It was 11:20 on a Friday morning when a bus of 50 high school students were rushed to Texas Children’s Emergency Center (EC) with gunshot wounds, blast and shrapnel injuries and psychological trauma. Physicians, nurses and other critical care teams worked quickly to attend to the victims’ injuries.
“It was a tense situation with lots of patients coming in with different diagnoses,” said Natashia Bush, one of the night shift managers in the EC. “One of our logistical challenges was to figure out how to get everything done in one room and still have the ability to triage the patients out of the room and get new patients in the room for emergent care.”
While the scenes played out in our Emergency Center looked real, fortunately, this was only an exercise. Texas Children’s emergency response plan was put to the test during a comprehensive mass casualty incident exercise on October 7, which included nearly 150 Texas Children’s staff and employees and about 150 members of the Houston Police Department SWAT team, Houston Fire Department Emergency Medical Services and 400 students and staff at Michael E. DeBakey High School for Health Professions.
The exercise involved mock shootings, an improvised explosive device and a hostage situation at DeBakey High School. Many of the shooting victims were then brought to Texas Children’s Hospital EC. The intent was to help assess the organization’s mass casualty incident plan, emergency communications, incident command structure and patient flow.
“I think Texas Children’s did a fantastic job during this drill,” said Texas Children’s Executive Vice President Mark Mullarkey. “We saw it as an opportunity to learn and identify our gaps. Our ability to be critical of ourselves afterward is only going to make us improve as we move forward and be better prepared to serve the community.”
This was the first time Texas Children’s executed an emergency exercise of this scale and scope with external and internal participants. Having multiple agencies involved and simulating a mass casualty incident as realistically as possible helped our teams identify what went well with the exercise and what areas needed improvement.
“One thing we learned from this drill is that our response needs to be the same, regardless of what the incident is,” said Executive Vice President John Nickens. “We can always lower our intensity, but we should respond the same and be prepared. We are fortunate at Texas Children’s to have the resources and talent to do it.”
While triage in the Emergency Center was very fast and efficient which demonstrated the existing level of preparation with the EC, one particular area of improvement that topped the list was improving the flow of communication from the EC to other areas.
“While we have certainly identified areas for improvement, we should not consider this a failure, but rather it is the goal of our exercise,” said James Mitchell, assistant director of Texas Children’s Emergency Management. “We should also remember that we carry out preparedness efforts not simply to meet regulatory requirements, but because we support a vulnerable community, and care deeply about those we serve.”
In the coming weeks, Emergency Management will meet with all of the major group participants for feedback to create a formal, institutional mass casualty incident plan. The team will work with teams in Radiology, the ORs, PICU, the Blood Bank and other areas to conduct smaller scale tabletop exercises using the same scenario to ensure we have learned all lessons possible from this event.