J Trauma Acute Care Surg. 2019 Feb;86(2):368-369

# Next-level thinking about mass casualty care.

Dutton R

QUOTE:"Seen in this light, the work by Lozado et al. falls in the middle of the science progressiontriangle—the trauma system level. The authors found that the postevent surge in blood donationwas too late to help the victims—because death from hemorrhage occurs in the first hours afterinjury 9—and led to the unfortunate waste of a precious resource. They advocate for a change in public rhetoric following mass-casualty events, combined with a prospective system for redirecting societal motivation into scheduled blood donations over the ensuing months.While it is hard to argue with the methodology or results of this work, it is worth a brief consideration of how generalizable the findings might be. Overall, medical outcomes of the Las Vegas shooting were better than expected. Patients reached definitive care quickly, in-hospital triage was relatively accurate and adequate resources were available. Sunrise Hospital was able to open a dozen operating rooms within hours of the event (S. Davidson, personal communication).

In many ways, the system got lucky: confusion in the EMS transport network was offset by the presence of multiple trauma centers; failure of the cell phone network was mitigated by public news broadcasts describing the magnitude of the event, enabling spontaneous return to the hospital of off-duty personnel; Sunday-night blood supplies were at their weekly high, and occurrence of the event just before evening change-of-shift made it easy to keep additional staff."