In 2017, Las Vegas hospitals treated victims from a mass shooting that killed 60 people and injured more than 400. In the aftermath, emergency response crews needed more of one crucial item: a Sharpie.
In the chaos, hospital workers were writing patients' vital signs and other data on their foreheads with Sharpies to help other response team members keep track, according to U.S. News and Las Vegas Review-Journal. Mike Schiller, senior director of supply chain at the Association for Healthcare Resource and Materials Management, said this example underscores the importance of planning for and reviewing responses to mass casualty events.
"That really speaks to the importance of these exercises so that you can find what that Sharpie is," Mr. Schiller said.
Amid the rising prevalence of mass shootings and extreme weather events because of climate change, hospitals need to stay nimble with preparing for sudden admission surges, experts at the American Hospital Association told Becker's.
Hospitals and health systems have long had plans in place for mass casualty events, according to Roslyne Schulman, director of policy at the AHA. In 2016, CMS finalized its conditions for hospitals to be eligible for Medicare and Medicaid reimbursements, including rules for emergency preparedness called the Hospital Incident Command System.
About 90% of U.S. hospitals comply with HICS, but, "we are all aware that with climate change and the changing violence in our society, these things are happening more frequently," Ms. Schulman said.
The rules are extensive, and they require hospitals to assess the risk of all hazards in their communities, whether they be earthquakes, tornadoes or more local concerns; have plans to continue care for existing and new patients during crises; prepare stocking enough supplies and have the necessary power to keep the facility running; and map out communication plans with local officials.
Hospitals also have to practice these emergency procedures twice a year, whether through drills or real emergencies.
Across the U.S., hospitals are adjusting and improving their emergency plans. After a shooting on Michigan State University's campus in February, Sparrow Hospital in East Lansing, Mich., expanded its mass casualty protocol. In Missouri, a three-hospital system is adding two 24-foot-long box trailers equipped for mass casualties after communication problems during a 2011 tornado.
Mass shootings and extreme weather events aren't the only type of mass casualty event hospitals brace for. In Columbus, Ohio, hospitals sprung to action after a traffic incident involving five vehicles.
Compared to these events, COVID-19 was a "game changer," Ms. Schulman said, because HICS is engineered for short-term emergencies, not pandemics that last years. Mr. Schiller agreed, adding that "COVID was the best drill."
"I think hospitals have always been well prepared," Mr. Schiller said. "It opened our eyes to some things that we do need to do from just a basic supply chain standpoint. Hospitals are now maintaining inventory reserves of PPE items, hospitals are engaging in a risk stratification" and conducting analyses on critical items.
Healthcare leaders are resilient by trade, the AHA experts said, but there are gaps that can be improved.
More recently, the 2022 "tripledemic" — when hospitals reported mass influxes of admissions because of COVID-19, flu and respiratory syncytial virus — spotlighted another "Sharpie" moment as hospitals struggled to stock enough cribs.
"Every disaster is different and you find there are things that you need that you hadn't thought of before, but luckily [hospitals] can be pretty creative and find solutions," Ms. Schulman said.
Engaging with the local community can buttress emergency planning. For example, if a hospital is short on linens during a mass casualty crisis, already having a strong relationship with a local restaurant can help, Mr. Schiller said.
John Riggi, AHA's national adviser for cybersecurity and risk, said ransomware attacks on hospitals have tripled in the past three years — and as this cybersecurity risk grows, so do patient care disruptions. Because of this, the AHA recommends hospitals plan for cyberattacks similarly to their procedures for extreme weather events.
"The bad guys are continuously evolving their tactics," Mr. Riggi said. "So, unlike a hurricane or tornado, bad guys change as we change. We implement a measure, they implement a countermeasure. So it's an evolving fight that we have to be fully engaged with our emergency management partners on."