Orlando Health Disaster Response Timeline

ORLANDO HEALTH

Disaster Response Project

THE PULSE TRAGEDY | TIMELINE

NAME/CREDENTIALS

Michael L. Cheatham, MD, FACS, FCCM

TITLE

Chief Surgical Quality Officer

Cheatham YEAR STARTED IN YEAR STARTED WITH
CURRENT ROLE ORLANDO HEALTH

2014 1996

NAME/CREDENTIALS

Eric R. Alberts, CEM, CHS-V, FPEM, FPEM-HC,
CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS

TITLE

Corporate Manager, Emergency Preparedness

UNIT/AREA NAME

Corporate Emergency Management

Alberts

YEAR STARTED IN YEAR STARTED WITH
CURRENT ROLE ORLANDO HEALTH

2017 2010

ORLANDO HEALTH | THE PULSE TRAGEDY

Synopsis

2 | Orlando Health | Pulse Tragedy Timeline

AT 2:00 AM ON SUNDAY, JUNE 12, 2016, one of the deadliest mass shootings in modern
American history occurred at the Pulse nightclub in Orlando, Florida. Celebrating “Latin Night,”
300 people packed the club, the majority dancing in a large room. A lone gunman, armed with a
.233 caliber Sig Sauer AR-15-style military assault rifle and a 9 mm semi-automatic Glock 17 pistol,
entered the club and began firing into the crowd. During a five-minute period, the gunman moved
from room to room, repeatedly shooting victims, reloading his weapons, and ultimately firing more
than 200 rounds. At 2:02 am, police officers entered the club and engaged the gunman, while he was
shooting victims, eventually forcing him to retreat into the restrooms at the rear of the club. This
enabled evacuation of victims by law enforcement to emergency medical services (EMS) personnel
waiting outside. Thirty-eight victims were brought to the Level One Trauma Center at Orlando
Health Orlando Regional Medical Center (ORMC), located only 2,100 feet from the Pulse
nightclub. They arrived by foot, police vehicle and ambulance. The nightclub quickly turned into a
hostage situation with the gunman barricaded in the restroom area. Law enforcement negotiated
with the gunman for two-and-a-half hours, but SWAT teams were forced to storm the club at 5:02
am when the gunman threatened to attach bombs to the remaining hostages. After an exchange
of gunfire, the gunman was killed and the remaining hostages, as well as an injured SWAT officer,
were evacuated to Orlando Health ORMC and two other Orlando hospitals. At the conclusion of the
stand-off, 49 victims had succumbed to their multiple gunshot wounds. This timeline details the
resulting mass casualty incident (MCI) response.

Pulse Tragedy Timeline | Orlando Health | 3

Pulse
Night Club

4 | Orlando Health | Pulse Tragedy Timeline

Orlando Aerial view of Orange Avenue demonstrating
Regional the location of the Pulse night club (lower left) in
Medical relation to the Orlando Health campus (upper
right). The proximity of the club greatly facilitated
Center rapid transport of victims to the Level One Trauma
Center at Orlando Health Orlando Regional
Medical Center. (Photo: Matthew Parks)

Pulse Tragedy Timeline | Orlando Health | 5

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 10, 2016 June 12, 2016

2300 0130 0202
MILITARY HOURS MILITARY HOURS MILITARY HOURS

Christina Grimmie, a contestant The ORMC inpatient census is 450 The hospital operator is notified
on NBC’s “The Voice,” is shot patients with 75 available beds. The by the Orlando Fire Department
following a concert at the Plaza emergency department is relatively that an “active shooter” situation
Live Venue in Orlando while quiet with approximately half of is occurring near the hospital.
signing autographs. She is brought the patient beds occupied. Many Numerous sirens are heard and
to ORMC, but her injuries are so team members are looking forward dozens of police cars are seen
devastating that the trauma team to the end of their shift at 3:00 am. racing south on Orange Avenue
cannot save her life. ORMC’s Level toward the Pulse nightclub. A
One Trauma Center is thrust into firefighter who’s married to an
the national limelight. Emergency Department nurse
texts her that multiple victims are
headed to ORMC.

