By Dr. Mallika Marshall

BOSTON (CBS) – It is fortuitous that many victims of the mass shooting in Las Vegas had access to a Level I trauma center.

University Medical Center (UMC) of Southern Nevada was flooded by more than 100 patients arriving in a short span, with gunshot wounds to virtually every part of the body as well as other injuries.

Level I trauma centers are equipped to handle any type of trauma with surgeons on site 24 hours a day, but not all areas of the country have this type of medical expertise. In fact, UMC is Nevada’s only Level I trauma center.

To put things into perspective, the city of Boston is home to six Level I trauma centers, five adult and one pediatric.

In a crisis, hospitals can be faced with dozens of severely injured patients within 5 to 10 minutes, and there isn’t time to wait to assess the situation before taking action.

Dr. Paul Biddinger is the Chief of Emergency Preparedness at Massachusetts General Hospital. “Not enough hospitals have a detailed ‘mass casualty protocol’,” says Dr. Biddinger. “It’s best practice. We see again and again how little time they have to react. All hospitals should have one,” he adds.

MGH has one, and in the event of a disaster, a computer notification system automatically makes phone calls and sends texts to get as many doctors, nurses, support staff, and security personnel into the hospital as possible.

Extra blood products are distributed to the emergency room. CT scanners and radiologists are on standby. The ER starts moving existing patients to other parts of the hospital to make room for incoming causalities, and the ICUs make preparations to accept critically ill patients.

Dr. Biddinger says it is better to call in too many reinforcements and have to send people home than have too few when patients start arriving.

Communication between medical centers is also key. In Boston, hospitals can communicate with each other and with Boston EMS through sophisticated control centers, so everyone knows who is at capacity and who can take more patients.

All of this came into play during the 2013 Boston Marathon bombings and undoubtedly saved lives.


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