Hospital disaster drills often focus on transporting patients to the emergency department and moving them into the appropriate operating room. And that’s where the drills stop. It’s what happens next that hospital leaders really need to focus on, particularly the emotional toll that incidents like the Pulse attack take on patients and staff, says Michael Cheatham, M.D., chief surgical officer for Orlando Health.
The hospital set up counseling sessions for its team members just four hours after the Pulse shootings. In conversations with those who treated victims of the 2012 Aurora, Colo., movie theater shooting, Cheatham learned that trauma can linger for a long time. “We’re fully cognizant of the fact that the disaster doesn’t stop the next day, and that we will continue to be looking out for the mental health of our team members for years to come,” he says.
Staff at Loma Linda University Health were similarly shaken after the Dec. 2, 2015, shooting that left 14 victims dead and 22 injured. The academic medical center accepted five of the shooting victims and feared the attack might spread into the hospital’s corridors. A week after the incident, staff huddled to debrief. That’s when they decided to bake cookies together for people outside the hospital who helped in the response. It was “therapeutic,” says Connie Cunningham, R.N., executive director of emergency and trauma services, and she hopes others dealing with the same kind of circumstances will find their own healing process. Too often, emergency physicians and nurses present tough exteriors when they’re crumbling inside, she says.
“As health care providers, we really need to start taking care of ourselves because everything you see becomes part of you, and it does affect you whether you want to admit that or not,” Cunningham says. “Self-care is really important, and I think Dec. 2 showed us that. You have to debrief the ugly out of your brain.”
Sometimes, certain strategies during the initial response can help to alleviate secondary stress later on, says Paul Biddinger of Massachusetts General. He’s a proponent of “micro zoning,” which involves placing a doctor and a nurse in a single ED room to wait for a patient, rather than in a hallway or other open area. This way, Biddinger says, they can focus solely on the patient in front of them, and allowing them to avoid experiencing some of the cumulative psychological trauma of seeing wounded patients whizzing by.
Mass General also found it crucial to offer support to staff immediately after the bombing, as well as in the short, medium and long term. “Because so far, we’ve found that basically all of it will be needed,” Biddinger says. Often, anniversaries of the attack can trigger stress in employees, and leaders should anticipate that some may ask for time off or for shifts away from sites that may trigger trauma.
Leaders must avoid the urge to push relentlessly toward business continuity in the wake of a mass casualty incident, says Alex Eastman, M.D., medical director of the Rees-Jones Trauma Center at Parkland Hospital and lieutenant and deputy medical director with the Dallas Police Department.
At Parkland, Eastman came into work the day following the attack and attempted to lead his weekly morbidity and mortality discussion on what had gone wrong or right at the trauma center in the past week. That quickly turned into a healing session to discuss the aftermath of the sniper shooting, and pressing on with the normal agenda just didn’t seem right. That doesn’t mean you have to shut down the ED and mandate that employees seek counseling, Eastman says, but you should provide a full array of therapy resources for employees — from casual peer gatherings to formal counseling — so that staff can heal on their own terms.
“You’ve got to build in time, deviate from your normal routine and get away from the idea that we have to continue business as usual, no matter what,” he says. “I think that’s really important, and it’s something that’s lost in most C-suites now. It’s actually not just about business. We’ve got to do a good job of taking care of each other so we can continue to take care of everyone else.”