How Hospitals Respond to the ‘Unthinkable’

A commitment to planning and preparation helps hospitals keep their communities safe

July 18, 2024

The news from Butler County, Pennsylvania this past weekend was shocking and scary. Many of the residents interviewed after the attempted assassination of former president Donald Trump mentioned they could not believe that something like that could happen in their community, an otherwise quiet, rural area that regularly stays out of the national spotlight. 

Without warning, the community was thrust into an emergency of significant scale. The tragedy resulted in injuries to several attendees and the former president of the United States, and a loss of the life of another attendee. We grieve the victims of this horrible incident, while trying to come to terms with what happened last week.

For emergency managers, this scenario reflects an adage we have always understood: you need to expect anything to happen at any time, anywhere. We know that an “it can’t happen here” mentality is a recipe to fall short when a crisis emerges.

While we cannot predict the future, a forward-leaning approach to emergency planning puts you in the right position for the “unthinkable.”

A forward-leaning mentality

Our communities rely on a hidden infrastructure of planning and preparedness that’s there when we need it the most.

While after action reviews of the response to the Butler, Pennsylvania rally shooting are only just beginning, the reports so far indicate that the health care community in Butler was indeed forward leaning. The Butler Ambulance Service, in cooperation with several other agencies including the Pennsylvania State Medical Assistance Team  (PA-SMAT), were on site with a large amount of resources originally intended to deal with the extreme heat and the effects on rally-goers. Additionally, Independence Health System Butler Memorial Hospital and Allegheny Health Network had personnel and resources on site supporting both the public attending the rally as well as the presidential protection detail. Medical efforts were coordinated through the county emergency management agency and the Butler County 911 center.

Back at Butler Memorial Hospital, plans were already in place if a high-profile arrival might occur during the weekend, and the potential implications for security and patient care. The hospital had the opportunity to develop plans after a previous presidential campaign event was held nearby in 2020, and was prepared to receive notification if an incident developed at the rally location.

Then, at 6:11 p.m, things changed quickly. Medical efforts switched from heat management to responding to an active shooter as a mass gathering event. EMS staff and medical providers, in cooperation with law enforcement and fire department personnel, quickly located injured individuals, provided treatment, and worked to evacuate them to trauma centers by helicopter.

At Allegheny General Hospital, trauma teams were activated and stood ready to receive the victims. The forward-leaning posture of on-site and hospital medical teams put them in a better position to absorb a sudden and tragic turn of events, which undoubtedly prevented the loss of additional life.

Fast-moving emergencies do not give you the opportunity to carefully plot every choice. Having plans in place helps you act quickly during a crisis and supports your decision-making.

Key lessons

Tragedies such as this certainly cause us all to pause and reflect, both on the loss of life and the lasting impact the event will undoubtedly have. As emergency managers, we must also take the opportunity to find lessons learned so that we can be better positioned to mitigate, prepare for, and respond to future events. With that in mind, here are a few things to consider:

• Does your hospital monitor mass gathering events within your community?
• Are you integrated in the medical planning for these events?
• While it may rank a bit lower in probability on your hazard vulnerability analysis, have you updated your “VIP arrival” plan? 
• Have you considered the impact that a VIP arrival may have on your normal operations?
• Do you have personnel trained and prepared to issue statements on behalf of the organization pertaining to a VIP arrival?  Have you exercised this?

This and other recent events have demonstrated that health care emergency managers need to be at the ready to guide their organizations through incidents that many might believe “won’t happen here.” 

Staying situationally aware, maintaining a common operational picture, and being “forward leaning” can position your hospital for success in the event of the unthinkable.

For questions about hospital emergency preparedness, do not hesitate to contact me or HAP’s emergency management team.