How Palomar Medical Center would deal with a Las Vegas-type mass casualty event

The tragic mass casualty shooting event occurring in Las Vegas this week tested the limits of the area’s trauma and emergency response systems. It may have raised questions in your mind about humanity and, oh by the way, how San Diego County and Palomar Medical Center Escondido, North County’s only trauma center, would respond in a similar circumstance.

Palomar Health Trauma Medical Director John Steele, M.D., says Palomar Medical Center Escondido drills on various scenarios throughout the year (dirty bomb detonation, earthquake, shootings and wildfire) to prepare for what everyone hopes will never come: a mass casualty event. Steele says history informs us that you can expect at least 50 patients from any mass casualty event will need immediate surgical attention (Las Vegas greatly exceeded that).

No hospital in the region would be able to handle that many people independently so Palomar Medical Center Escondido works in partnership with the region’s five other trauma centers as part of the San Diego County Trauma System, coordinated by the County of San Diego’s Emergency Medical Services (EMS). The San Diego County Trauma System is a nationally recognized model and has been in operation for 33 years. Steele says the system allows the trauma centers to complement instead of compete with one another.

When a mass casualty/injury event occurs (including multi-car accidents), EMS activates a computer tracking system that directs emergency responders to transport patients to the closest trauma center based on geography, bed availability and patient condition. For example, Palomar Medical Center Escondido would receive the most critical patients for an event occurring in the North County and less critical patients would be routed to other trauma centers further south. Steele says it’s impossible to calculate the exact maximum capacity for the trauma center because it depends on many factors including the severity of injuries.

If an influx of patients is directed to the trauma center, the emergency department will immediately shut down to non-urgent patients and current patients would be evaluated for discharge. All medical personnel will be called into work and made available to assist with medical procedures.

In answer to the question — “Is Palomar Medical Center prepared for a mass casualty event?” — Steele says staff can only train so much, but the best indication is how they perform every day.

The trauma center averages 4-to-5 trauma activations weekdays and 10-to-12 on weekends. At least one Board Certified trauma surgeon is onsite 24 hours a day, seven days a week with another immediately available as backup. A total of seven trauma surgeons are on staff. A team of highly skilled emergency room physicians, nurses, therapists and anesthesiologists are at the ready with specialists on call.

Palomar Medical Center Escondido Trauma Center Facts:

• Serves the largest geographic area in San Diego County.
• Serves an average of 1,700 patients annually.
• Classified as a Level II Trauma Center, which provides the highest level of care equal to a Level I. Level I Trauma Centers have the added requirement of training residents and publishing research.
• Traumatic injury is defined as a physical injury that requires immediate medical attention to save life and limb.
• Before the system was implemented, the rate of preventable trauma deaths in San Diego County was 21 percent. Today, it is less than one percent.
• Person sustaining a life-threatening injury in San Diego County is more than twice as likely to survive as compared to the national average.