Such raw emotion, however, was on full display last week, during a keynote presentation on the final day of the Institute for Healthcare Improvement. This past Monday marked six months since the Pulse nightclub tragedy in Orlando, Fla., the deadliest mass shooting in U.S. history. June 12, 29-year-old Omar Mateen killed 49 individuals and wounded 53 others at the gay nightclub, before he was killed by police. (See video with the doctors at the scene below.)

Orlando Regional Medical Center — a Level One trauma center that’s part of Orlando Health system — is located just a few short blocks from the nightclub, and it was there that scores of victims started arriving that night. All told, paramedics rushed 44 victims to ORMC with gunshot wounds, and 35 treated there survived their injuries.

Five leaders from Orlando Health took the stage last week to share their experiences and lessons learned from the tragedy in a somber and emotional discussion of the events that transpired. Elisabeth Brown, R.N., an ED nurse, described the initial scene in the early-morning hours of that day.

“Our first patient came in and then we got to work. That’s what we do in the emergency department. We get to work,” she told attendees. “We work together and things go well. So we were starting, and then another patient came in. And then another patient came in. And another patient came in, and they just kept coming, and they had wounds like I had never seen before, and I started to get really scared, and I looked in the other nurses’ eyes and they were scared, too.”

As the scene unfolded, with death and despair in every direction, Brown remembered, “looking across at one of my best friends and saying ‘I love you.’”

Thankfully, just three months prior to the incident, Orlando Health had conducted a communitywide mass-casualty drill to prepare for such a situation. Mark Jones, senior vice president of the system and president of ORMC, said they would not have been so successful in avoiding further fatalities without such practice.

“There is no question that the work that was done that day helped to save lives,” he said. “Hospitals, we would really, really urge you to practice incident command. Drill often. Do the tabletop exercises as often as you can. You need to do this, in our opinion, when it’s not convenient. You always think that, you know what, the hospital is too busy. We would urge you to drill when you’re busy. Drill at night. Practice on the weekends, because what comes out of that are lessons and learnings and gaps that are identified that allow you to address them and prepare.”

He also urged hospitals to build relationships with both police departments and emergency medical services. Speakers, too, emphasized the importance of caring for the caregivers like Brown, who are left traumatized after such incidents.

I spent a few minutes after the session, speaking with Chadwick Smith, M.D., a trauma surgeon at ORMC, along with Michael Cheatham, M.D., chief quality officer of surgery.

For more on how hospitals are working to both prevent and treat violence in their communities, be sure to check out the American Hospital Association’s resource page on the topic. Plus, watch for continuing coverage on the AHA’s Hospital’s Against Violence initiative in the print edition of Hospitals & Health Networks, and at