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Dome - September 16

October 2010

September 16

Date: October 7, 2010

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During the tragic event that occurred at The Johns Hopkins Hospital on Sept. 16, employees in pairs, groups and singly played important roles in securing the safety of patients and staff. These are some of their stories. We recognize that there were many others whose contributions don’t appear in this article.

‘We aren’t leaving the patients’

The pop of gunfire brought Calvin Orr running from the nurses’ education room on Nelson 8. The nurse clinician describes those first few minutes that late morning on Sept. 16 as people running, chaos and confusion. He panicked for a second but continued down the unit, turned the corner and saw surgeon David Cohen lying on the floor outside Room 877.
The man who shot Cohen, Paul Warren Pardus, walked calmly into Room 873, where his mother, a surgical patient, lay.

Sharon Owens had never heard gunfire at close range, but she says the sound was unmistakable, even in as unlikely a setting as the hospital. She was waiting for colleagues to join her for an 11 a.m. meeting on the eighth floor of the Harvey Building. Owens, a lead nurse practitioner for Cardiac Surgery, left the meeting room and hurried the 25 feet or so to the Nelson Building.

“I went around the corner and saw the surgeon lying there,” Owens says. She couldn’t see the smoke from the gun, but she could smell it—an aroma like an old fire. “The staff did what they were supposed to do,” she says. “They went to the patient rooms and closed the doors.”

At this point, Owens was joined by Kathy Robertson, a clinical system developer and former nurse educator, who had been heading to the same meeting.
Someone phoned the medical code team and Security.

Meanwhile, Orr, along with others, helped give the wounded doctor aid until trauma surgeon David Efron and the trauma team arrived. “They got him out of there fast,” Orr says, “and took him to the ED.”

Security personnel said, “Go. Leave.”  But Owens and Robertson replied, “We have patients here. We can’t leave the floor.”
With police approval, they went into a medication room on the unit, which had a window and gave them a sense of what was happening. “I think they knew we were not going to leave the patients,” says Owens.

Police began directing them to move the patients out one room at a time, starting in the rear of the unit and progressing closer toward the front, where the shooter was in the room with his mother.

“We were in communication with the surgical nursing office to tell them what was going on,” says Robertson. “So as soon as we could get a patient out of a room, they arranged to get Security to give us an elevator.”

Owens, Robertson, Orr and two other clinicians went into the patients’ rooms, quickly assessed their conditions—Could they walk? Did they need a wheelchair? Did they need to stay in bed?—disconnected their equipment, and took them to the elevators in the back of the unit. From there, other caregivers accompanied the patients to the first floor of Nelson, where a triage area had been set up for them.

Owens and Robertson say that on the whole, the patients were calm. They understood what had happened.

Still, a few were shaken. “One elderly woman was in her wheelchair, and I could see she was shaking,” recalls Robertson. “I tried to calm her and talk to her. She didn’t want to show that she was going to cry, so she said, ‘I’m just a little bit stuffy.’ I told her that when we got her to her new room, the nurse there would help her with that.”

Owens and Robertson say that with the police presence, they didn’t feel in danger at all.

“I felt they were in charge and knew what they were doing, and this is what we can do,” says Owens. “We can move patients, we can talk to patients, and that’s our role.”

At one point they moved empty beds out of the patient rooms so that law enforcement could use them for barricades near the entrance to Room 873.

“It’s hard to say it went like clockwork, but it actually did,” Orr remembers. “It was a big team effort.”

Eventually, the police said it was all clear. The caregivers checked on the patients in the two rooms at the front of the unit who had not been evacuated because doing so might have put them in a line of fire.

Owens and Robertson stayed on the unit to help police with anything they might need and to keep an eye on the belongings of the patients who’d been evacuated. They also sent the patients’ charts to Admitting.

“No one ever said, this is your role,” says Owens. “People just kind of took the cues about what they needed to do.”

Extraordinary time, extraordinary teamwork

Across from her office in Admitting eight floors below, Bobbie Lyons saw police streaming through the front doors of the hospital’s Wolfe Street entrance. She had just heard about a shooting, but she didn’t know that she would soon play a role in the response.

With the patients on Nelson 8 being removed to safety, someone would have to quickly find them beds so that their care would be as uninterrupted as possible. As the head of the hospital’s bed management office, Lyons is an expert in handling the flow of patients in and out of the hospital’s beds.