0205
MILITARY HOURS

Twitter messages from inside the
club advise, “Everyone get out of
Pulse and keep running.”

6 | Orlando Health | Pulse Tragedy Timeline

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

0214 0221 0222
MILITARY HOURS MILITARY HOURS MILITARY HOURS

The first victim arrives in the The Emergency Department is The City of Orlando Fire
ORMC Emergency Department placed on “lock-down” due to the Department notifies the hospital
with a gunshot wound to the multiple gunshot wound victims that an MCI shooting event with
abdomen, followed in quick that are arriving. Patients are up to 20 victims has occurred.
succession by three patients being carried the three blocks to Dr. Chadwick Smith, the trauma
with multiple gunshot wounds ORMC by bystanders or are being surgeon on call, summons all
to the chest. The trauma team transported in the backs of police available trauma surgeons to the
and Emergency Department cars / trucks and by ambulance. trauma center. Given the ongoing
staff work together to treat the gunfire at the club, police blockade
increasing number of critically the streets and neighborhoods
injured victims. Three Emergency surrounding the Pulse nightclub.
Department thoracotomies are This extends to the medical
performed and multiple chest center, hampering the arrival of
tubes are inserted. Many of the physicians and team members.
initial victims arrive “in extremis” Patients are triaged based upon
with limited or absent vital signs. A their acuity and injuries. Patients
total of 9 patients succumb to their who succumb from their injuries
injuries soon after arrival to the are moved to the hallway outside
trauma center. the trauma resuscitation room to
allow additional victims to receive
care. Physical examination,
plain radiographs and bedside
ultrasound are utilized to assess
patient injuries.

Pulse Tragedy Timeline | Orlando Health | 7

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

0235 0240 0307
MILITARY HOURS MILITARY HOURS MILITARY HOURS

The gunman calls 911 from inside Two Pulse victims are in the The first wave of 38 shooting
the Pulse nightclub. Negotiations operating room undergoing victims has arrived at the ORMC
between the gunman and law emergent surgery for their gunshot Emergency Department, 36
enforcement begin. wounds. Additional operating victims within 36 minutes.
room staff are summoned from
Orlando Health Arnold Palmer
Hospital for Children and Orlando
Health Winnie Palmer Hospital for
Women & Babies, both hospitals
on the same campus as ORMC.
Four operating rooms are in use
within 60 minutes and six rooms
within 120 minutes of the first
patient’s arrival. Orthopedic,
vascular and neurosurgeons are
called to provide operative care
as needed. Eight operating rooms
are ultimately used to treat Pulse
victims that morning.

8 | Orlando Health | Pulse Tragedy Timeline

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

0314 0320 0325
MILITARY HOURS MILITARY HOURS MILITARY HOURS

The Hospital Incident Command The hospital’s MCI page results Gunfire is reported in the
System (HICS) is activated. As in a rapid influx of additional Emergency Department waiting
the priority in any response is to physicians, nurses and allied room. The hospital’s Code
preserve and save lives, instituting healthcare workers to help care Silver (Active Shooter) plan is
HICS prior to this time was not for the large number of victims. implemented. Heavily armed
possible due to the number of Arriving staff are staged in the police officers and sheriff’s deputies
victims and focus of the available hospital’s conference center and immediately search the Emergency
staff on direct patient care. This deployed to appropriate areas as Department for a rumored “second
command center is responsible for needs are identified. The hospital shooter” thought to have arrived
all logistical needs related to the works with law enforcement to as a potential victim. Many
MCI as well as working to facilitate arrange clear avenues of entry physicians, nurses and other team
normal hospital operations. to the campus from the north, members continue to move around
avoiding the ongoing active shooter the Emergency Department
situation to the south. These and care for victims despite the
instructions are communicated to potential for personal injury.
arriving hospital team members.

