Hospitals leaders in Orlando and Las Vegas never could have predicted that on these random nights they’d see dozens upon dozens of gravely injured patients flooding their hallways with injuries unlike anything they’d seen.

But that was just the case for Orlando Regional Medical Center and Sunrise Hospital and Medical Center — two of the biggest responders to this country’s two largest mass shootings in modern history. Thankfully, both institutions had practiced mass casualty drills just before the incidents — the Pulse nightclub shootings in Orlando, Fla., in June 2016 and the shootings on the Las Vegas Strip last month — and caregivers were ready, according to leaders who spoke during a recent webinar hosted by the American Hospital Association.

Michael Cheatham, M.D., a trauma surgeon with Orlando Health, said that all hospitals must be prepared, under the assumption that something similar could happen in their own communities.

“I would argue that it is not a question of if your hospital is going to be subjected to such an event like this, it’s just a question of when,” he said. “Our society is changing, the world is changing, and, unfortunately, we are seeing these mass casualty events with increasing frequency.”

Cheatham, along with CEOs from HCA Sunrise Hospital and Medical Center and University Medical Center, both in Las Vegas, shared some of the key lessons learned from the incidents, as part of the AHA’s ongoing Hospitals Against Violence initiative. The Orlando surgeon, for one, emphasized the importance of practice, practice, practice. He also urged clinicians to stick with their normal routines — using the same forms, procedures, etc. — when responding to a mass casualty incident.

“You need to rely on your training. And, as much as you can, you want to use your normal practices,” he said. “Disaster response is not a time to start doing special things and use special forms that people are not familiar with. You want to try and have people do what they normally do.”

The clinical management of such tragedies may be second nature for hospital leaders, but other aspects of the response were unexpected, leaders said on the call. These hospitals weren’t as ready for the swarms of media that showed up at their doorsteps, along with the number of victims’ family members who arrived, too.

With so many visitors spending countless hours at HCA Sunrise, CEO Todd Sklamberg said, people’s phones began dying, and the hospital had to seek out chargers. And, with the waiting room packed, staff had to shift those folks over to the hospital’s theater. There was also the toll taken on hospital staffers and visitors who suffered from severe trauma following the incident, and the hospital had to make sure that it had crisis counselors on hand to help all who needed it. “Family support was absolutely critical,” said Sklamberg, who personally visited the auditorium every 45 minutes to give updates.

Mason VanHouweling, the CEO of University Medical Center in Las Vegas, said hospitals must also be prepared for the presence of dignitaries, as his institution was visited by President Donald Trump and Las Vegas Mayor Carolyn Goodman, among others, adding more security concerns into the mix. Plus, the hospital received numerous donations and community volunteers in the weeks that followed, which is why the chief executive believed it was crucial to keep its communication channels open long after the tragedy ended.

“We actually had to set up a separate phone bank, just to handle the amount of calls and keep the lines open,” VanHouseling said. “Just to put into perspective how many phone calls were coming in, the vice president of the United States actually called into my office, and we weren’t able to take his call because we were so inundated. So, it’s vastly important to have a plan with the amount of phone calls and inquiries coming into your facility.”

The important lesson here is that these hospitals were ready for what transpired on those nights. ORMC received 44 victims the night of the Pulse nightclub shooting. Nine died because of the severity of their injuries upon arrival, but all 35 patients who made it to the operating room survived. HCA Sunrise, too, had some 230 patients in its emergency department at one point, with more capacity available and no blood shortages in spite of performing more than 80 surgeries.

“By far, this was the most horrific and sombering experience of my life,” said Sklamberg. 

Later, he added: “With that said, and obviously we wish we were not on this call to report what happened, I have never been so proud of Sunrise Hospital, but more importantly the hospital industry and health care industry in Las Vegas and the entire city. How this community pulled together was unprecedented.”

For more on hospital lessons learned from mass casualty incidents, be sure to review the recording of this webinar and Hospitals & Health Networks' March cover story on the topic. You can also read more about the AHA’s Hospitals Against Violence initiative at www.aha.org/violence.