By KATHLEEN NELSON
At 10:38 a.m. on Oct. 1, a 911 call came from the campus of Umpqua Community College in Roseburg, Ore. Shots had been fired in a classroom. Nine people were dead at the hand of Chris Harper-Mercer, who then killed himself. Ten others were wounded.
Victims from the shooting at Umpqua Community College arrive at Mercy Medical Center in Roseburg, Ore., on Oct. 1. The tragedy's impact was magnified by the familiarity and close connections in the small community.
The emergency room staff at Mercy Medical Center, about five miles from campus, had 15 minutes to prepare before the ambulance delivered the first victims. The 10 victims, all with gunshot wounds, arrived in ones and twos and were treated over the course of three hours.
Roseburg is situated 65 miles south of Eugene with a population of 22,000, and the tragedy's impact seemed magnified by the close connections in the small community. "We all knew everybody was going to know somebody that was treated here or passed away," said Kelly Morgan, Mercy's president and chief executive.
A Level III trauma center with 174 beds, Mercy clinical staff had trained for a mass casualty event, with drills once a month in the hospital and twice a year with community partners, such as first responders, city officials and other local health care providers.
"You think that this can never happen," said Morgan, "but you prepare."
Mercy found that the press to simultaneously treat multiple trauma patients was the first of many demands placed on a hospital staff.
Non-clinical staff played an essential role in the hospital's emergency response too. Pastoral care staff soothed patients and communicated with distressed families, and public relations staff managed a crush of national media attention while protecting patient privacy. (See sidebar.)
All hands response
As news of the shooting broke, surgeons canceled office appointments to be available to treat gunshot victims. Pediatricians, obstetricians, retired orthopedic and vascular surgeons called the hospital to offer their services.
Not all the volunteers were needed, said Dr. Jason Gray, Mercy's chief medical officer, but the outpouring "showed the coalescence of the community," he said. "Not just the doctors, but the nurses, administrators, technicians all wanted to do their part."
Four campus shooting victims underwent surgery at Mercy. Two were treated in the emergency room and released. One died shortly after arrival. Three of the victims required neurosurgery and were stabilized at Mercy, then airlifted to PeaceHealth Sacred Heart Medical Center at RiverBend in Springfield, Ore. With three helicopters waiting, the transfers from Mercy to Sacred Heart at RiverBend about 70 miles north took less than an hour.
"I just wanted to say how impressed I was with all that you guys did," Dr. Hans Notenboom, medical director of the emergency department at Sacred Heart at RiverBend, wrote in a note he sent to staff at Mercy. "You handled an incredibly chaotic scene, stabilized incredibly sick patients, and made the transfer to us seamless. … Being from Roseburg, it made me proud to know how well you all did in such a horrific situation."
The biggest challenges for the medical staff through the initial triage and treatment, Gray said, stemmed from "the lack of clarity, not knowing (who) is coming in or when they're arriving, their conditions. They come in as John Doe or Jane Doe, but they could be a father or daughter to someone on staff. There were staff that had relatives who were injured or shot. I have to give amazing accolades to them. They focused on their jobs."
Again, Gray credited the clinical staff's crisis training with their measured, professional response. As the situation unfolded, members of the hospital's mission and ministry department, who had no mass casualty training, followed their instincts as they stepped in to console patients
"In the great chaos of tragedy, God is our first line of defense," said David Price, Mercy's director of mission services. "Our response came together organically. That part was impressive. Everyone assumed an important role with no instruction."
Price and two of his chaplains went to the emergency room and triage area to offer support and comfort to the victims. Aware that Harper-Mercer had asked victims their religion before opening fire, Price purposefully did not ask victims if they wanted to pray. He did not want an invitation to prayer to cause a flashback to their moments of abject terror.
"We were loitering with compassion," he said.
Anxiety, sudden and delayed
Parents of community college students who couldn't contact their sons or daughters after the shooting also headed to Mercy's emergency room. They were shepherded to the quiet and privacy of meeting rooms staffed by members of the hospital's six-person mission office, the human resources director and employees from the community behavioral health services agency which has an office on the hospital campus. The mission staff and counselors offered comfort and worked as liaisons between the families and emergency room. Later, Mercy's mission staff helped some of the families move to the command center set up by Roseburg officials at the fairgrounds, where uninjured students had been bused following the shooting.
