1. “Together We Thrive” UMC’s Response to a Tragedy: The Tucson Shootings

2. Objectives Understand the preparation and readiness an organization must have for large-scale events 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 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 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 Appreciate the challenges and opportunities an event can bring to an organization

3. Arizona Health Sciences Center - Tucson

4. Who is UMC? Arizona’s only academic medical center Tertiary Care Center –Level I Trauma Center –Pediatric Medical Center –Cancer –Heart –Transplant Magnet Hospital for Nursing

5. Critical Success Factors Organizational readiness and commitment Organizational readiness and commitment All hazards emergency preparedness All hazards emergency preparedness Patient Progression initiative Patient Progression initiative Patient Family Service Excellence Initiative Patient Family Service Excellence Initiative Investment in Trauma System participation with EMS and community partners 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. Academics: we are expected to be the innovators, leaders, and challenge ourselves to find a bigger and better way.

6. 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 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 Next call UMC asked to take 7 “immediates,” 4 DOA on scene Media and law enforcement begin coming to UMC Media and law enforcement begin coming to UMC

7. Emergency Department Response Emergency Medicine Physicians mobilized and prioritized the care of all patients and called in additional physicians. 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. 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. 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. 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 Went on lockdown as the whereabouts of the shooter were unknown and media arriving

8. Emergency Medicine and Trauma Surgery Joint Conference slide designed by Joy Hardison MD MPH 1 2 3 4 5 6 7 = Surgery Intern = Surgery Upper Level = EM Intern = EM Junior = EM Senior = Surgery Attending = EM Attending Physician Room Assignments

9. llllllllllllllllllllllllllllll 10301100113012001230130013301400143015001530160016301700…2100 ~ From sceneTransfer in Multi-Casualty UMC Arrivals Timeline, Jan.8, 2011 A B C D (helicopter) E (helicopter) F (helicopter) G H I J K

10. Patient Destination 6 of the patients were taken directly from the ED to the OR 6 of the patients were taken directly from the ED to the OR 5 patients admitted to the Trauma Surgical ICU 5 patients admitted to the Trauma Surgical ICU 5 patients admitted to the Trauma Intermediate Care Unit 5 patients admitted to the Trauma Intermediate Care Unit 1 deceased PICU 1 deceased PICU

11. Incident Command UMC is prepared to address multi-casualty incidents. UMC is prepared to address multi-casualty incidents. Ongoing focus on preparedness Ongoing focus on preparedness UMC had the clinical resources needed to manage the event. UMC had the clinical resources needed to manage the event. A formalized incident command was set up due to the high profile nature of the event. A formalized incident command was set up due to the high profile nature of the event. Media Media Agencies Agencies

12. Incident Command Initially, a multiagency incident briefing was completed. UMC, Sheriffs, TPD Initially, a multiagency incident briefing was completed. UMC, Sheriffs, TPD UMC implemented formal incident command structure for emergency operations. 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. 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. Daily morning briefings prior to press conference and as needed.

13. Incident Commander Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief Public Information Officer Safety Officer Liaison Officer Medical/Technical Specialist Incident Command

14. Incident Commander Administrator on Call 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

15. 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 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 Others on call and stayed overnight to manage media Teams brought in from other departments to support efforts Teams brought in from other departments to support efforts

16. Safety Officer Director of Security Director of Security All security staff required to do extended shifts All security staff required to do extended shifts Immediately locked down and secured entrance to UMC (due to violent event) 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 high profile patient Protection of staff and patients from media Protection of staff and patients from media Protection of visiting dignitaries Protection of visiting dignitaries

17. Security Detail, cont. Worked collaboratively with multi-agency response –TPD –FBI –Sheriff –Secret Service –NASA –Congressional Police –Staff with dignitaries –Victim Witness

18. Liaison Officer Role not really assigned formally; functions done by many 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 Facilitated UMC response and duties with other agencies involved in the event Point person for agency relations Point person for agency relations Facilitating agencies with right UMC point of contact Facilitating agencies with right UMC point of contact

19. Agency Relations Mayor’s Office Mayor’s Office Congress woman’s office Congress woman’s office NASA NASA Secret Service Secret Service Congressional Medical Team Congressional Medical Team FBI and Pima County Attorney’s Office victim witness FBI and Pima County Attorney’s Office victim witness Donations from community food Donations from community food Coordination of dignitary visits Coordination of dignitary visits

20. Agency Needs and Accommodations Need for space for them to work Need for space for them to work Space close enough to patient and families Space close enough to patient and families Dedicated family lounge and or conference rooms Dedicated family lounge and or conference rooms –Need television –Need Internet connections, computers –Refreshments

