Besieged in the Bronx: Lessons from an In-Hospital Mass Casualty Report of a single institution's response to the largest mass casualty event in a hospital in the history of the United States.
Kristen Bridges-Tran1, Pratibha Vemulapalli4, Allen Deborah2, Bentley John3, Brian Gilchrist1
1Surgery, Richmond University Medical Center, Staten Island, New York, United States, 2Orthopedic Surgery, Bronxcare, Bronx, New York, United States, 3Surgery, Bronx Lebanon Hospital Center, Bronx, New York, United States, 4Surgery, Brooklyn Hospital Center, Brooklyn, New York, United States
Objective: An active shooter in a hospital is an emergency extraordinaire. We report a single institution"s response to the largest mass casualty event in a hospital in the history of the United States.
Design: Review of notification, flow, and key elements of the day"s dynamic after hospital attack by a lone gunman was conducted. The review included outcomes on seven victims and assailant.
1. 32F- family medicine staff physician- shot in the heart- dead at scene
2. 38M- physician in training- shot in the left wrist- multiple carpal bones obliterated, median nerve singed but intact- loss of full range of motion of left wrist
3. 31M- medical student- shot in the abdomen- greater omental and gastro ligament tears, ruptured rectus sheath
4. 29F- intern- shot in the neck- L sternocleidomastoid mastoid muscle injured, obliterated distal L clavicle. No neurovascular injury
5. 29M- intern- shot in the abdomen and chest- grade IV liver laceration and right lung laceration- prolonged ICU stay, ERCP for bile leak, discharged home after 3 weeks
6. 26M- medical student- shot in the head and right knee- comminuted intraarticular fracture of right knee, subdural hematoma and intraparenchyal brain hemorrhage- extubated and following commands
Results: "Code Silver" announced: open display of a weapon. Concise, known, and published chain of command implemented. All house staff to Emergency Department (ED) via text blast. Operating room (OR) notified. Injured to ED, then triaged to OR by Surgeon-in-Chief. NYPD stationed throughout OR. Senior surgeons controlled key vantage points during attack with triage from the ED and OR control desk. Five operative incidents and one fatality ended on the shooter"s suicide.
Conclusions: Success favors the prepared. The response to attack, readiness of medical personnel, mitigation, and recovery have brought the following recommendations:
1. Single entrance access
2. Armed, professional guards at all entrances
3. Camouflage metal detectors
4 .Mandatory, recurrent hospital-wide active shooter training, mock and table top
5. Published physician chain of command
6. Intercom code system known to all hospital personnel indicating a weapon is openly displayed
7. A "no fly" list of former employees who are prohibited on premises
8. Stop the Bleed training with kits on every floor
9. One voice, one face to disseminate information
Injuries sustained by victims
|Patient||Age (years)||Gender||Occupation||Injury||Operative Findings||Disposition|
|1||32||F||Family Medicine Staff Physician||Shot in the heart||N/A||Dead at scene|
|2||28||M||Physician in Training||Shot in the left wrist||Multiple carpal bones obliterated. Median nerve intact, but singed||Left wrist: loss of full range of motion|
|3||31||M||Medical Student||Shot in the abdomen||Greater omental and gastro ligament tears. Ruptured rectus sheath||Uneventful post-operative recovery|
|4||29||F||Intern||Shot in the neck||Skin and left sternocleidomastoid muscle injured. Obliterated distal left clavicle. No neurovascular injury||Uneventful post-operative recovery|
|5||29||M||Intern||Shot in the abdomen and chest||Grade 4 liver laceration. Right lung laceration||Prolonged ICU stay, ERCP performed for bile leak; discharged to home three weeks post injury|
|6||26||M||Medical Student||Shot in head and right knee||Comminuted intra-articular facture of the right knee. Subdural hematoma and intra-parenchymal brain hemorrhage||Extubated; able to speak and follow commands|
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