Not only did the displaced patients need to receive care in new locations, but shutting down the 28-bed unit on Nelson 8 had a ripple effect elsewhere in the hospital. Getting beds for these patients while still accommodating others coming out of operating rooms, from the Emergency Department and from elsewhere was a tall order, particularly on an afternoon when 98 percent of the hospital’s beds were occupied.

Redonda Miller, vice president of medical affairs, was rushing to Nelson 7, where a group had formed to help find beds for the displaced patients. She swung by Admitting to pick up a census of all patients who had been on Nelson 8 and asked Lyons to come with her.

“Bobbie is the bed guru,” says Miller. “She knows all the shift coordinators and how to get in touch with them.”

Asking admission services expeditor Lisa Schiff to assist her, Lyons joined a group that included several shift coordinators—who oversee bed usage—as well as nursing leaders and the medical control chief for the hospital’s incident response team.

Relocating the Nelson 8 patients meant helping departments work together to board patients they don’t typically care for. In non-emergencies, it’s unusual for Medicine units, for example, to board patients from Surgery. But with the extraordinary situation urging them on, staff from different departments who’d gathered around a table and others available by phone pulled together to meet the need.

The medical intensive care unit agreed to accept stable patients from the cardiac intensive care unit so that it could receive patients just coming out of surgery. (These patients had been unable to move to the cardiac progressive care unit, where they would typically go, because several Nelson 8 patients were temporarily occupying beds on that unit.) 
Weinberg 4B, a Gynecology floor, took a Nelson 8 patient who had undergone laparoscopic abdominal surgery. “She was doing very well, and Gynecology is used to doing a lot of laparoscopic abdominal surgeries,” says Lyons, a nurse by training. “It was within what this unit could handle.”

House staff in the Department of Medicine threw themselves into discharge paperwork so that they could open up more beds for surgical patients on Medicine units. On one surgical floor, rooms that were equipped to handle two patients but had since been converted into private rooms once again became dual-occupancy. Johns Hopkins Bayview Medical Center admitted six patients from the Hopkins Hospital Emergency Department who were awaiting beds.

After being moved off of Nelson 8, the displaced patients had been transported to temporary locations, such as the postanesthesia care unit. By 7 p.m., all had been moved onto other units.

“It was a little chaotic,” says Lee Daugherty, the medical control chief for the hospital’s incident response team and an instructor in pulmonary and critical care medicine, “but I was impressed by everyone’s ability and willingness to jump in and help.”

First responders

George Economas, head of internal security at Johns Hopkins, was about to leave a meeting on the first floor of the Nelson Building when his colleague Donald Biedenback stopped him.

“George, it just went over the radio,” Biedenback said. “We have a doctor shot on Nelson 8.”

It was 11:12 a.m.

Both men took off running, grabbed an elevator and were on the scene within a minute. When they arrived, Cohen was lying on the floor in front of the nurse’s station with a gunshot wound and was being tended by a medical team. Staff told the security executives that they believed that after shooting Cohen, the man had run back into his mother’s room. Nobody knew for sure.

Biedenback, a retired police colonel, pulled out his weapon and stood outside the door. “I was constantly assessing the situation,” he says, “and how I would react if the door had opened.” At the same time, he complimented the nurses and other staff on the floor: “None of them ran from that area.”

A minute later, the hospital put into place its Active Shooter Plan, which was announced over the radios of the Hopkins security team. Off-duty police officers quickly arrived on the unit and by 11:15 a.m., Baltimore Police took over Biedenback’s post outside the suspect’s room, taking the reins from Hopkins Security. They began removing staff from the nurse’s station, which stands just feet away from Room 873.

Soon the entire hospital was being notified by text message and e-mail about the shooting. Access to Nelson 8 was restricted. A police command center was set up around the corner in Harvey 811, as police took over the offices of neurosurgeons Henry Brem and Benjamin Carson.

Police tried to call the suspect’s room and also used a loudspeaker, imploring the man to pick up the phone. Across the street, meanwhile, snipers atop the school of nursing had a direct view of the room’s window.

Unlikely resources

When he received the text alert about the shooter, Anatoly Gimburg was discussing how to make the hospital more energy efficient. In an instant, the senior director of facilities had only one thought: How to make it safe.

Gimburg and associate facilities director Bob Kuhn rushed to Nelson 8, where Hopkins Security and Baltimore police had set up a tactical command post in offices across from the passenger elevators. They supplied the police with information about the unit’s floor plans, including the location of stairwells, windows and other points of exit and access. They made sure that they could operate the elevators and turn off lights and power in the unit if the officers needed them to.

