Since 1991, the Killeen area has witnessed three mass shootings that left more than 40 people dead and more than 60 wounded.
Down Interstate 35, in Jarrell, 27 people lost their lives when an F5 tornado tore through the town in May 1997.
“We know things are going to happen. We don’t know what, and we don’t know when. We always want to be as well-prepared as we possibly can,” said Dr. Tim Stallard, director of Simulation Education and an emergency department physician at both Scott & White Medical Center-Temple and McLane Children’s Hospital.
Hospitals in the area attend meetings and conduct regular drills to test and practice scenarios — whether created by man or nature — that involve mass casualties.
At Metroplex Hospital in Killeen, medical staff conducts drills on a regular basis to practice situations involving incidents occurring within the hospital to coordinating a mass casualty event, said Erin Spencer, public relations specialist for the hospital.
“We attend quarterly meetings with area hospitals to get on the same page so we can communicate during a large-scale event,” Spencer said. “We all have relationships with our counterparts at the other hospitals too to make it easier to coordinate.”
Spencer said Metroplex will participate in training exercises conducted by Fort Hood once a year and other opportunities as they come available.
“The events and training is how we iron out the logistics during a mass casualty event,” Spencer said.
Looking at mass-casualty events on a larger scale is the Bell County Office of Emergency Management.
“The first priority is to secure the imminent threat, which would be a law enforcement response, such as locating and containing an active shooter (in the case of a mass shooting event),” said Michael Harmon, Bell County Communications Center director and emergency management coordinator.
Harmon said in most cases, once the shooters are contained or confronted, the shooters either shoot themselves, as was the case in the Las Vegas shooting that killed more than 50 people earlier this month), or is shot or taken into custody by law enforcement as was the case in the 2009 Fort Hood shooting.
In such cases with mass casualties, the first steps that will be established as soon as possible will be setting up an incident command post, medical triage and a staging area.
“The first paramedics on scene will quickly survey the injured and determine the most critical patients to be transported first from the scene,” Harmon said. “In the case of gunshot wounds, time is of the essence. The quicker the critical gunshot patients get into surgery, the better chances they have for survival.”
Harmon added that one of the most difficult decisions medical first responders have to make is to pass over victims with mortal injuries and focus on treating those with survivable injuries.
In a situation like Las Vegas, with hundreds injured and many heading to the hospital in a private vehicle, Harmon said, “It would be helpful, if possible, for officers at perimeter checkpoints to direct drivers carrying the less severely injured to go to the more remote hospitals so as not to overwhelm the closest trauma centers with less critical patients.”
Area hospitals, such as Metroplex, Seton Medical Center-Harker Heights, Darnall Army Medical Center at Fort Hood, and Scott & White Medical Center in Temple run simulations to practice events.
Carolina Silva, marketing and communications specialist for Seton, said the Harker Heights hospital is required “to hold two mass casualty events yearly. We attend the large-scale community exercise that Fort Hood has every year usually in May — and we hold a second one at the hospital usually toward end of the year. We also have active shooter scenarios quarterly.”
If an event similar to the Las Vegas shooting happens in e Bell County, Stallard said it would take awhile to get through and would put quite a strain on the system.
“But we have a fairly robust medical community,” said Stallard, adding Scott & White had just completed an active shooter scenario the Thursday preceding the Las Vegas shooting.
He said some of the acting patients in training scenario were sent to the children’s hospital. “Because they’ve got active (operating rooms), they’ve got surgeons that can operate, everything that’s needed to take care of folks.”
All health facilities in the area said they work with each other to create a pocket of resources within the community. Mikaela Cade, chief of public affairs at Fort Hood’s Carl R. Darnall Army Medical Center, said Darnall “and the area hospitals work together through the Central Texas Healthcare Coalition that is a committee under the Central Texas Regional Advisory Council, and its mission is to coordinate and preparedness and responses to acute medical mass casualty and disaster situations.”
First responders are also vitally important in saving lives in the event of a mass casualty event.
The Killeen Fire Department uses the Simple Triage and Rapid Transportation guide to triage patients. They place a colored tag on them to indicate their next steps, according to Killeen spokeswoman Hilary Shine,
In that system, a “green” tag indicates minor injuries. Yellow is a little more serious, red is immediate transport and black is deceased.
Harmon said when patients are triaged, emergency officials will check their wallet or see if they have a medical alert tag to determine any allergies or medical issues. If they do not find any, then they have to wait until the hospital reaches the next of kin.
Dr. Taylor Ratcliff, Emergency Medical Services director at Scott & White, said medical crews are trained on how to identify patients who arrive unconscious at the hospital.
“People should always try to have some form of ID on them,” he said, adding the emergency department staff is really good at knowing how to locate the emergency information in a person’s phone, so people should make sure that is entered on their devices.
He said if a person dies and they don’t know who they are, then a medical examiner will go through the process of identification with dental records and fingerprints. However, for those who are alive, people will usually become cognizant after 12, 24 or 36 hours and can give them information, or a lot of times a family member will come looking for them.
Ratcliff said medical crews will work to save a person’s life and address medical issues as they arise, including any allergic reaction they may have.
Still, there are a couple of different systems they use in a disaster, and they are set up to assume the patient will not have ID. The color tag they are assigned will have a unique bar code associated with it, Ratcliff said.
“Let’s say Jane Doe is evacuated from the scene and given a triage tag. We’ll scan in that triage number, and that number becomes permanent,” Ratcliff said. “Then, if we find her driver’s license, then we will scan it and it will automatically dump all of her information into the disaster record.”
That unique bar code will stay with the patient and follow them through the continuum of care.
All that said, what’s the bottom line for mass casualty event in he Killeen area?
“We try to be as prepared as we can, but with humans in the mix, there will never be a perfect situation, however, because there are humans in the mix, it also makes us very adaptable,” Stallard said.
After a mass casualty event, Harmon said, a critical incident stress debriefing is now standard operating procedure for first response agencies and public safety communication centers in major responses.
“Trained counselors meet with all involved, one on one, to help them cope with what they experienced,” Harmon said, adding it is necessary to maintain an emotionally healthy emergency response workforce and avoid and mitigate the effects of post-traumatic stress disorder.
Stallard said the team in the emergency department — from the unit clerks to the nurses and those that clean the rooms — lift each other up.
“I have some patients still linger with me because they had such an impact. So, it takes a toll on you emotionally,” he said.
Stallard said if the public wants to help, then best way is to donate blood. “Giving blood is one of the biggest things you can do. Having a ready supply of blood is crucial for these types of events.”