“Together We Thrive”
UMC’s Response to a Tragedy:
The Tucson Shootings
Objectives
 Understand the preparation and readiness an
organization must have for large-scale events
 Understand the course of the events in the first couple
weeks following the shooting
 Understand the global hospital response to a high profile
event in a community
 Appreciate the challenges and opportunities an event
can bring to an organization
Arizona Health Sciences Center - Tucson
Who is UMC?
Arizona’s only academic
medical center
Tertiary Care Center
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Level I Trauma Center
Pediatric Medical Center
Cancer
Heart
Transplant
Magnet Hospital for Nursing
Critical Success Factors
 Organizational readiness and commitment
 All hazards emergency preparedness
 Patient Progression initiative
 Patient Family Service Excellence Initiative
 Investment in Trauma System participation with
EMS and community partners
 Academics: we are expected to be the
innovators, leaders, and challenge ourselves to
find a bigger and better way.
10:15 January 8, 2011
 Notified by central medical communications that there
had been a shooting with 10 victims and 4 medical
helicopters were dispatched
 Next call UMC asked to take 7 “immediates,” 4 DOA on
scene
 Media and law enforcement begin coming to UMC
Emergency Department Response
 Emergency Medicine Physicians mobilized and
prioritized the care of all patients and called in additional
physicians.
 Available Trauma Surgery Staff in house (4) arrived in
the ED as well as surgical resident staff available.
 Attending and resident staff divided themselves among
the trauma bays to care for patients.
 Additional nursing staff pulled from other ED areas to
staff the trauma bays and incoming.
 Went on lockdown as the whereabouts of the shooter
were unknown and media arriving
Physician Room Assignments
= Surgery Intern
1
= Surgery Upper Level
2
= EM Intern
= EM Junior
= EM Senior
4
3
5
= Surgery Attending
6
= EM Attending
7
Emergency Medicine and Trauma Surgery Joint Conference slide designed by Joy Hardison
MD MPH
Multi-Casualty UMC Arrivals Timeline, Jan.8, 2011
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K
J
I
H
G
F (helicopter)
E (helicopter)
D (helicopter)
C
B
A
l
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l
l
l
l
l
l
l
l
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l
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1030
1100
1130
1200
1230
1300
1330
1400
1430
1500
1530
1600
1630
1700
From scene
Transfer in
l
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2100
Patient Destination
6 of the patients were
taken directly from the ED to
the OR
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 5 patients admitted to the
Trauma Surgical ICU
 5 patients admitted to the
Trauma Intermediate Care
Unit
 1 deceased PICU
Incident Command
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UMC is prepared to address multi-casualty incidents.
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Ongoing focus on preparedness
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UMC had the clinical resources needed to manage the
event.
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A formalized incident command was set up due to the
high profile nature of the event.
 Media
 Agencies
Incident Command
 Initially, a multiagency incident briefing was completed. UMC,
Sheriffs, TPD
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UMC implemented formal incident command structure for
emergency operations.
– This lasted through Sunday
 UMC maintained “stand down” emergency operations mode
through the following week with regular briefings to key
stakeholders.
 Daily morning briefings prior to press conference and as needed.
Incident Command
Incident
Commander
Operations
Section Chief
Public
Information Officer
Safety Officer
Liaison
Officer
Medical/Technical
Specialist
Planning Section
Chief
Logistics
Section Chief
Finance/Admin
Section Chief
Incident Commander
 Administrator on Call
– Manned incident command
– Point person for communications and assignment of
duties
– Facilitated briefings and staff communications
– Coordinated communications between other positions
– “Anchor” collected information and disseminated
information to key parties
Public Information Officer
 The on-call person assumed responsibility early in the
situation and then other staff called in, recognizing the
high profile patient and media response
 Others on call and stayed overnight to manage media
 Teams brought in from other departments to support
efforts
Safety Officer
 Director of Security
 All security staff required to do extended shifts
 Immediately locked down and secured entrance to UMC (due to
violent event)
– Facility visitation by patient families
– Controlled access to the facility
– Name badges for patient families
 Protection of high profile patient
 Protection of staff and patients from media
 Protection of visiting dignitaries
Security Detail, cont.
Worked collaboratively with multi-agency response
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TPD
FBI
Sheriff
Secret Service
NASA
Congressional Police
Staff with dignitaries
Victim Witness
Liaison Officer
 Role not really assigned formally; functions done by
many
– Emergency Preparedness Manager
– Director of Trauma and Emergency Services
– Extra Clinical Supervisor
 Facilitated UMC response and duties with other
agencies involved in the event
 Point person for agency relations
 Facilitating agencies with right UMC point of contact
Agency Relations
 Mayor’s Office
 Congress woman’s office
 NASA
 Secret Service
 Congressional Medical Team
 FBI and Pima County Attorney’s Office victim witness
 Donations from community food
 Coordination of dignitary visits
Agency Needs and Accommodations
 Need for space for them to work
 Space close enough to patient and families
 Dedicated family lounge and or conference rooms
– Need television
– Need Internet connections, computers
– Refreshments
Medical Technical Specialist
 Dr. Peter Rhee
 Dr. Lemole, supportive role
 Dr. Andy Theodorou, Chief Medical Officer, supportive
role
 Dr. Gruessner, supportive role and facilitated emergency
credentialing with UA Healthcare legal team
– Legal facilitated emergency credentialing
Incident Command
Incident
Commander
Operations
Section Chief
Public
Information Officer
Safety Officer
Liaison
Officer
Medical/Technical
Specialist
Planning Section
Chief
Logistics
Section Chief
Finance/Admin
Section Chief
Operations Section Chief
 Extra Clinical Supervisor on duty
– One for daily clinical operations and functions
– One to assist with logistics of the event and assist with details
that day
 Normal operations was a priority to ensure that all
patients and families were just as much a priority in our
eyes as the victims.
