Keith Miller briskly walks down a bare, white hallway, through swinging doors and into what could be an emergency room movie set.
Here, he said, patients would be operated on if there were a bottleneck in the actual operating room caused by too many patients – like in the case of a mass shooting like what happened in Las Vegas this week.
“The types of injuries you’re talking about responding to in a mass casualty event are the types of injuries we see here every day, it’s just that there are substantially more of them,” said Miller, a trauma surgeon at University of Louisville Hospital. “So when it comes to preparing for something like this, it’s always in the back of your head.”
Not only is University of Louisville Hospital the only Level 1 adult trauma center in Louisville—it’s the only Level 1 trauma center in a 70-county area spreading south into Kentucky and north into Indiana. The “Level 1” designation indicates the facility is capable of providing the highest level of surgical care for trauma patients, and University of Louisville Hospital is staffed 24/7 to deal with traumatic injuries–everything from car accidents to workplace explosions.
And in the event there’s a mass shooting or any large-scale disaster in the region, this sterile space would quickly be filled with patients, and extend into a nearby hallway and other areas.
In Kentucky, hospitals and first responders have contingency plans if something were to happen. The people with the most traumatic of injuries – like a gunshot, knife wound or severe burn – would go to University Hospital. If children are involved, they’d go to Norton Children’s Hospital downtown, where there’s a Level 1 trauma center for kids. And Miller said other hospitals in the area would take on patients with less severe injuries.
“This isn’t a single hospital response to this [a mass shooting or other disaster] – this is a community-wide, and a regional, sometimes state-wide approach,” Miller said.
University Hospital and Norton Children’s each have their own playbooks for what would happen if a disaster occurred. And though these plans haven’t been tested at the magnitude of what happened in Las Vegas, both emergency departments get practice.
Sometimes that practice comes with disasters that involve multiple casualties, like when tornadoes tore through southern Indiana and parts of Kentucky in 2012, killing 35 people. Miller said that was the last time he remembers the emergency department really being taxed beyond the usual daily traumas.
But the playbook is also used every day on routine injuries.
“You can scale it as big as you want, or as big as you want,” said University Hospital Emergency Manager Joshua Goss.
Miller added that both hospitals have times when they put more staff on call.
“There’s no doubt that the day of Derby, Thunder Over Louisville, that’s it’s more at the forefront of our minds, where we may all have to be here very quickly,” Miller said.
At Norton Children’s—the region’s Level 1 pediatric trauma center—attending trauma physician Keith Cross said in case of a disaster, the mode his staff would go into is a more intense version of what they already do.
“It’s kind of like Clark Kent and Superman. You’re not Superman all the time, you can’t live that way, but sometimes you switch into that mode, and that’s what you do when there’s a mass casualty event,” Cross said. “And you have to have a staff that’s trained in how to switch to that mode temporarily.”
Cross said the daily practice in dealing with small-scale traumas is important to help his staff prepare for the worst. Plan, practice the plan, and in case of a disaster, they’re ready.
Featured photo: Keith Miller (left) and Joshua Goss of University of Louisville Hospital.