# Report on the El Paso Mass Casualty Incident Hospital Response: Enhancing Surge Capacity

## TL;DR

This paper examines how trauma centers in El Paso responded to a mass casualty incident and how new triage practices improved outcomes in a later event.

## Contribution

The study demonstrates that dual-physician triage during an MCI is as effective as single-physician triage and highlights improved response through rapid team mobilization.

## Key findings

- Dual-physician triage did not significantly differ in survival rates compared to single-physician triage.
- 14 patients were treated within an hour due to rapid mobilization of 132 personnel from 16 departments.
- New practices improved communication and patient registration in subsequent MCI responses.

## Abstract

On August 3, 2019, a mass casualty incident (MCI)/active shooter event in El Paso, TX, left 21 people dead on scene and 27 transported. Our main objective in this article was to describe trauma center responses to a sudden patient influx after a MCI/active shooter event. We hypothesized that a triage practice in which two physicians providing care while simultaneously triaging would be equivalent to triage with a single physician providing triage only. The secondary objective was to describe patient injuries and treatment. Our third objective was to describe how a large, multidisciplinary team of hospital personnel were rapidly notified and arrived at the trauma center. Finally, we describe how the problems identified in a review of hospital response led to better results after implementing new practices in a 2023 MCI/active shooter event.

We conducted a retrospective cohort/medical record review and departmental survey. We performed the Fisher exact test using survival as an outcome to compare the two centers’ triage methods.

A total of 15 patients arrived at the University Medical Center of El Paso, 14 of them within 35 minutes and one in a later transfer; 14 survived at 24 hours. Total patients included 10 females and 5 males, mean age 40.6 (1–88) years. Mean hospital length of stay (LOS) was 13 ± 16.4 days. For the six intensive care unit (ICU) patients the mean LOS was 5.7 (1–11) days. In comparing day 1 survival between the center where a surgeon and an emergency physician triaged patients while also providing care and the center where a sole triage physician was on duty, survival rates were equivalent (P = .56). Six surgeries occurred on day 1 with four laparotomies performed within 43 minutes. The trauma team expanded rapidly as 132 persons from 16 departments, notified by phone calls and text, arrived, improving communication and patient registration in two 2023 MCI responses.

The survival rate of victims of a mass casualty incident brought to a Level I trauma center and triaged by a surgeon and an emergency physician who simultaneously provided care did not differ significantly from the survival rate at a Level II trauma center with a single triage physician on duty. The rapid arrival of multiple specialists resulted in 14 patients treated within an hour.