Mass Shooting: How the University of Colorado Hospital Emergency Department Responded

The Univ. of Colorado Hospital security cameras captured this image of four police cars arriving in the ambulance bay, each bearing one or two victims. BeckyDavis, RN, charge nurse on duty that night, with arm extended, is directing emergency staff. (Image Credit: University of Colorado Hospital)

After gunman James E. Holmes opened fire in a theater during the midnight showing of the new Batman movie, the 58 victims that survived required expert medical intervention. The Emergency Department (ED) at the University of Colorado Hospital, a level II trauma center, received the bulk of the victims. This is the story of how they responded.

Justin Oeth, RN, BSN, associate ED nurse manager, was working the night shift. Just after midnight, he noticed some chatter on the police radios, followed by a call from police dispatch asking how many victims their ED could take. “That was our first clue that something had happened,” Justin says. About 10 minutes later, the first wave of victims began to arrive.

April Koehler, RN, BSN, ED nurse manager, was at home when her pager went off. The subject line read only “mass shooting.” Almost immediately, she received another text from Justin, telling her that the ED was receiving numerous gunshot victims. April rushed to the hospital, not knowing what she would find there.

As the first victims began to arrive, the ED staff met them in the ambulance bay. One squad car was followed by another and another, each bearing one or two victims in the backseat. In all, the University of Colorado Hospital received 23 of the injured, one of them dead on arrival. All of the 22 victims who arrived at the ED for treatment survived.

Sensing the magnitude of the event, the staff called a disaster code and performed disaster triage on the victims. About half of the victims were critical. The ED was already full when news of the shooting broke. Because the hospital was at capacity, several inpatients were boarding in ED treatment rooms. To accommodate the shooting victims, the ED team worked in the ambulance bay and trauma rooms, cycling victims in and out of these areas based on their needs. A storeroom was turned into a treatment room and stretchers lined the hallway.

At about this time, April arrived in the ED. Pat Conroy, the hospital’s safety officer and incident commander, and CNO Carolyn Sanders, RN, PhD, were already there. “I took one look at the ED and I knew this was big,” April says, “but I knew that we were going to get through it.”

Support from the Hospital

April was assigned the role of ED branch director; Pat and Carolyn would set up a command center. It was clear that the ED staff was going to need support. April quickly touched base with the physicians and then talked with Becky Davis, the charge nurse on duty, to check nurse staffing. Each department did its own call down. Some staff came in without being called. Neurosurgeons, chest and vascular specialists, and orthopedic surgeons raced into the hospital along with 100 other staff—everyone from nurses and physicians to dietitians and maintenance personnel.

Nurses and residents already on duty were reassigned from other floors. The ICU had been alerted and had sent nurses and code carts. April contacted Central Supply to replenish supplies. A pharmacy tech and pharmacist helped administer narcotics and other medications throughout the night. Meanwhile, the command center had arranged to move eight inpatients from the ED to the PACU to make room for the victims.

Operating rooms were opened to handle the nine surgeries that followed. Extra security personnel were also on the scene. “We wanted to be sure that we were safe on the medical campus,” April explains. Every entrance except the main ED entrance was locked down.

In addition to caring for the shooting victims, the ED had to continue to function for incoming emergency patients. Several were in the waiting room and two other critical patients came in while the victims were being triaged. “We were managing the disaster and still functioning as an ED because we continued to have serious medical patients coming through,” April recalls.

When it was over, the ED staff had performed 150 X-rays and CT scans within two hours of the event. They also managed countless family and friends looking for loved ones. The command center’s hotline fielded more than 2,000 phone calls that night. By 10:30 a.m. the next morning, only one victim remained in the ED. The others had been discharged home or sent to the OR, the ICU, or to the floors.

How Preparation Made the Difference

The shootings proved a test of the ED staff’s skill and teamwork—but the team was prepared. The disaster drills they had practiced served them well. “This hospital is dedicated to being prepared for disasters,” April says. “Since 9/11, I’ve attended numerous disaster training programs, and we do exercises every month that involve every discipline so we are ready if something happens.”

After the crisis was over, the hospital conducted an immediate debriefing for the ED staff. Several additional debriefings were held during the next week. Soon after, debriefings began to expand beyond the ED to the OR and ICU staff. Sessions were set up as open forums with staff members discussing what had happened, what they saw, and how they felt. “Debriefing offered a huge coping mechanism for our staff,” Justin says.

April describes the experience as probably the hardest thing the staff will ever go through in their lives. “We cared for many victims that night who needed to tell us their stories. It was hard to detach emotionally,” she says. “You can never underestimate the effect that an event like this has on the staff.”

Some things that happened that night will never be forgotten. Justin remembers talking to a victim who had critical gunshot injuries. She pointed to another patient and asked Justin to help him first. “He looks worse off,” she told him. “To see that kind of humanity after such an event is something I will never forget,” Justin says.

April will never forget the patients and their stories. She vividly remembers one young boy asking her what was going to happen to him. She told him that he was going to surgery. “He asked me if he was going to die,” April says. “I will always remember these patients asking me questions like this and the fear in their faces.”

Lessons Learned

One of the lessons driven home that night is that a facility has to be ready to handle whatever comes through its doors. April believes that communication and planning are key: “I had to think about what we would do if another wave of patients came in. How would we handle it? Where would we put them?” Shortly after the shooting, the ED was tested again when it received numerous victims from an apartment fire. April is confident of the staff’s ability to handle such situations—as she was the night of the shooting. “We are prepared to get through this,” she says.

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