S. E. Williams
“It has been said, ‘time heals all wounds.’ I do not agree. The wounds remain. In time, the mind, protecting its sanity, covers them with scar tissue and the pain lessens. But it is never gone.”
– Rose Fitzgerald Kennedy
Just twelve short months ago bullets cut through the air at the Inland Regional Center in San Bernardino and forever changed the lives of those directly impacted by the tragedy and broke the heart of a community.
On December 2, 2015 at approximately 11:00 a.m., two terrorists, later identified as 28-year-old Syed Rizwan Farook and his 29-year-old wife, Tashfeen Malik, entered a conference room at the Inland Regional Center and opened fire with semi-automatic military style weapons.
The Inland Regional Center (IRC) is a not-for-profit organization that provides services for over 31,000 people with developmental disabilities and their families, including children—it employs nearly 600 people.
The attack occurred during a holiday party for employees of San Bernardino County’s Department of Environmental Health where just moments earlier, Farook had sat in attendance with his co-workers.
Before the massacre ended, 14 citizens were dead and 22 lay injured. Later that day, suspects Farook and Malik were killed in a shootout with the police. At the time, the event was the deadliest attack in the United States since September 11, 2001.
This week, members of the community will gather to remember those taken so suddenly, so tragically last year; to honor those who bore witness to the deadly event and as a result, were irreparably harmed either physically, mentally or both; to support the families and friends and co-workers of those lost and injured; and in support of first responders who were forever changed that day.
In 2015, in addition to the massacre at the IRC, America experienced a series of mass shootings that stoked terror in the hearts of many. On June 18, nine people were killed at Emanuel African Methodist Episcopal Church in Charleston South Carolina; on July 16, five people were killed at a Navy support center in Chattanooga, Tennessee; on October 1, another nine people were killed at Umpqua Community College in Roseburg, Oregon; and on November 29, three people died at a Planned Parenthood clinic in Colorado Springs, Colorado. The fourteen lives lost in San Bernardino on December 2, was the culmination of a year of deadly events in the United States.
The unmitigated terror fostered on the residents of the inland area with the attack at the IRC was reignited this year when another mass shooting occurred at an Orlando nightclub during the early morning hours of Sunday, June 12. That attack left 50 people dead and more than 50 people were injured. The Orlando attack took its place in the history books as the deadliest mass shooting to ever occur on American soil.
Just this Monday morning, the nation was starkly reminded once again that the threat of terror and actual terrorist acts, are rapidly becoming the nation’s new normal, when a terror suspect was killed after he injured at least eight others during an attack that occurred at The Ohio State University.
During most terror events heroes rise-up among victims and first responders alike. The terror event that occurred in San Bernardino last December 2 was no exception. In addition, the response by healthcare professionals at local hospitals was also essential to the overall successful handling of the catastrophic event by emergency officials.
The National Institute of Health conducted an account of how two separate teaching hospitals in the Inland Empire successfully responded to the attack.
On the day of the massacre, emergency departments at the Loma Linda University Medical Center (LLUMC) in Loma Linda and the Arrowhead Regional Medical Center in Colton received and treated victims of the attack.
Loma Linda University is a Level 1 Trauma Center located about three miles from the IRC. Its Emergency Department has 38 adult beds, 18 pediatric beds and sees more than 70,000 patients each year; while the Arrowhead Regional Medical Center (ARMC) is a 456-bed university-affiliated teaching hospital located approximately five miles from the scene of the terror attack. ARMC is the only American College of Surgeons’ verified Level II trauma center in the region and has one of the busiest Emergency Departments in the state—it handles more than 116,000 patient visits each year.
LLUMCs disaster plan required the facility to set up a triage tent outside that included basic supplies. This was completed in less than 20 minutes from the initial activation. Registration personnel prepared patient labels and charts so that incoming patients could be quickly registered, this is necessary for placing orders and charting, as well as for tracking. Patients already in the waiting room were moved. The first patient arrived at LLUMC around 11:44 a.m. with a gunshot wound to the chest.
The Emergency Department charge nurse at the ARMC was notified of the attack by the Colton Police Department at around 11:10 a.m. that morning. The facility received a total of six injured patients. One went directly to the operating room; one was discharged home from the Emergency Department and the others were admitted to either Intensive Care Units or trauma floor units with various injuries.
The December 2nd shooting resulted in twenty-one patients being transported to several local hospitals including LLUMC and ARMC and underscored the importance of disaster training. Other local hospitals that responded so capably that day included Community Hospital of San Bernardino; the Kaiser Hospital facilities in Fontana and Ontario; the Riverside County Medical Center; San Antonio Community Hospital; and St. Bernardine’s Medical Center. In total, twenty-two patients injured by the terrorists were evaluated and treated at local hospitals and all of them survived their injuries.
The Healthcare professionals at the region’s hospitals involved in the event were familiar with what was expected of them during the emergency and responded effectively. According to the National Institute of Health (NIH), “Having the infrastructure in place served to organize and focus the response.”
There were so many things at both LLUMC and ARMC that went exceptionally well during the crisis and there were also areas worthy of process improvements.
Assigning ‘treatment teams’ worked well and having a blood bank immediately available was invaluable. On the other hand, improved communications between those at the scene and the emergency room teams could add increased efficiency to the process. For example, in some instances information received by emergency room teams was limited and at times, inaccurate.
“We could not verify the exact number of patients we would be receiving, nor the severity of their injuries,” a hospital official told NIH. “Each patient en route was called into the base station, but the information we received was patchy in terms of their acuity, stability, and types of injuries.”
Another area of concern that occurred at one of the hospitals involved employees attempting to live stream newscasts to keep abreast of the rapidly evolving situation—the IT department recognized it might slow down hospital communication services. As a result, Internet access was restricted for a short period of time to hospital and emergency operations only. Employees were advised to centralize their access to news.
Safety and crowd control was another concern. The NIH stated, “The Emergency Department [at one hospital] was inundated with essential and nonessential personnel offering assistance. This could have impacted efficiency and posed a potential security threat.” It is possible that the staging of additional personnel in an area near but outside the emergency room is a better option. This would provide access to personnel when needed but would also allow verification of each individual and accountability for who is on site. Similarly, NIH stated, “There should be an established location for family assistance.”
Another concern that surfaced during the event was that, “When everyone in the trauma bay was fully gowned and masked, there was no way to identify the person’s role.” It was suggested there should be additional tags or banners with labels (such as “team captain,” “airway doctor,” “trauma nurses,” etc.) to help identify each team member. “Anyone without a proper label should be questioned, as there was always a concern of breach of security.”
The NIH audit also discussed whether all patients should have been completely undressed at the ambulance bay to check for any hidden weapons or explosive devices before they were allowed inside of the hospital. “For this particular incident, every patient was searched beforehand by the law enforcement officials. However, for future scenarios, this should not be assumed and we should consider a more standard way for law enforcement, paramedics, and receiving hospitals to communicate that patients have already been searched and cleared as a potential threat.”
As the nation continues to grapple with the threat of terror and works to refine its already exceptional ability to respond and care for those impacted by such tragedies, this December 2nd Americans will join the residents of San Bernardino County by not only reflecting on the horror of the attack; but more importantly to honor the memory of those lost and celebrate the heroism of those who looked fear in the eye and defied it.