21. Medical Technical Specialist Dr. Peter Rhee Dr. Peter Rhee Dr. Lemole, supportive role Dr. Lemole, supportive role Dr. Andy Theodorou, Chief Medical Officer, supportive role Dr. Andy Theodorou, Chief Medical Officer, supportive role Dr. Gruessner, supportive role and facilitated emergency credentialing with UA Healthcare legal team Dr. Gruessner, supportive role and facilitated emergency credentialing with UA Healthcare legal team – Legal facilitated emergency credentialing

22. Incident Commander Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief Public Information Officer Safety Officer Liaison Officer Medical/Technical Specialist Incident Command

23. Operations Section Chief Extra Clinical Supervisor on duty 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. Normal operations was a priority to ensure that all patients and families were just as much a priority in our eyes as the victims.

24. Logistics Section Chief Human Resources Vice President Human Resources Vice President –CISM debriefings for staff coordination with other agency response and victim witness Director of Environmental Services and Food Service Director of Environmental Services and Food Service –Food and nourishment for staff, families of victims, and media on front lawn Portable restrooms for media Portable restrooms for media Electricity for media Electricity for media Security at the memorial Security at the memorial

25. Planning Section Chief Chief Nursing Office and Directors of Adult Health and Critical Care 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 Privacy Officer –Fast Command Webpage updates –Authorizing and validation of patient record access

26. Finance/Admin Section Chief CEO filled role and facilitated activities CEO filled role and facilitated activities Decision making group for financial decision to support event Decision making group for financial decision to support event Supported by President of UA Healthcare Supported by President of UA Healthcare

27. Overview of Activities Visitation/Access to Facility by patients and families Visitation/Access to Facility by patients and families Staff Arrivals and Support Staff Arrivals and Support Privacy Privacy Discharges Discharges Media response Media response Dignitaries visiting Dignitaries visiting Donations and Memorial Donations and Memorial

28. Visitation/Access Lock down -- Stayed on Lock down from 1/8/2011 through 1/13/2011 at 1:00 pm 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 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 Provided UMC ID badges to families to facilitate visitation Difficult and challenging at first but improved over time 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

29. 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

30. Discharges Discharges which normally occur at the main hospital entrance were redirected due to media truck presence and pedestrians out on the lawn 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 UMC was fortunate to have the Diamond Children’s lobby to avoid congestion for discharging patients

31. Staff Arrivals and Support Staff arrivals were encouraged through badge control entry ways in facility to avoid front lobby congestion 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 support for CISM debriefings and team discussion 1/9/2011 and continued through the week Staff volunteering coordinating through the staffing office 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 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 Enhanced leadership rounding in the facility

32. Dignitaries Visiting Security and Safety for high profile visitors Security and Safety for high profile visitors Clearing visitation with families Clearing visitation with families Frustration for staff who wanted to meet and see these high profile visitors and the need for their security 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 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 Facility walk through with secret service –Formalized protocol with Presidential Medical Team

33. Dignitaries Visiting President Obama and First Lady President Obama and First Lady Governor Brewer Governor Brewer Congressman Raul Grijalva Congressman Raul Grijalva Nancy Pelosi Nancy Pelosi Janet Napolitano Janet Napolitano Senator Kyle Senator Kyle Senator McCain Senator McCain Dr. Sanjay Gupta Dr. Sanjay Gupta

34. Privacy The challenge of ensuring patient privacy with transparency to the media The challenge of ensuring patient privacy with transparency to the media 3 employees terminated for unauthorized access to the victims medical record 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 Resources to protect the privacy of the patient and monitor medical record access of victims

35. Donations Received large donations of food for the victims, staff, law enforcement, and media Received large donations of food for the victims, staff, law enforcement, and media Restaurants in the community stepped up to provide food Restaurants in the community stepped up to provide food Donations of money to the Trauma Program and the victims Donations of money to the Trauma Program and the victims –Coordinated through UMC Foundation –Community Food Bank –Flowers to local nursing homes

36. Memorial The memorial was beginning to take form on day 1 and grew every day 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) 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 Archivist and volunteers to pack and protect the items Determine a future for the items in the community Determine a future for the items in the community

37. "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

38. 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 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 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 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 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. Visits to Washington DC, Phoenix, the Mayor, etc.

39. Lessons Learned Our team benefited from going through this together Our team benefited from going through this together Greater cohesiveness among the team Greater cohesiveness among the team More purpose and meaning to our work More purpose and meaning to our work Emotional impact--it affected all of us Emotional impact--it affected all of us Community response and how much the community and the nation cared for 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”

40. 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. 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. 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 level of visibility and awareness for the things we do everyday. (Difficult to get used to) The nation became “Arizonans.” The nation became “Arizonans.”

41. Together We Thrive: Tucson & America The next steps of community collaboration to move forward from this event