HCMC chair of emergency medicine recounts hospital response to Annunciation shooting

NINA MOINI: Beyond the two children who were killed during the attack at Annunciation Catholic Church yesterday, 18 people were wounded. 15 of those were children, as young as six years old. And three parishioners in their 80s were also shot. The injured were treated at HCMC and Children's Minnesota. Dr. Tom Wyatt is the Chair of Emergency Medicine at HCMC. He's on the line now to talk about just what they have been dealing with over there at the hospital. Dr. Wyatt, thanks so much for your time this afternoon.

TOM WYATT: Yeah, thank you for having me.

NINA MOINI: I've seen you a lot in front of cameras the last couple of days and your teammates over there at HCMC and your staff. This is the county hospital, for folks who don't know, in Hennepin County, Level 1 Trauma Center, accepts all people, a safety net place. So I know that you all see a lot of things and that you probably don't always want to talk about your own work. But people really are curious and very grateful, Doctor. So I appreciate you joining us. Why do you feel that it's important right now to be transparent and before the public, talking more about what you all do?

TOM WYATT: Well, I think it's really important for us at this time to really just to have the community recognize that we are a critical resource for the community and that we are here and to really understand the work that we do, because as you stated, we are a Level 1 Trauma Center. We always have this level of readiness, this preparedness day in and day out, so we're here to respond to incidents like the one that occurred yesterday and the day before yesterday.

So for us, I think it's really important for the community to understand what we do. I think it's also important to recognize the work that everyone did yesterday during this incident. Our pre-hospital, our first responders, paramedics, the people in our Emergency Department, which I can obviously talk more about, and all areas of the hospital, this whole organization, really came together once this call went out once we knew what we were dealing with.

NINA MOINI: All hands on deck. And we broadcast live the news conference that everybody had earlier from the hospital. And there were lots of stories of people coming down from other departments and floors and stepping in. Tell me a little bit more, if you would, Doctor, about just the training for instances like this, where there are so many victims coming in at once. Is that something that you practice very often? Is it like a drill? Or how do you go about preparing? And then in the moment, if you want to describe, just how does that feel when you realize, oh, this is happening?

TOM WYATT: Yeah, we do, to your first question, we do practice this. We have different drills, exercises, and other disaster preparedness things that we do every year. And unfortunately, we have to practice this in real time, in real life as well. We respond to a number of mass casualty incidents every year, anything from multiple victims from a car accident, and unfortunately, to victims with multiple gunshots coming in from the same scene.

So whenever we do receive the call that we need to activate a mass casualty incident, again, that puts into motion a number of different resources that get mobilized very quickly. And really, it's a really collaborative and team effort from just about every facet of the organization. We have administrators that come in and form a command center so they can keep track of different issues of getting different areas, the Emergency Department, the operating rooms, up and running with personnel and equipment.

We have security that has to be alerted and brought in to make sure that our hospital is safe for patients that are and families that are coming in. We have different floors of the hospital, the medicine floors, the general medicine floors, for example, that have the role of coming down and seeing what they can do in the Emergency Department to maybe take some of those patients that were awaiting admission up into the floor, taking them up and continuing their care up there, and sometimes when the beds aren't even ready, just so they can decompress the Emergency Department.

And yesterday, our clinic system-- I mentioned at the press conference earlier that it was the morning. And we had a lot of personnel around. Our clinic system really stepped up and opened up a number of slots so that we could send some of our low-acuity patients across the street to the clinics so we could decompress our triage area during this incident and also immediately following it. So it was very, very helpful.

NINA MOINI: Yeah, and one of the things, Doctor, that you mentioned in one of the early on-- this only happened yesterday-- but the early on news conferences was something that many of us knew that it had already been, unfortunately, a violent few days, in terms of gun violence, particularly, in the area. I know that gunshot victims is something that you all deal with pretty frequently there at Hennepin County Medical Center. How did it feel to have so many people at once? Were you already dealing with other patients from other incidents? It just sounds like it could feel really chaotic.