Pulse Tragedy Timeline | Orlando Health | 9

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

0335 0414 0500
MILITARY HOURS MILITARY HOURS MILITARY HOURS

The frenetic activity of the first The Code Silver alert at ORMC Orlando Health releases the first of
hour-and-a-half gives way to a is determined to be “all clear.” No multiple media updates.
period of relative calm. After the second shooter is found and the
initial rapid influx of 38 victims, original report of gunfire in the
this lull allows the trauma team to Emergency Department is found to
evaluate the initial wave of victims be false.
and systematically review their
injuries and disposition. Patients
are reevaluated and triaged to
determine which should go to the
operating room next. Previously
admitted intensive care and step-
down unit patients are rapidly
triaged to increase critical care
bed capacity. Stable victims are
rapidly moved to the intensive care
units and hospital floors to open
Emergency Department beds for
incoming victims. The lull also
allows the hospital staff to restock
the Emergency Department with
needed supplies from color-coded
disaster supply carts. Calls to the
Incident Command Center result
in rapid correction of equipment,
supplies and staff deficits.

10 | Orlando Health | Pulse Tragedy Timeline

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

0502 0519 0520
MILITARY HOURS MILITARY HOURS MILITARY HOURS

A loud explosion is heard in the A “second wave” of 11 victims, Orlando Health counselors
distance as the Orlando Police including the SWAT officer, arrives arrive to provide mental health
Department SWAT team breaches at ORMC. Triage, evaluation counseling to staff and families.
the rear wall of the Pulse nightclub and resuscitation of these new Counseling sessions with team
to rescue the remaining hostages. victims begins. Police warn that members begin at 0700 hrs and
The gunman is killed and a SWAT there are numerous victims still continue every two hours for the
officer sustains a gunshot to his in the nightclub and that a “third next 24 hours, ultimately serving
Kevlar helmet. wave” of up to 40 victims should 1,500 team members in the first 10
be expected. These remaining 40 days post-event.
victims, one third with gunshot
wounds to the head and some with
up to 10 gunshots per patient,
are subsequently found to have
succumbed to their injuries and the
“third wave” never materializes.

Pulse Tragedy Timeline | Orlando Health | 11

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

0529 0703 0730
MILITARY HOURS MILITARY HOURS MILITARY HOURS

Orlando Health Internal Orlando Health President David All 49 Pulse victims brought to
Communications sends an internal Strong sends an email update to ORMC have been treated. The
communication to all team Orlando Health team members trauma surgeons and surgical
members about the incident. about the incident. residents assemble to reevaluate
each victim. Each patient’s injuries,
laboratory data and radiologic
studies are methodically reviewed
and a tertiary survey performed
again to ensure that all injuries
have been identified and addressed.

12 | Orlando Health | Pulse Tragedy Timeline

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

0900 0930 1033
MILITARY HOURS MILITARY HOURS MILITARY HOURS

The large number of victims and After initially being closed to Five operating rooms remain in use
the significant number of deceased all but Pulse victims by Orange to repair injuries sustained in the
victims still within the nightclub County EMS, the trauma center shooting. A sixth operating room is
results in an unprecedented is reopened for trauma alerts and staffed and ready if needed.
influx of family members and transfers from the community.
friends seeking information. Law A motor vehicle crash victim is
enforcement refers all inquiries received as a trauma alert.
regarding possible victims to
ORMC. Hundreds of family
members and friends congregate
outside the medical center
requesting information. The
Federal Bureau of Investigation
(FBI) requests that no information
be provided to families and
friends until the victims can be
interviewed. FBI agents staff a
hospital conference room in which
to interview victims.

Pulse Tragedy Timeline | Orlando Health | 13

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

1035 1045 1050
MILITARY HOURS MILITARY HOURS MILITARY HOURS

Patient discharges scheduled A Family Assistance Area Mr. Strong and Dr. Michael
for that day are expedited to is established in the ORMC Cheatham, the senior trauma
make room for Pulse victims. A conference rooms and staffed with surgeon, meet with law
patient discharge area is created hospital personnel. Families are enforcement and local government
to facilitate timely discharge of provided with an email address to officials. They request permission
patients from the hospital. send photographs and other details from the FBI to begin sharing
to assist in the identification of names and conditions of patients
victims. Hospital administration with family members and friends.
works with the trauma team to Patient confidentiality and the
identify each of the victims. Almost Health Insurance Portability and
300 emails are received from Accountability Act (HIPAA) are
family and friends trying to locate discussed with local government
victims. officials and law enforcement.

