‘Herculean task.’ Doctors, nurses stayed calm while treating Fort Worth explosion patients

For those who didn’t already know what was going on, the emergency room at Texas Health Harris Methodist Hospital in Fort Worth probably looked the same as it always did. But in the minds of the doctors and nurses, the afternoon of Jan. 8 was anything but ordinary.

They maintained a sense of calm, but the urgency was palpable to those who knew what was happening. Information was limited. A call from MedStar came in at about 3:30 that an explosion had rocked downtown Fort Worth. The hospital would start seeing the survivors coming in at any minute.

The medical staff at Texas Health Fort Worth didn’t know at the time that the gas explosion at the Sandman Signature, a hotel in a historic downtown skyscraper, had injured at least 21 people, one in critical condition and four serious. They didn’t know people had been trapped under rubble, a couple was stuck in an elevator or people were unaccounted for. They didn’t know how many patients they would be getting or what types of injuries they would see.

They did know, though, that they had to be ready for anything and that patients would start arriving at any minute.

Trauma response

Chakeria Bracey had only been on the clock for 30 minutes on Jan. 8 when the call came in.

Information was limited, but MedStar said there was an explosion downtown and it was clear that they needed Texas Health Fort Worth and several other hospitals to be ready to receive patients. It’s a scenario Bracey, the charge nurse running the emergency room at the time, has spent countless hours training for along with all the other nurses, doctors and staff in the department.

It was already a busy day, with around 120 patients already in the ER and another 40 on hold. So Bracey started her shift by looking at the number of patients and deciding how to manage their care with the staffing she had.

A busy day, but not an unusual one for a Level 1 trauma center ER.

But when MedStar called the hospital, that instantly changed. First responders weren’t able to share a lot of details, just that there was a possible mass casualty incident and that the emergency room should be ready to receive survivors.

What they did know, though: They needed to be ready to take in and treat as many patients as they were brought.

“There was a sense of calm,” Bracey said. “It was like, it’s happening, we have to deal with it.”

After training in scenarios that ranged from massive scales to smaller events, the ER staff has been able to get the time it takes to prepare for a large number of trauma patients down to less than 10 minutes. Bracey’s first task was to look at resources available and determine how many explosion patients the hospital could take in.

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Before the first ambulance pulled up at the emergency room, the hospital had 10 operating rooms ready for explosion patients. Elective surgeries were rescheduled. The ER made 12 rooms ready for patients in a matter of minutes. Trauma doctors and surgeons were ready and standing by.

Triage was established to determine the severity of injuries. Respiratory and heart specialists almost immediately volunteered their expertise and a helping hand. The blood bank set up to provide for patients. Supervisors readied themselves to coordinate treatment and resources. And beds in the intensive care unit were made available for any survivors who needed them.

Bracey, along with charge nurses Peter Gailiunas and Taylor Ballesteros, trauma surgeons Jennifer Grant and Ashleigh Fontenot and medical director Dr. Terence McCarthy were in a mindset crafted by adrenaline, determination and muscle memory.

Survivors

“We never know what we’re getting from something like this,” Grant said. “The report is always not accurate because you’re still trying to get information.”

That’s why so many doctors and nurses were ready. A disaster garners volunteers from all over the hospital, the doctors, nurses and administrators who were involved in the response to the explosion told the Star-Telegram. Even the chaplains responded to provide spiritual guidance and help the survivors process the trauma of the explosion.

Until the patients are on the way to the hospital, there’s little to no clue as to what doctors and nurses will see. MedStar paramedics called in with basic details about the people they were treating en route to the hospital, but the full extent of injuries isn’t always clear until they arrive.

And they don’t show up one by one. Usually, patients show up multiple at a time. When the ambulances pull up, they’re greeted by disaster triage to determine how severe their injuries are.

One patient was trapped under rubble and another had a severe laceration. Three more had other serious injuries. The doctors and nurses treated things like blunt trauma, cuts, and gas and smoke inhalation.

While the patients are coming in, a sense of time is warped. Even with all the training, and despite the calmness they felt, the urgency of their tasks was palpable.

“There was a lot of anxious energy but also a lot of sereneness about the whole thing, a calmness,” Gailiunas said. “We were all excited in a way, obviously not that anybody could be injured but that we could put our training to use and serve our community in a beneficial way.”

That was echoed by many of the medical staff. They said that they hoped they would never have a need to use the training, but when the time came it was good to see how everyone worked together so seamlessly.

Corey Wilson, the chief operating officer, said every disaster response is driven by the scenario. On 9/11, people in New York walked up to hospitals and medical staff were standing outside, ready to bring them in. When a mass shooter opened fire at a country music festival in Las Vegas in 2017, people drove themselves or others to hospitals in private cars.

“We don’t know what to expect at that point but it was still a controlled environment,” Wilson said. “It didn’t matter if they came by their own vehicle or if they came by the ambulance, they were ready to take those patients regardless.”

Training

Alyssa Kaminsky, a charge nurse and chair of the hospital’s disaster committee, has worked over the past year to prepare medical staff to respond to things like the explosion downtown. Last October, Texas Health Fort Worth held a large-scale training exercise that brought in doctors and nurses from across the hospital along with paramedics.

In the scenario, a person plowed through a crowd of people and then got out and opened fire. Actors played victims and the nurses and doctors were required to treat it like a real mass casualty incident. Paramedics showed up with patients with blunt force injuries and gunshot wounds. At one point, the attacker and a police officer showed up at the same time, both having shot each other, and the emergency room had to find a way to secure them both and keep them separated.

Smaller trainings aren’t planned. In a lot of cases, the charge nurse running the ER is randomly handed a sticky note with a disaster scenario, like “train wreck” or “mass shooting,” and the number of victims. That nurse has to organize the staff and prepare the ER as if it were a real disaster.

The hospital calls them micro training sessions, and they do them so often that the first response to the real explosion downtown almost felt like another drill. Bracey said that because they have drilled disaster scenarios so often, muscle memory just kicked in.

This time it was different, sure. There was more emotion, more urgency, but the doctors and nurses credited the training and drills with their ability to stay calm and work efficiently.

At the end of the day

“ER staff does not leave the [emergency department] during a disaster or mass casualty,” Ballesteros said.

Even after patients stopped arriving at the hospital, the emergency room was filled with the same energy. The staff wearing vests identifying them as those treating explosion patients didn’t relax until their days were over.

When they walked out the door, the adrenaline that comes with a disaster like the explosion disappeared and the day caught up to them. They left exhausted with a need to process everything they’d seen.

“The drive home was silent,” Ballesteros said.

Hospital administrators said they do everything they can to take care of the staff who care for others. They have counseling available and access to the chaplains.

But in the end, the doctors and nurses said the feeling they’re left with is positive.

“We all looked at each other and we sort of said, ‘We did this,’ ” Gailiunas said. “It really is an incredible thing to see.”

He said Bracey deserves a lot of credit for managing everything during the disaster response, calling it a “Herculean task.”

Ballesteros said the nurses and doctors do all the training hoping that they never have to use it, but that when her day was done she was glad she was one of the people who helped people.

“I went home that night with a really, really proud heart,” Ballesteros said. “You have this immense pride already in what you do, and then you have these days and it’s just cool that you get to do this.”