As Americans awoke to the news on June 12 of the deadliest mass shooting in the country’s history, Sarah Duran, BSN, RN, and her co-workers were just beginning to grasp the full extent of the Pulse Nightclub attack in Orlando, Fla. Throughout the night, Duran and her fellow ED nurses at Orlando Regional Medical Center had integral roles in saving the lives of the injured. In total, the medical center had treated 44 victims from the Pulse Nightclub attack, 7 of whom remain hospitalized as of June 28.
“Five or six of us went back to my house after our shifts that morning to debrief together,” Duran said. “We turned on the news and heard details. We didn’t realize what had happened while we were [working].”
No longer business as usual
Duran had begun her shift as the charge nurse in the center’s ED at 7 p.m. on June 11. The day progressed as usual in the Level One trauma center, with dozens of patients trickling through the ED with a range of injuries — until around 2 a.m. “We saw about 50 cop cars swing by and head down the street about three blocks away,” she said. “We thought that was a little unusual.”
Within minutes, however, the overnight shift would become chaotic, as waves of shooting victims arrived at the ED seeking help. “They came in squad cars, in civilian cars, on foot,” Duran said. “There were hordes of people coming in. We knew this was something we’d never seen before.”
At 2:30 a.m. Michele Fackler, MSN, RN, ORMC’s nursing operations manager, said her phone rang, calling her in and signaling the beginning of the call for help. “We have a very high-functioning team working the overnight shift at ORMC,” Fackler said. “We’re used to seeing penetrating traumas at night and on weekends, just not of that magnitude. So for my phone to ring at that time, I knew it was big.”
Nurses came from other units at the medical center and from other hospitals to care for the unprecedented influx of nightclub victims.
In all, 27 nurses worked the ED that night to triage patients.
Training and teamwork
Duran said the triage skills she and other nurses at ORMC had learned working in a Level One trauma center were vital that night. “It helped us know the injuries, anticipate what needed to be done and keep the chaos moving through,” said Duran.
Amid the chaos, Duran said there was nothing but cooperation and commitment to the tasks at hand. “I remember standing in the trauma bay as it was beginning, thinking that I couldn’t believe this was happening,” she said. “I think we were all like that. There was no stopping point, they just kept coming in, but there was no one yelling at each other — just teamwork.”
Fackler could not say how many nurses came from hospitals such as Arnold Palmer Hospital for Children or South Seminole Hospital in Longwood, Fla., but she said, “there was no shortage of help that night.”
Fackler said the hospital regularly practices mass casualty scenario exercises. “That night it paid off,” she said. Still, confronting real mass shooting victims has shaken her nurses and other medical professionals at the hospital, she said. “It was horrific. Many are having difficulty with what they saw that night.”
But she said actually confronting real mass shooting victims still has shaken her nurses and other medical professionals at the hospital. “It was horrific,” Fackler said. “Many are having difficulty with what they saw that night.”
She said even nurses who didn’t work that night have struggled with the fallout from the attack, as well, with feelings Fackler compared to survivors’ guilt. “I try to tell them somebody had to be here later, to relieve us,” she said. “But they feel troubled that they weren’t able to be here to help.”
To assist nurses in processing their emotions and with coping skills, ORMC arranged for special debriefing sessions, which included counseling for those requesting it.
As a nurse, Duran said she has found solace in realizing her place in the “whole picture” of such events. “It seems miniscule,” Duran said. “But we can see just how important [nurses] are.”
Soon after that night, Fackler said her work as a nursing leader to help her team work through the memories and experiences of that night was just beginning.
But she said the recovery began with taking a walk through the hospital’s trauma center and ICUs, where she took her ED nurses to see all the patients who were alive, in no small measure, thanks to their skill, care and steely dedication on that terrible night. “It was very gratifying to see that we had saved a lot of lives, a lot of people.”
Freelance writer Jonathan Bilyk contributed to the writing and research of this article.
Read the story “The healer’s journey-Part 1: How nurses navigate the wake of a mass casualty shooting,” for more information on how nurses care for victims and themselves.
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