14 | Orlando Health | Pulse Tragedy Timeline

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

1057 1104 1400
MILITARY HOURS MILITARY HOURS MILITARY HOURS

Orlando Health participates in Fourteen operations have been All but four of the 35 surviving
the first press conference with the completed on Pulse victims. victims hospitalized at ORMC
media and provides an update on have been identified. Dr. Joseph
patients received and the hospital’s Ibrahim, trauma medical director,
operational status. Over the next addresses several hundred family
few hours, the medical center is members and friends in the
surrounded by reporters, film Family Assistance Area. After a
crews and satellite trucks. brief discussion of HIPAA and
patient confidentiality, all agree
to allow the names and conditions
of victims to be read aloud.
Several family members collapse
and require medical assistance.
Family members are united with
hospitalized victims.

Pulse Tragedy Timeline | Orlando Health | 15

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016

1454 1502 1600
MILITARY HOURS MILITARY HOURS MILITARY HOURS

Family members and friends of ORMC Emergency Department HICS Team 2 assumes
victims not hospitalized at ORMC lock-down is lifted. responsibility of the incident
are moved to a nearby hotel or command center. Team 1 and Team
transported to other area hospitals 2 alternate continuous staffing of
as patients are identified. Only one HICS in 12-hour shifts for the first
victim cared for at ORMC has not 36 hours following the MCI event.
been identified.

16 | Orlando Health | Pulse Tragedy Timeline

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 12, 2016 June 13, 2016

2057 2152 0400
MILITARY HOURS MILITARY HOURS MILITARY HOURS

The FBI moves the Family Orlando Health updates media on HICS Team 1 assumes command of
Assistance Area to a local patients received. the incident command center.
community center.

Pulse Tragedy Timeline | Orlando Health | 17

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 13, 2016

0522 0730 1030
MILITARY HOURS MILITARY HOURS MILITARY HOURS

Mr. Strong provides the third Two operating rooms are dedicated Mr. Strong and Dr. Jamal Hakim,
update to Orlando Health team to the operative care of Pulse Orlando Health Chief Operating
members. victims while the normal elective Officer (COO), accompany the FBI
operative schedule resumes.. to a local community center to find
the family of the last remaining
unidentified patient.

The Orlando Health campus sign
becomes a make-shift memorial
as the area surrounding the Pulse
nightclub remains cordoned off by
law enforcement.

18 | Orlando Health | Pulse Tragedy Timeline

Makeshift memorial for the Pulse
victims near the Emergency
Department of Orlando Health
Orlando Regional Medical Center.

Pulse Tragedy Timeline | Orlando Health | 19

ORL ANDO HEALTH | THE PULSE TR AGEDY/TIMELINE

June 13, 2016

1053 1410 1438
MILITARY HOURS MILITARY HOURS MILITARY HOURS

The last patient is identified and Florida Governor Rick Scott HICS is deactivated.
reunited with his family. visits ORMC to tour HICS, the
Emergency Department and the
intensive care units.

20 | Orlando Health | Pulse Tragedy Timeline

September 6, 2016
The last Pulse victim is discharged from the

Orlando Health Rehabilitation Institute.

Pulse Tragedy Timeline | Orlando Health | 21

Conclusion

The Pulse nightclub tragedy has been identified as one of the worst mass shootings
in modern American history. Forty-nine victims were killed by the gunman while
another 59 individuals were injured. While it is not possible to fully anticipate the effect
of a mass casualty event such as occurred just blocks from our hospital, we strongly
suspect that the outcome of this event could have been significantly different were it
not for the countless hours of training and frequent disaster drills that we completed
in the preceding two decades. Each of these exercises helped to prepare our hospital
and staff for the events of June 12, 2016. Our hope is that the information here and our
website, will help you and your hospital similarly prepare for mass casualty events. It
is no longer a question of “if” you will encounter either an environmental or man-made
disaster – it is just a question of “when.” Are you prepared?

OrlandoHealth.com/DisasterResponse