Integrated Response to Aurora Mass Shooting

Mar 13, 2013, 11:55 AM

On July 20, 2012, during a midnight showing at a local movie theatre in Aurora, Colorado, a gunman opened fire, killing and injuring unsuspecting moviegoers. Ultimately the massacre killed 12 and injured 57 — presenting an enormous challenge for local emergency dispatch, fire departments, police, hospitals, public health, and more, and requiring all to work together on an integrated response in the midst and the wake of a chaotic, unprecedented active shooter situation. Partners came together to share their lessons learned at the 2013 Public Health Preparedness Summit.

>>Read continued NewPublicHealth coverage from the Summit.

When the first 9-1-1 calls came in following the shooting, the University of Colorado Hospital, a level II trauma center, already had full emergency department — 49 out of 50 beds were filled.

“We’d been notified we were going to get three to five gun shot victims,” said Patrick Conroy, manager of support services and safety officer for the University of Colorado Hospital. “But we had this queasy feeling something was not quite right. We started notifying emergency services to get ready.”

In total, 22 living patients arrived at the hospital, many with critical injuries. By the end of the night, 22 patients were treated and those 22 are still alive and well today thanks to a heroic effort from hospital staff, in coordination with police, dispatch and others.

One of the turning points in this emergency came from one line-level police officer’s decision to begin taking victims to hospitals in squad cars rather than waiting for ambulances, which were tied up in the midst of a very tenuous active shooter situation.

“There are those leadership moments when one person steps up,” said Conroy. “It worked, and lives were saved as a result of this decision.”

The hospital only received three patients by ambulance that night. Most came from patrol cars or private cars. It was not medical staff unloading patients from those cars. “Nowhere in their job description did it say you will pull a person out of a patrol car with a total abdominal evisceration due to gunshot wound. But they did it. And it freed up the medical staff to do their jobs,” said Conroy. “It was organized chaos.”

Those stories emphasize the flexibility and creativity, as well as willingness to work together across the boundaries of traditional roles and responsibilities.

Another critical and incredibly challenging role was communication through and following the event. Tri-County Health Department ensured consistent messaging and coordination with other partners, including use of 2-1-1. They were able to tap into a database so 2-1-1 could be used for patient tracking to help panicked families and patients find each other, while also ensuring adherence to privacy regulations.

The Tri-County Health Department Office of Emergency Preparedness and Response staff responded to the incident and the impact on the health and medical system in the jurisdiction, and was formally activated as the ESF #8 (Health and Medical) Lead for the response through the City of Aurora Office of Emergency Management. The health department coordinated to ensure that each facility had a common operating picture for the event — including mental health support.

An 18-member volunteer disaster team was immediately activated by the Aurora Mental Health Center after the shooting, to deliver timely and immediate “psychological first aid.” Between the disaster response team, fully staffed phone bank, school response team and other mental health services, the small mental health unit served more than 3,000 people following the shooting.

And mental health support continued well beyond the day of the disaster. In fact, the month after the shooting the Center experienced a 58 percent increase in mental health visits. The Center also deployed teams out to schools en masse when schools went back into session.

According to Kirsten Anderson, disaster coordinator for the Center, lessons learned from the event include:

  • Care for your staff — earlier and more often (the Center ended up bringing in a masseuse for overburdened staff)
  • Pay attention to multicultural population needs
  • Ensure partnerships are in place ahead of time
  • Plan for using volunteers effectively
  • Be ready for the enormous demand from media requests

Health department staff worked closely with the Center to identify behavioral health needs, staff support centers, and connect them with resources at the state level.

Area hospitals surged to meet the needs of injured victims and public health and behavioral health partners immediately responded to the needs of both those affected and the surrounding community.

"Building those relationships doesn't happen overnight.”

This commentary originally appeared on the RWJF New Public Health blog.