Ring…ring… a phone call broke the stillness of the night. Calls in the middle of the night are often filled with bad news, but such calls are not foreign to doctors. This one though, was difficult for most doctors to have been prepared. Mass casualty training held a month earlier at Orlando Regional Medical Center (ORMC) had come to life for Northeast Ohio Medical University graduate, Andrew Loudon, M.D.
Dr. Loudon, who serves as chief surgical resident for the blue trauma team at ORMC, was awakened from his vacation early Sunday morning, June 12, to help save victims of a shooting at the Pulse night club.
“I got there in time for the second wave of patients,” says Dr. Loudon. “It was my job to do secondary evaluations on people in the ER who had been triaged to the different wings of the hospital and then start my rounds on the blue trauma floor. I needed to make sure people who were admitted were still stable.”
Besides Dr. Loudon, three other NEOMED College of Medicine alumni were at work at ORMC: Dr. Ashley Frommelt, a fourth-year surgical resident; Dr. Kenneth R. Lee, M.D., FACS, plastic and reconstructive surgeon; and Dr. Charles F. Hunley, M.D., a critical care physician.
Loudon and the hospital staff used a series of colored tags attached to the individual to determine where patients needed to be sent. Green meant isolated gunshot wounds, but able to wait for surgery. Yellow meant stable, but in need of surgery for possible abdominal bleeding. Red meant critical condition and in need of surgery…and those with no pulse would receive a black tag, which meant deceased.
Preparing for the Worst
At the Rootstown campus, NEOMED students in the emergency medicine interest group recently held a mass casualty training in partnership with the Canton Public Health Department and Summa Health’s simulation medical director Rami Ahmed, D.O, FACEP. In this training, the students learned the triage tagging system and how to triage using the acronym S.A.L.T. which stands for: Sort the victims based on the level of severity; Assess who can be saved and who you may have to move on from; identify Life- threatening injuries; and provide Treatment/transport.
“In a mass casualty situation, treatment is very different from a hospital,” says Dr. Ahmed. “There are often limited resources and few physicians. You have to realize you can’t save everyone.”
At the NEOMED simulation, students were given two scenarios: a school shooting and a bomb in the school that had been defused by security (aka NEOMED’s police). Unlike Dr. Loudon, in his real-life situation, the students were guided by the watchful eyes of faculty overseeing their decisions.
To make the scenes realistic, each scenario included fog machines; an actual working ambulance; sound effects; and students covered in moulage (fake wounds) while portraying the victims of the mass casualty.
A debriefing was held with students after each scenario to discuss ways to improve on the skills taught that day. A doctor’s level of training can make a difference in how many lives they save in the field, Dr. Ahmed told students.
“By doing these seminars, students can understand how complex this type of learning is,” says Dr. Ahmed. “Simulation training is very different from a student’s first or second year of medical school because now they are practicing what it’s like to be in the field working with a screaming, wounded patient,” he notes.
NEOMED has offered disaster training since 2011 as part of the third-year boot camp required of medicine students before they begin clerkships.
A Practiced Communicator
In Orlando, Dr. Loudon had another responsibility: breaking good and bad news to victims and their families. He credits the extensive patient interviewing experience he had at NEOMED with helping him be more comfortable talking to victims.
“NEOMED really taught me how to hold a professional conversation with a patient,” said Dr. Loudon. With practice, he learned to be more comfortable interacting with patients both verbally and non-verbally. “This included making sure my body language matched what I was saying.”
Such training takes place in NEOMED’s Wasson Center, where students practice interviewing with standardized patients (actors) who represent all areas of diversity including race, age, gender identity or expression, gender, national origin, sexual orientation and mental/physical ability.
Many of the victims in the mass shooting were gay, and Dr. Loudon shared information with their partners as well as their families. While gay partners have historically had trouble obtaining medical information in hospitals—especially before gay marriage was legal—Dr. Loudon says their protocol is to first discuss the information with the patient, then to share the information with those of whom the patient gives the physician permission to speak.
He tries to be direct but also empathetic when delivering news to family and partners. And while the large number of injuries and deaths in the Orlando shooting made the situation difficult, Dr. Loudon’s training prepared him to cope with practiced, steady and compassionate hands.