HJNO Mar/Apr 2025

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2025 11 Maslanka It's blurry. We have definitions because people like definitions, people like numbers. We give them five to 10 for a small, 10 to 20 for a moderate, greater than 20 for a large. But you also have to look at the context of the incident. Sometimes it's two cars crashing into each other and there are eight trauma patients coming in — that would mean a small. Sometimes, if we heard about something along the lines of a mass shooting in a very crowded area of the French Quarter — which, luckily, isn't something that's happened yet — that's where we're going to start looking at moderate or large. You hear something along the lines of a huge explosion in a very crowded, populated area, and we're definitely going to pull the trigger on activating a large. It's looking at the incident; it's looking at the rough numbers you have — they're always rough to begin with — and deciding on the level you think you need to activate. Elder And I think with that it's: what are the resources you need? For example, a small MCI, we really have everything at the hospital that we need. We need to make sure people in the hospital know this is going on to help clear up some space, to get some extra hands, and make some things happen; but we don't need to wake people up at home or bring anybody in from the outside. Once we escalate to the moderate or the large, that's when you're going to need some additional resources, whether that's more nurses, more doctors, more surgeons, more ORs open, or just that administrative support to help deal with everything going on. And that's really when I think about the moderate or large, because that's what starts to wake people up. We also did it in a very strategic way — we don't want to wake everybody up because we need to be able to function with what's happening now, get the right leadership to know that this is going on, then they can choose who they need to bring in to help support the incident. Because at the same time, when we're talking about 3:00 or 4:00 in the morning and handling what's happen- ing then, this really became an all-day inci- dent. You have to be able to handle what's coming in and then be ready at shift change at 7:00 a.m. to have people that are fresh to come in so that they can stick it out for the next shift and continue that cycle. You want to make sure that you're alerting and waking up the people that you need. And the people that you don't need immediately, let them sleep, because we're still going to need themwhen they come in at 7:00 a.m. to take those patients and to continue the care of the patients moving forward. Maslanka We've coordinated with each department so that they provide a notification list — who do you want to know in the event of an incident?Then they know to activate their phone tree based on the information that they get, so they can call in everyone from their department they know needs to come in. Editor John Nickens [LCMC Health president of hospital services and chief executive officer of UMC] was telling me earlier that you were getting a lot of rumors coming in, and that you thought it might've been much larger than it actually was. Did you have to send people home? Did you prepare for too many and then back off? Elder No. When I first got here in the morning — my phone went off just before 4:00 a.m. — my first thought was. “Is this really something that somebody put in the wrong alert?” But I knew that it was what it was, and it was real, so then I came in quickly. I don't live too far from here. At the time I got here, we had about half the patients already here. Now, we didn't know at the time that it was half; we just knewwe had what we had and that there were more patients coming. We didn't know what had caused it. Initially, we heard that there were maybe two vehicles and there was some sort of shooting, and maybe they were shooting at each other. Then somebody drove into the crowd. That was initially what we heard. Pretty quickly, I spoke to EMS on scene who told me what's going on: we have these patients, and we have over 10 people that are deceased on scene. We knew there was more happening on the scene. We still didn't really know what was going on yet. And then, when we first started caring for the patients, like Dr. Grei- ffenstein said, one of the early patients was critical and needed to go to the OR imme- diately. The backup surgeon that was there took the patient immediately to the oper- ating room. When I walked into that emer- gency room, it was actually flowing really well. I remember walking through the back doors; I could see all the way through the ER, so I knew that things were happening and we weren't overwhelmed with people because there was space. I talked to one of our senior residents who had a list and was keeping track of who had come in and what was coming in. She pretty quickly told me what was going on. We saw the types of injuries that we were dealing with. We knewwe had a lot of orthopedic inju- ries pretty quickly. One of the first things we did, in addition to talking to our emergency department leadership and calling in a few extra nurses, is that I talked to one of our VPs who's over radiology and said, "Hey, look, I think we're going to need some more X-ray techs because we have a lot of films to get." He said, "No problem. I'm calling." I literally walked right back into the main part of the ER, saw one of the supervisors, and told her. And she said, "I already got it. He's here, the first one's here." He was already with her, and the departments had already independently started to ask for what they needed, and we already had people coming into the hospital to deal with it. Editor Some of the patients were diverted to Ochsner. Was that because you couldn't handle all of them?