Gray said that the emotional stress of the day's events started to weigh on some of the staff just after the rush in the emergency room. Others started to feel effects two to four days later. Others held their emotions until the series of funerals and memorial services the following week.
The ministry staff and the Community Health Alliance, the non-profit group that provides behavioral health services for Douglas County, held debriefing sessions and offered one-on-one counseling and ad hoc support to hospital employees, talking with them about coping strategies. Price made daily rounds for more than a week in the emergency department, "paying attention to who is shedding tears, who is lost in thought, being sensitive to that and aware that it's completely normal for grief to handicap us, making myself available to provide a safe space to decompress, unload."
Building mental health capacity
Since the shooting, Mercy's mission staff also has worked with the alliance, the U.S. Public Health Service and the Trauma Intervention Program of Portland to provide grief counseling and to start the healing for families, first responders and community college students and employees.
"We probably have more mental health resources now than we've seen in a long time," Gray said. "The fear is that two or four weeks from now, that will wane."
Morgan said the mass shooting of unarmed students puts a penetrating spotlight on the region's dearth of mental health services. Cuts in state funding led Mercy to close its 29-bed inpatient behavioral health center in 2007 and reduce programs across the continuum of mental health services, according to a release from the hospital.
"We've made it clear to Oregon that there needs to be a reinvestment in mental health services, not just in Douglas County but throughout the state," Morgan said. "We've had numerous conversations in trying to be the advocate. Hopefully this will provide a motivating factor for moving that agenda ahead."
Managing media demands in a mass casualty event
Monthly mass casualty drills and semi-annual simulations with emergency responders prepared the emergency medical staff at Mercy Medical Center to react with efficiency, compassion and professionalism when the victims of the community college shooting in Roseburg, Ore., began arriving in the ambulance bay.
One phase of a mass casualty event that was nearly impossible to simulate, though, was the onslaught of national and international media that arrived to cover the story, said Kathleen Nickel, Mercy's director of communications.
On Oct. 1, the day of the shooting at Umpqua Community College, Nickel said Mercy received 2,500 more calls than usual. Reporters from the area's newspapers, TV and radio stations, as well as national and international reporters from CNN, ABC, CBS, NBC, Fox, NPR, the BBC, Al-Jazeera, The New York Times and The Washington Post dialed multiple hospital extensions, hoping for information. Some reporters asked staff with little information and no authority to speak for the hospital to verify facts.
"When you see the national people coming in, you can get distracted, especially by the volume of requests," said Nickel, who managed the situation with a staff of two and support from administrative staff helping to answer phones. "Our prime responsibility is to treat patients and maintain privacy."
The national media started to converge on the hospital just hours after the shooting. Nickel prepared a two-sentence script for every member of the hospital staff, which directed all inquiries to her office. She worked closely with the security staff to keep the media in an overflow lot near the hospital, then to direct them to the south entrance for press conferences at 5 p.m. on Oct. 1 and 6 a.m. on Oct 2. She prepped Kelly Morgan, president and chief executive at Mercy Medical Center, and Dr. Jason Gray, chief medical officer, who answered questions at the two on-site briefings and conducted one-on-one interviews with NBC's Natalie Morales, Dr. Sanjay Gupta of CNN and about 15 other media outlets.
"The media has a strong interest in hearing from an MD," Morgan said. "But the key is to stay on message. Jason was absolutely stellar in working with the media."
Nickel also met with the families of the surviving victims, "to ensure them that our responsibility was protecting their privacy," she said. "But we said that if they wanted to talk to the media, which we're not encouraging, we could help manage that. In the end, though, we really wanted to honor their privacy."
One family contacted the media directly, and Nickel assisted them in three interviews.
Nickel advises communications colleagues in the ministry who find themselves in a similar situation to use text messaging rather than email to answer media questions more expediently and to issue updates for the public through their hospital's Twitter and Facebook accounts.
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