One Sunday last September, Dr. Ron Walls opened a chilling e-mail over his morning coffee. A colleague in Colorado had shipped him a crackling recording of 911 calls from the Aurora cinema shootings that summer. Walls, who runs the emergency department at Brigham and Women’s Hospital in Boston, listened in astonishment at the escalating alarm.
“We got another person outside shot in the leg, a female,’’ reports a police officer who was among the first on the scene. “I got people running out of the theater that are shot.’’ Another shouts: “Do I have permission to start taking some of these victims via car? I have a whole bunch of people shot out here and no rescue.’’
“Just notify all the hospitals that we got people coming in,’’ someone commands.
Dr. Richard Zane had also sent a timeline of the bloodied victims who had arrived in his emergency department at University of Colorado Hospital starting at 1 a.m.
“I counted the arrivals,’’ Walls said. Twenty-three in an hour. “I was worried. We had done a lot of drills at the Brigham. But I couldn’t remember ever doing a drill with that many patients. The kind of [patients] who need immediate attention.’’
That e-mail from Zane, a former Brigham physician and emergency department leader, was a red flag for the hospital. Lessons from the mass shooting in Colorado that killed 12 people and injured 58 others played a key role in preparing the Brigham to treat the onslaught of victims injured in the Boston Marathon bombing. Coincidentally, 23 arrived in the first hour.
The Brigham and other hospitals in Boston and across the country have put staff through dozens of emergency drills since the September 11, 2001, terrorist attacks, simulating airplane crashes, fast-spreading viruses, and terrorist bombings. But as time passed, the intensity of preparations at some institutions naturally waned, said Dr. Kristi Koenig, a professor at UC Irvine in California and coauthor of a textbook on disaster medicine.
It can take another crisis to shake up things, she said. Massachusetts General Hospital had a similar turning point a number of years ago, when an Israeli medical team visited the hospital.
“We thought, ‘We’re not even geared up,’ ’’ said Dr. Alasdair Conn, head of emergency medicine there. “They said you need to have an experienced doctor look at every ambulance that comes in the parking lot, saying who is the sickest.’’
The Aurora timeline led Walls and several colleagues to analyze and strengthen the Brigham’s emergency response plan. “I was worried we might be getting complacent,’’ he said. “We needed to reenergize.’’
The Brigham had new leadership, and those executives and caregivers were trained and others were retrained to fill various roles during a disaster, such as incident commander and public information officer.
Walls realized the hospital would need more resuscitation teams if they received as many victims as the Colorado hospital did after the Aurora shooting. The new plan called for 12 to 15 teams of doctors, nurses, and emergency medical technicians, rather than four or five.
And they prepared themselves psychologically to triage large numbers of patients.
In the minutes after the Marathon bombings, a patient came into the emergency room who had penetrating shrapnel wounds that required surgery, said Dr. Michael Zinner, chairman of surgery. But the patient was awake and stable. Doctors decided to wait.
“We didn’t know if someone worse was going to come through the door,’’ Zinner said. “Someone bleeding to death and with a leg blown off. We did have patients like that. What we learned from Aurora was how to triage and set priorities. And that made a difference.’’