B Middleton: All right. Welcome back, Jacksonville. Happy Saturday to you all.
We’re so glad you’re joining us today for the conversation with Dr. Ali Kasraeian. I’m Brian Middleton and we have another great show for you today. We can’t wait to jump into it. To all of the listeners, if you have a question for Dr. Kasraeian or any of our guests at any point in today’s show, you can always call into our phone lines, 904-340-1045. Again, that’s 904-340-1045 and our producer, Walter, will make sure that you get on.
Dr., what are we talking about today?
Dr. Kasraeian: Well, today on the conversation we are joined by a full house of trauma surgeons discussing how trauma surgeons deal with mass casualties. In face of what we just went through with the events in Las Vegas I thought it would be very interesting to not only get the perspective through the eyes of people who deal with mass casualty on a regular basis, depending on what your definition of a mass casualty is, and also get their perspective on what they think when they see. I men when you and I look at a TV and turn it on and see things like that happen over and over and over again, obviously it affects us, but during the time when those events are going on, a trauma surgeon may have a different perspective and a different set of lenses through which they view the same event.
I thought that perspective would be very interesting, and then, the other thing that I find important and ever so growing in importance, is to find out how we need to be prepared should something like that happen in our own neighborhood and in our communities, and God forbid, somewhere where we are actively present when something like that may happen, and one of the greatest programs that’s been going on recently over the past several years is the American College of Surgeons, Stop the Bleed program, so we’ll be discussing that and how bystanders and less injured people at the scene may stop people from dying by controlling bleeding and hemorrhage at the scene and getting people to the hospital quicker and alive.
Joining us today on the conversation to have these discussions we have in studio, Dr. Albert Hsu, who is a trauma surgeon here at UF Health, which is out Level 1 Trauma Center. [inaudible 00:02:25], we will discuss during the course of this show, a lot of the amazing work and the history of dealing with mass casualty comes from the work done here in Jacksonville, by giants like Dr. Frieburg, Dr. Tiepaz, and a lot of giants through the history of trauma here in Jacksonville.
Also joining us, via phone, is a former Surgeon General, also a trauma surgeon with whom I had the pleasure of working for a short bit, when I was a Urology resident in the University of Florida, Dr. John Armstrong, and a friend of mine from my years as a resident in University of Florida, also a trauma surgeon from the University of Kansas, Dr. Robert Winfield and I had the pleasure of working with him on the Young Fellows Association at the American College of Surgeons.
It’s like a family show here today, talking about a very, very bittersweet topic from the surgical perspective, because unfortunately from events like this we learn a lot to make us better, as we saw happen, through the progression of these events, where unfortunately they’re happening more and more. When Pulse happened in June of 2016, it was the, at the time, the largest mass shooting we had in the Unites States at the time. The events that happened on October 1st in Las Vegas, where unfortunately fifty-eight people were killed, and more than five hundred injured in ten minutes of shooting. Steven Paddock began shooting at 10:05. More than a thousand rounds from his thirty-second floor suite into more than twenty-two thousand people. Ten minutes later at 10:15 when he stopped, he had that level of injury. Five hundred people injured, more than fifty-eight unfortunately lost their lives. These were innocent people, and when the police arrived at 10:17, two minutes later, and he had passed away, we’re left with no answers.
Today, we’re going to discuss what happens from the surgical perspective. How do we get people managed at ground zero.
How do we get them to the hospital safely, and then what do we do now afterwards. Gentlemen, thank you for joining me.
Dr. Armstrong: Thank you for having me.
Dr. Kasraeian: I will start from, I guess the senior level down. Dr. Armstrong, [inaudible 00:04:31] look at this both from the perspective of a trauma surgeon, but also as someone who had saint level, as a hat as a former Surgeon General of the state and the work that you do with the American [inaudible 00:04:43] of Surgeons. How do you view this? When you were watching the television and turned it on to see a mass casualty event like this happen in Las Vegas, which unfortunately is grander and they seem to be getting more frequent and more common around the world, and they’re become more and more violent. What is your perspective on this as a trauma surgeon?
Dr. Armstrong: Ali, I’m glad to be joining you today, and obviously wish this were under different circumstances. I think our hearts and prayers continue to go out to the families of those who lost lives in the Las Vegas shooting, and to those who sustained injuries and their families, as well as the entire Las Vegas community. I think we are seeing a display of Vegas strong.
When I see something like this emerging, my thinking goes to saving lives, and how can a system rapidly develop so that from the scene where the injuries occur to the hospital and through the hospital, as many lives are saved as possible.
Dr. Kasraeian: Now, when we look at this, so here in Jacksonville, there’s a lot of work that goes into our trauma center here, and keeping what Dr. Armstrong was mentioning, what goes into preparing for things like this? When you, Dr. Hsu, look at this, and you are witnessing five hundred people that are injured and have to be triaged at the scene and figure out how many hospitals are available to go. Nevada had one level one trauma center that had a good portion of the patients that went to it, but interestingly enough, I was kind of looking at the numbers of patients transferred, and they received a hundred and four of the shooting victims.
The next hospital close by, which was the Sunrise Hospital and Medical Center, as a level two trauma center, they actually received a hundred eighty patients. When you see this, what are some of the thoughts that go through your head.
Dr. Hsu: That’s a good question. Fortunately these events are uncommon, so it’s important that in order to manage these mass casualty events, it’s important to have a well developed plan, and the plan is just the start of being prepared. We do do drills, we have to do drills at least twice a year. It’s important part of any trauma system, is disaster preparedness, and so we do have a disaster management committee that meets regularly throughout the year and we do discuss our responses to any number of disasters, such as hurricanes. We just had a disaster management plan which is put in place recently because of Hurricane Irma.
We also are looking at doing a drill in the next few weeks with the airport. The Jacksonville Aviation Authority is required by the FAA to do a disaster drill once every three years, so a lot of planning goes along into this preparation and the plan that’s instituted has to be flexible because there are many number of different disaster events that could possibly occur.
Dr. Kasraeian: You know, a lot of people that write about these things, and are interviewed, say that we plan for these things but the unfortunate thing is, most of the time the actual event that occurs is far more grave and far more serious and nothing like we imagined in our preparation, but the fact that we planned allows us to be prepared. Which sounds redundant, but it’s actually an amazing truth, which we saw actually happen in Pulse. The team in Pulse actually had some planning events that went on very shortly prior to the actual event that they needed to step up and they did an amazing job.
Dr. Hsu: Right. That’s a good point. What’s also just as important as planning is the post-disaster phase, where you have an ability to look back at what you did well, and look back at how things could have been done better or differently. We do rely on past experiences. For example, the Hurricane Katrina, the 9-11 incident, a lot of those experiences we did learn from.
Dr. Kasraeian: We’re constantly learning. Dr. Winfield, in the Midwest, so you and I always have fairly philosophical discussions about things and they’re always fantastic, so when you see this, from a trauma surgeon’s perspective, looking at the constant education, the constant learning, what are your thoughts, both in terms of what we’ve learned from lessons past and moving f-