Logistics Section Chief
 Human Resources Vice President
– CISM debriefings for staff coordination with other agency
response and victim witness
 Director of Environmental Services and Food Service
– Food and nourishment for staff, families of victims, and media on
front lawn
 Portable restrooms for media
 Electricity for media
 Security at the memorial
Planning Section Chief
 Chief Nursing Office and Directors of Adult Health and
Critical Care
– Tracked updates on all shooting victims
– Worked with families to coordinate and facilitate visitation by
dignitaries
– Tracking clinical status and patient progression toward discharge
 Privacy Officer
– Fast Command Webpage updates
– Authorizing and validation of patient record access
Finance/Admin Section Chief
 CEO filled role and facilitated activities
 Decision making group for financial decision to support
event
 Supported by President of UA Healthcare
Overview of Activities
 Visitation/Access to Facility by patients and families
 Staff Arrivals and Support
 Privacy
 Discharges
 Media response
 Dignitaries visiting
 Donations and Memorial
Visitation/Access
 Lock down -- Stayed on Lock down from 1/8/2011 through
1/13/2011 at 1:00 pm
 Night-time visitation process only two entrances open and manned
by Security and Tucson Police Dept
– Validation of ID
– Check in for appointments
 Provided UMC ID badges to families to facilitate visitation
 Difficult and challenging at first but improved over time
– Additional computers and staff required to manage the influx of patients
and visitors
– Management of access for patients/visitors, physicians, staff, and
students
– Much improved within 48 hours
Family Advocacy
Family first, then the media
updates
Support, advocate, and educate
for families
Family spokesperson and wishes
articulated
Challenges with patient’s right to
privacy and patient confidentiality
National media and the President
can make you drop your guard.
Policies and procedures over
ruled and brought us back to
focus
Discharges
 Discharges which normally occur at the main hospital
entrance were redirected due to media truck presence
and pedestrians out on the lawn
 UMC was fortunate to have the Diamond Children’s
lobby to avoid congestion for discharging patients
Staff Arrivals and Support
 Staff arrivals were encouraged through badge control entry ways in
facility to avoid front lobby congestion
 Staff support for CISM debriefings and team discussion 1/9/2011
and continued through the week
 Staff volunteering coordinating through the staffing office
 Hospitality cart for all departments to recognize all staff in the facility
and support them. Continued daily through January
 Enhanced leadership rounding in the facility
Dignitaries Visiting
Security and Safety for high
profile visitors
Clearing visitation with families
Frustration for staff who wanted
to meet and see these high profile
visitors and the need for their
security
 Ensuring the facility remained
safe when others who maybe
unstable in the community could
see the hospital as a target
Facility walk through with secret
service
– Formalized protocol with
Presidential Medical Team
Dignitaries Visiting
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President Obama and First Lady
Governor Brewer
Congressman Raul Grijalva
Nancy Pelosi
Janet Napolitano
Senator Kyle
Senator McCain
Dr. Sanjay Gupta
Privacy
 The challenge of ensuring patient privacy with
transparency to the media
 3 employees terminated for unauthorized access to the
victims medical record
 Resources to protect the privacy of the patient and
monitor medical record access of victims
Donations
 Received large donations of food for the victims, staff,
law enforcement, and media
 Restaurants in the community stepped up to provide
food
 Donations of money to the Trauma Program and the
victims
– Coordinated through UMC Foundation
– Community Food Bank
– Flowers to local nursing homes
Memorial
 The memorial was beginning to take form on day 1 and grew every day
 Week three began discussions on discontinuing the memorial and
working with others in the community with memorials (Safeway and
Congresswoman’s office)
 Archivist and volunteers to pack and protect the items
 Determine a future for the items in the community
"When something happens like this in a public place and anyone could
have been a victim, we suddenly realize we're all vulnerable and we're
all connected in a profound way. . . “ The Arizona Republic
Trauma Center Fundraising and
Support
Create a coordinated case statement and facts to support those in the
community who want to help and support their trauma center
Organization of events and activities to support the trauma center and create
trauma system awareness
Development of the “wish list” and needs for the program
Political gains from government supporters to seek government funding and
support for trauma centers and trauma systems
Visits to Washington DC, Phoenix, the Mayor, etc.
Lessons Learned
 Our team benefited from going through this together
 Greater cohesiveness among the team
 More purpose and meaning to our work
 Emotional impact--it affected all of us
 Community response and how much the community and
the nation cared for us:
– Admiration for the work we do
– “You must really work hard”
– “You did a fantastic job”
– “You made us proud”
Lessons Learned
 Tucson became caregivers. The whole community came together
to unite and care for each other. We cared for them while they
cared for us.
 People feel like they know us. The community is proud.
 The level of visibility and awareness
for the things we do everyday.
(Difficult to get used to)
 The nation became “Arizonans.”
Together We Thrive: Tucson & America
The next steps of community collaboration
to move forward from this event