TOM WYATT: Yeah, it can feel that way sometimes. We weren't dealing with any patients from any other incident yesterday morning, but we did have a relatively full Emergency Department with other patients that came in with other both traumatic and medical conditions. So that's one of the things that we work very quickly, to try to decompress the ED, knowing that we're going to have to put all our resources into these critically ill patients that are arriving.

We unfortunately do see a lot of gunshot wounds in our emergency Department. It's one of the things that we specialize in, and that's penetrating trauma. We have gotten so good at managing these types of injuries. We really have a distinction of ranking among the best, or the very among the very best, of institutions in the country that handle penetrating trauma. And that's because we see so much of it.

And it's also because we've developed a system to really, with our trauma surgery colleagues, our pediatric colleagues, the surgical ICUs, our neurosurgeons, orthopedic surgeons-- so again, it involves a whole team of people, including our pre-hospital personnel and our Emergency Department personnel. So we are used to seeing these. But whenever you have a mass casualty incident like this, even though we have a lot of resources, those resources are finite.

And so we have to be able to get those patients who need, for instance, the operating room or interventional radiology where they might have a procedure to stop bleeding. We have to identify them upfront and get them to those resources and try to stabilize and temporize some of these other patients that might need that same care, that might not be available.

But we we've practiced it and have so much practice that we're quite good at it. I think yesterday, what is true and what made yesterday different is that the majority of the patients were kids. And that also just kind of takes our work up another level, whenever you're dealing with multiple injured and hurt kids.

NINA MOINI: Absolutely, just so tragic. And I do wonder, the last five years-- and of course, there has been a lot of burnout in your industry, just having to do with the pandemic. And you all do-- you treat a lot of trauma, but I'm sure you experience a lot of trauma as well. What do you try to put in place, as a culture, or how you all speak to each other, or any other types of resources for your own teams and your own staff to just be able to continue on operating at the level that you want to operate on?

TOM WYATT: Yeah, I think that's a great question. And I think we're still working on that. Even with as many resources as we currently have, I think you're referring to something called vicarious trauma, where workers that work in these jobs, from the Emergency Department, and pre-hospital providers, law enforcement, et cetera, firefighters, can actually experience and absorb that trauma of the patients that they're caring for. And over time, that can have a cumulative effect that can be detrimental to your own well-being.

We have dedicated teams of providers, psychologists, psychiatrists, that really engage with our personnel after an event like this, our nurses, our pre-hospital personnel, our resident physicians. That's something that often we don't talk about as much during these incidents, is we're a training institution.

So we have a lot of resident doctors, a lot of resident physicians, who are the first, second, and third year of their training. And they also-- this is a new experience for most of them, these types of incidents. And so they do require also a lot of resources to help them process this and try to move forward, because again, this is work that obviously is very much important for the community.

And we, on the front lines of medicine, really struggle sometimes after events like this. And how do we reflect on what we do? Is there that purpose there And I think the answer to that is, yes. I think most of us are in this business because we feel that what we are doing is helping people. And there's a sense of purpose. So that, a lot of times, is a really great anchor for us in these times.

NINA MOINI: Yeah. Just lastly, Doctor, is there anything, just as the chair of the Emergency Medicine Department, that you say to your team? Or do you all get together before a shift swap or a new shift begins? And just if you want to share, just what have you been telling your team the past couple of days?

TOM WYATT: Yeah, I have had some opportunities to connect with teams, members, residents, and groups of nurses, and also other faculty, emergency physicians. And my message is typically the same. And it's I'm very proud to work amongst you. I think that we do have a sense of purpose. The work we do is very important. Whenever we're doing this work, we have to focus on what we can control at the time.

But then later, there comes that period where you have to actually process this and work through it. And I remind people that we need to check in on each other, that we have resources available to us. And that's what is the glue that kind of holds us together. And really, this is a time, in the next few days, weeks, months, where although someone might not externally be showing signs of suffering from this event, from being a caregiver in this environment, it can certainly manifest at any time. So we just have to be aware of that when we go forward.

NINA MOINI: Absolutely. Good advice for everybody really, Dr. Wyatt. Thank you so much for your time.

TOM WYATT: Thank you so much.

NINA MOINI: That was Dr. Tom Wyatt, the Chair of Emergency Medicine at HCMC in Minneapolis.