Monthly Response Highlight

On May 28, 2023, around 1914 hours, the House Supervisor (HS) contacted the Safety Officer to inform him that there had been a possible Mass Casualty incident in Liberty County involving a second-story balcony collapsing about 14 to 16 feet from the ground with 30-40 of people.  

The Safety Officer immediately questioned was there any other reliable information to confirm the seriousness of injuries from this event.  According to the HS and the on-call Trauma doctors (Dr. McKeown and Dr. Ott), there were several other sources confirming the incident was real.  Following the Code Mass Casualty protocol, the decision to activate was announced at 1945 hours.

Five patients were received and treated from the incident (two by medivac and three by ambulance).  The Safety Officer confirmed with the Liberty Hospital and Liberty County EMS that all patients had departed and they were calling all clear. 

Safety Officer informed the Liaison Officer (Dr. Meguiar) in the ED and he consulted with other leaders to make the decision to call all clear at 2050.  A “hot wash” was immediately call in the Incident Command (IC) in Conference Room C by the Safety Officer.

Things that went well:

  • Because the incident happened as the outgoing and incoming staff was changing out, there was plenty of support staff on site
  • The Mass Casualty Protocol was implemented in a timely manner
  • The Mass Casualty HCA Send Word went out to all personnel
  • The Safety Officer immediately provided radios for the IC room, Liaison Officer and ACNO
  • HICS and Departmental Leadership was in place immediately after the call.
  • Staff and equipment were immediately positioned at the ambulance bay to receive whatever came through the door
  • Ancillary Departments were in position (etc. Lab, X-Ray, Cath Labs)
  • Other key leaders were reported (etc. Peds, Behavioral Support for Families, Chaplin & Registration)
  • Lab notified Red Cross for additional blood if needed.
  • Transfer Center was open
  • OR had 6 suites and staff prepared for surgery
  • Departments initiated their inter-departmental phone trees
  • Safety Officer notified Division through Code Ready EOC to inform them of the situation


Need improvement opportunities:

  • Messages that went out from the operators was not clear.
  • HICS Message to HICS staff:

Attention all team members: Code Mass Casualty is now in effect. This is not a drill. The Memorial Hospital Incident Command Structure has been activated. 1st Tier please report to the Incident Command Center. 2nd Tier please report to the Conference Room C / Boardroom hallway to await further instructions. Thank you.

There was some confusion on the 1st and 2nd tier location.  Dr. Meguiar took a minute and explained that Conference Room C is for the HICS Leaders immediate reporting area and support Staff report to the Boardroom across from the hall.

Recommendation:  The Safety Officer sent a message out to the operators to review their protocol:

  1. Under Mass Casualty Protocol, you only need to send out the Send Word announcement “only” because all are inclusive in that message….unless the Safety Officer or someone in HICS request to send out a separate message for the HICS group in Everbridge.
  2. Make sure the operator state “per [name and title]” and then provide the message detail.


Utilizing the critical elements within the Joint Commission’s Emergency Management Standards, allow us to analyze gaps within our preparation:

  • Communications (used during this event):
  • Activated Send Word Now
  • Everbridge
  • Resources and Assets:
  • N/A     
  • Safety and Security:
  • N/A    
  • Staff Responsibilities:
  • Staff was immediately available for this event. 1st & 2nd shift was onsite
  • Utilities:
  • N/A
  • Clinical Support Activities:
  • “All” Departments responded to this event



The words of Dr. Meguiar, “He was so proud of this team on how everyone responded to this Code Mass Casualty event.”

It was very evident that the “Team” had learned a lot from previous Tabletop Exercises (TTX), Full Scale Exercises (FSE) and Real-World events.  Each member executed their role as expected.  The future challenge for this group is to continue to improve around every opportunity that presents to Memorial.  The EMC will continue to develop drills to enhance the readiness of Memorial Hospital.