When nurses at Milwaukee's Froedtert Hospital & The Medical College of Wisconsin heard the sheriff's radio announcement that there'd been a shooting at a church, ice ran through almost every clinician's veins.
"It really hit home," said Beth Liebhardt, MSN, RN, Froedtert's emergency department director, of the recent shooting at the Sikh temple in Oak Creek, WI, that killed six worshipers.
"All we knew was that there was some act of domestic terrorism in a church and everyone was frantically calculating if their family was at church that day. It could've been any one of us"
Prepared for the Worst
Relieved that no Froedtert families were among the victims, staff focused on the task at hand: preparing for the possible patient surge.
As eastern Wisconsin's only level I trauma center, staff knew they'd play a significant role.
It wasn't long after the heads up from the sheriff's radio that Froedtert got the official call, confirming the fact that a shooting had occurred and alerting the physician staff.
"Nursing-wide, we started to prepare," recalled Liebhardt. "We weren't sure how many victims we'd get but wanted to be prepared for anything. We acted upon a plan to keep rooms open, add more trauma bays and get extra carts."
In the early chaotic minutes after the shooting, initial reports were estimating 20 victims and Froedtert staff focused on that number.
Although they didn't need to call in extra staff -employees volunteered their day off in almost every discipline - they did issue a housewide incident command.
By classifying the shooting an internal disaster, extra resources like nurses specially dedicated to transport and additional carts were made available.
In the end, it wasn't necessary. Froedtert received three victims before getting the call that those would be the only ones arriving in ambulances.
Santokh Singh, who suffered a single gunshot wound that penetrated his chest, liver, stomach and diaphragm, was released Aug 14. Still in critical condition is Punjab Singh, who was shot in the face, causing fractures and damage to the right carotid and vertebral artery.
Lt. Brian Murphy was shot multiple times but had been upgraded to satisfactory condition.
Had the number of wounded been two or 20, Liebhardt is confident the ED staff wouldn't blink an eye. Sadly, victims of shootings are nothing new at the Milwaukee facility.
"We get a lot of patients who've been shot," acknowledged Liebhardt. "Sometimes several times a week, and that increases during the summer months. Our staff sees this every day, and it's a standard patient here."
Still, managing a potential surge begets stressful moments. Froedtert receives patients after multiple vehicle crashes and explosions on a somewhat regular basis, for instance.
"We rely on our inter-department resources," said Liebhardt. "If we have a surge of patients or ambulances, we just call upstairs and ask them to send someone down. On that day, I was getting calls from other departments volunteering."
Protecting Patient Privacy
Though Froedtert nurses had some experience in dealing with high-profile cases, like the time the mayor was attacked with a metal pipe at a state fair a few years ago, as well as city shootings that don't even make the evening news, the outpouring of attention after the massacre that killed six was unprecedented
For Liebhardt and her staff, though, the three victims of the Oak Creek temple shootings needed the best of their clinical skills - the same as any patient - with a special eye toward privacy.
In this case, there was particular interest in the police officer's condition. The medical center's close relationship with city police, developed after years of collaboration, justified a little extra effort to keep other officers updated about their fallen comrade. Public relations staff was indispensable at this point as they kept police officers updated.
PR also scheduled two news conferences in the days following the shootings and enforced the hospital's "escorted only" policy for journalists so sensitive medical information wasn't released.
Other departments helped divert the media - and public - glare so the three victims could concentrate on recovery. The police liaison and FBI managed security. Even so, the distraught families were an object of unnecessary attention in the waiting room so staff secured a private room for them.
Even those not on Froedtert's payroll wanted to reach out. California Pizza Kitchen in neighboring Bayshore, WI, sent 35 pizzas to the hospital because they wanted families and staff to keep up their strength and also know the community was thinking of them.
"When those pizzas arrived, everyone said 'I'm good' and just sent them to another department," said Liebhardt. "That 'pay it forward' atmosphere illustrates the kind of profound support we had that day."
Amazingly, support and understanding permeated the patient rooms as well.
The ED is likely the busiest in the state and patients were following the developments about the Oak Creek shooting on the smartphones and TVs in the rooms. Patients even told their nurses they'd understand if the tragedy caused a delay in their own care.
One patient's feedback that dreaded Sunday was one of Liebhardt's proudest manager moments.
"I had a voicemail from a woman who happened to be in the ED when the shootings occurred," she shared. "The lady said she would've understood a delay in her care but noticed the staff was calm and collected.
"She said never once was she made to feel that she was any less important to our nurses."
Robin Hocevar is senior regional editor at ADVANCE.