways she can better fine-tune her hospital’s response.

That has led to refinements such as having extra scissors available in the emergency room to cut clothes off patients and extra magic markers so medical staff can write down a patient’s name and vital signs when there isn’t time to log that information electronically. The hospital must also plan for an influx of parents who will be beyond anxious to know whether their child is alive and safe.

“We have to make sure we have a process in that seeming chaos,” Martin said. “That our patients are getting the best care we can offer with the resources we have.”

When the number of casualties is high, agencies from neighboring communities including fire-rescue, law enforcement are likely to be called for assistance with the county’s emergency management office acting as coordinator.

Hillsborough County has five levels of mass casualty procedures based on the number of victims. A Level 1 event has between 7 to 10 victims. A Level 5 event at Level 1 to anything over 1,000 for an event like a stadium bomb.

On the scene of any mass casualty event, Hillsborough County Fire Rescue medics and personnel would report the number of casualties to 911 dispatch, which would work with hospitals to see how many patients they can take. Triage and transport officers would then make decisions where to transport victims, said Katja Miller, operations section chief for the county’s Office of Emergency Management.

The bigger the disaster, the bigger the response. The collapse of the Surfside condo tower in Miami in June 2021 was considered a Level 4 event with 100 to 1,000 victims. Miami-Dade County emergency management officials reached out to the state to seek specialists, including search and rescue teams.

Joseph Ibrahim got the call to report to work at 2:15 a.m. after the Pulse nightclub shooting.

The director of surgery for the Orlando Health Medical Group, which owns Bayfront Health St. Petersburg hospital, has taken part in drills for mass shootings and other disasters there. High school students serve as mock patients.

The preparation made a huge difference, he said. But there is always the unexpected.

“At one point there was a fear that there may have been more than one shooter as gunshot echoes were carrying to the ambulance bay, he said.

Medical staffers learned that family members waiting for hours for news might need medical attention themselves.

Ibrahim recalls that the last mass casualty drill performed at Orlando Regional Medical Center before the Pulse attack was for a school shooting. Watching the images from Robb Elementary School in Texas, he thought about the children and first-responders and that they had probably drilled for that unthinkable day.

“Given what we went through six years ago it’s heartbreaking,” he said.

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