In addition, they told police about the material composition of the walls, ceilings and floors of Room 873, as well as what was above and below it. They also showed them some of the mechanical and plumbing systems.

When Gimburg and Kuhn needed to pass by the gunman’s room, officers protected them with bullet-proof shields. “Although we’re not trained specifically for something like this,” says Gimburg, “we do have a lot of training for different emergency situations. In most cases, it’s communication that saves you or creates real difficulties. And we did very well this time.”

One floor below

On the transplant unit on Nelson 7, the team informed their patients that there was a security issue, that police were responding and that everything would be OK. They instructed patients not to leave their room and closed every door. “Patients were  understanding,” says nurse manager Lisa Purdy, “and we continued to dispense meds.”

Police instructed charge nurse Katie Warner to relocate four patients in the rooms immediately below the crime scene so that if there were more gunshots, ricocheting bullets wouldn’t hurt them. In addition, oxygen in those rooms was shut off to avoid a potential explosion should gunfire erupt. “The response was very organized,” says Purdy of the eight nurses, three clinical associates, doctor and pharmacist on the floor that day.

The team also cleaned several rooms on their unit to house displaced patients from Nelson 8. “Everyone stepped up,” says Purdy. “We got the rooms in tip-top shape in no time.”

In the aftermath

After 30 to 45 minutes of calling, of pleading with the man, police used an FBI robot to look into the room with a camera. That’s when they learned that the suspect and his mother were dead. The incident was over.

But the aftermath was just beginning.

When Michelle Carlstrom, senior director of the Office of WorkLife and Engagement, heard about the shooter on Nelson 8, the tragedy was the latest news bulletin in an already traumatic week for the Hopkins community.

Two graduate students were hit by a drunk driver; one subsequently died. Another graduate student was carjacked and injured. A professor died at work and was discovered by employees. Another Hopkins employee was clinging to life following an accident.

“That week was particularly intense,” Carlstrom says. Her office houses the Faculty and Staff Assistance Program, or FASAP, which responds to people affected by such events. When requested, FASAP’s crisis-response team visits groups to facilitate conversation about traumatic incidents and related fears, anger and frustrations, and how and where to move forward.

After the Sept. 16 shooting, Carlstrom was part of the leadership team that briefed employees about the situation. Over the next 10 days, the FASAP clinical team visited 27 groups on campus, some of them nurses, to help them discuss and process their reactions to the incident. The program also provided services to individuals seeking additional help.
“The idea is to get people talking about their reaction and thoughts,” she says. “Not only is it healthy to discuss it, we should discuss it.

In the aftermath of the shooting, some employees have expressed concerns about safety, while others are grateful for how well the situation was contained. There is both pride and frustration. Carlstrom says the sessions emphasize the need to listen to others’ opinions and emotions without judgment and to realize that the community is going through a “tender time.”

“One of the ways people process anger is through criticism, judgment and opinion,” she says. “It’s important for us to realize that it’s a cathartic process and that it has to run its course.”

The hospital is conducting a thorough examination of the events surrounding the shootings and cooperating with outside investigations. A root-cause analysis team from Risk Management will schedule a special session in which employees can come to talk about events related to Sept. 16.  

They were OK

Near the end of the day, Sonja Garrison got the call for help: Could the patient relations manager come to Nelson 8 to retrieve patients’ belongings and bring them to their new rooms?

It was a new twist to a job that requires long hours tending to patient’s complaints and concerns. Garrison, along with volunteers Melanie Morgan, her assistant, and patient representative Ashley Frison-Watford, arrived at the unit with transportation carts around 4:30 p.m.

As Security and police worked on the crime scene, the women went room by room, painstakingly collecting patients’ possessions and double-checking to make sure they hadn’t missed anything. Make-up, wallets, handbags, get-well cards, flowers, clothing, shoes, Bibles—even a pound cake—went into carefully marked bags.

When the women returned to their office almost three hours later, their next task was to determine the new location of each patient, then deliver the bags to rooms in the Marburg, Nelson, Halsted and Weinberg buildings.

“We left the hospital probably around 9 that night,” Garrison says. “The patients were all very grateful that we had their belongings, that everything was OK and that we were OK.

Writers Jamie Manfuso, Linell Smith, Stephanie Desmon and Judy Minkove collected these stories. We’re extremely grateful to employees for their participation.