HJNO Mar/Apr 2025

ROUNDTABLE 10 MAR / APR 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS met and triaged as well. That's the role of the physicians in the ED. Primarily, the trauma surgeon on call is tasked with identifying people who have the highest degree of need — those persons who need, for example, life- saving surgery — and then going down from there. So, the system is set up, everything's in place, and then individuals have to identify the people with the highest acuity. And we have an entire trauma center behind it ready to take those on. At any point in time, we have a minimum of three operating room teams ready to go. That's more than most hospitals in the state, and one of those teams is always ready for a trauma. We can literally pull somebody from a car and have them on an OR bed and a team ready to go within five minutes. Beyond that, because all of these procedures are absolutely key and essential and are the framework of a response, there's also some- thing you can't teach and you can't make into a system, and that is the experience. These people in there every day, every night. We are extremely busy, and that hones our skills as a team — to have those quick responses to unusual situations. It went from a small mass casualty to something bigger and bigger and bigger, and it just blew up over the course of a few minutes, but at every point in time, the team was able to respond. Dr. Kevin Harrell was the trauma surgeon on call and called in his backup right away. All of the trauma surgeons got alerted that something was going on, and we were waiting, ready for them to come in, and didn't need to come in. But that's some of the institutional memory that is really essential — these folks know how to do this. Editor Did you say you didn't need to come in? Greiffenstein I didn't need to come in between 3:00 and 9:00 a.m. Editor So, what's the difference between a small mass casualty incident and a larger one? for incoming patients and open other areas for overflow patients. They also review their active patients and determine who can be moved elsewhere in case we receive an even larger influx than expected at the time. We practice this a lot, and this protocol's been in place for a while, so everybody's able to do this with a knee-jerk reaction. Elder Dr. Maslanka is really the architect of this for the hospital. She really spent a lot of time — years now — on what this looks like, howwe drill it, and then howwe tweak it on the back end as we've done this over and over again. One of the things that really gets us ready for this is the fact that we have that small MCI that we routinely use to get everybody in the habit of doing it. What that does, as we talked about, is alerts internally that something's happening. Other people, like some of us here, will get notified just to know that it's happen- ing but not to have to respond. What that does is to give the group in the ED and the trauma team that are getting these calls the ability to activate and start the MCI process on a more routine basis. It's not something that we forget about when we have a larger MCI like this — which, fortunately, doesn't happen very often — but we're used to the process. Then, when we have to escalate and it turns into a larger incident, we're used to going through that process. Elizabeth Lacy It's almost as if using these small MCIs as an internal relationship builder. This is what we need at this point in time, we're reaching out to you to let you know that this is what's going on so that when the big stuff happens, this is what this process is going to look like. Patrick Greiffenstein, MD There aremany tiers to this response, and what you're hearing is the macro tier — the system-wide aspect of it. I just want to point out, that then trickles down to the on-site, immediate response to each individual patient, or the immediate needs of each individual patient have to be said, "Okay, good. I'm glad we called it, and we're going to start sending people that way and notifying our other key leadership who needed to be on site, too." Editor This is not a drill. Baudouin It was not. Editor What were the first critical steps taken within the trauma center as patients started to arrive? Misty Dufrene, RN I wasn't there when it all started, but basically what we do is we just try to make space, because that's what you need. You need the space to be able to care for the patients. If it's a very busy night already, we have to move patients out of the ER, where our acutely trauma, acutely sick patientsare. And that's done by either getting the admitted patients upstairs or discharging who we can to create space. All of that started to go into play. And then they went from there and just started getting patients, and they came hot and fast. They came based on the calls, multiple patients per ambulance. And they were great at dealing with who we needed to get seen first. Editor How did you coordinate the team to manage the influx of patients with that short notice? I’m imagining you’re probably not fully staffed yet. Meghan Maslanka, MD We have a protocol in place for each level of MCI, and there are some basic concepts that you need for a mass casualty protocol. You have to recognize the incident. You have to put out an alert, and that alert is usually roped in with the notifications. You need notifications to tell other people that it's happening, and our notifications consist of an overhead announcement and a mass alert over the Everbridge system. Then, you reorganize your staff. We have predetermined roles for all the doctors and nurses in the ED — they move to those positions to get ready