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Trauma in Orlando

Aug 21, 2017

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I fell in love [with trauma nursing] the first day that I was there. It was the adrenaline rush. It was the fast pace. It was the critical care thinking and the variety of injuries that you saw with trauma.

Marisa Kreuzer

On June 12, 2016, a lone gunman killed 49 people and wounded 53 others in an attack inside Pulse, a nightclub in Orlando, Florida, the deadliest mass shooting by a single shooter in United States history. Thirty-five victims were admitted to Orlando Regional Medical Center – all of whom survived. Trauma nurse Marisa Kreuzer was one of those on hand providing direct care. One year later, she reflects on that shift, the unforgettable impact of that day, and the days that followed.

“My sister is a nurse,“ Kreutzer said. “I've got an aunt that is a nurse. I'm a very big people person. I like helping people. I'm compassionate, and I just felt like it was the right thing for me to do.”

“I never saw myself doing that (trauma), never thought I could be one of those nurses, but I decided that I would go ahead and try to further my nursing career and push myself a little bit and was offered a position in a trauma ICU down in South Florida, and I fell in love the first day that I was there.

“It was the adrenaline rush. It was the fast pace. It was the critical care thinking and the variety of injuries that you saw with trauma.”

Kreutzer’s career choice is telling, because there is a recognized need to leverage nurses’ impact in trauma care.

An article published in the Journal of Nursing Scholarship acknowledges the need to enhance nurses’ roles as leaders, educators, responders, policymakers and researchers in disaster preparedness and response.

In part, the article says that “despite considerable funding for hospital and public health preparedness since the attacks of September 11, 2001, efforts to prepare and mobilize nurses for disaster preparedness and response have been episodic and difficult to sustain.”

Kreutzer does not believe either she or others in her unit were ill-prepared for the events of that day.

“In terms of preparation, I felt we were as prepared as we could be,” she said. “We do practice mass casualty drills often. So we had the training and had the knowledge, but I had no idea what to expect when I walked in. I felt like we were prepared as much as possible; I just don't think there's anything, though, at least from the emotional standpoint that could prepare you for this.”

Kreutzer was actually scheduled to be off that day, but when she began hearing the horrifying details, she did what nurses do – she called in.

“So I was actually off. I had woken up at about 9:00 that Sunday morning, and it was all over the news, and as soon as I saw that, I called my unit, the trauma ICU, to see if they needed help, and they asked if I would be able to come in and help out, that basically it was all hands on deck at that point, so I went on in. This is roughly probably around like 10:00. “Well, one of the first things that sticks out is that walking into the hospital the amount of media that was surrounding the area was very overwhelming. I've never seen anything like that before. Then just all the police vehicles that were at the club (where the shooting happened) were very close to the hospital, and I had to take a detour, but seeing all of the police vehicles and all that as well was very overwhelming. Upon walking into the unit then it was still somewhat chaotic, but it seemed there was some level of control.”

The experience that Kreutzer recalls the most was dealing with the first patient.

“Upon getting into the trauma ICU at that time there was a patient coming back from the operating room. There were multiple physicians helping bring the patient into the room, so I went and jumped in and was helping take care of that patient, and at that point that particular patient was probably a four-to-one, as in four nurses to one patient, and there were multiple physicians in the room constantly as well. This is the patient that sticks out to me the most from that whole experience.

“This patient had sustained multiple abdominal and multi-organ injuries and was taken to the operating room several times within a 24-hour period. This patient also received more blood products than any other patient I've ever seen and was essentially on our massive transfusion protocol for 24 hours or so.

“I think it stands out the most because it was the first one, and then I had taken care of the patient the next day or the day after as the primary nurse at that time.”

Kreutzer was there that first day until about 7:30 p.m., but it wasn’t until she left that she was fully able to process what she’d seen.

“I would probably say it was when I got into my car after that first shift and had a moment of quiet to kind of start processing everything.

“It just is a flood of emotions. First and foremost I was sad that somebody could actually do something like this to all those innocent people, and then at the same time I was also proud of the team that I work with to see how we all came together.“

But eventually the despair of tragedy gives way to the overwhelming euphoria that comes with victories.

“After all of this there was a meeting just to see how well the patients-- to see their progression and to see them get better. This particular patient that I've been mentioning, I did go see on our step-down unit, and at that point they were doing better and were able to talk to me.

“And I just remember going into the room and immediately grabbing the patient's hand, and I just started crying, and I apologized, and I just said that I just was like overwhelmed with joy to see how well they were doing, because you see someone coming in that is almost dying to now this person's able to talk to me, and I was able to help be a part of that progression.”

The aftermath of the events of that day left its impact on Kreutzer and her colleagues in additional ways.

“I did not find it easy to move on,” she acknowledged. “Even after the road by the club wasn't blocked off anymore – like I said, I drive past that to and from work every day that I go in – it took me a long time just to be able to drive past the club without getting tears in my eyes. And then also I don't know how much this was shown on the news or anything, but on the entrance to the hospital somebody had made these 49 white crosses.

“So on these 49 white crosses then families had put pictures of the victims, and these are the 49 people that did not make it out of the shooting, that did not survive, and having to drive past that in and out of work every day too was very difficult. At one point I thought ‘Okay, I feel a little bit better.’ I was getting back into a routine, and then those crosses were put up, and then the pictures were put up, and then you see all these people are by the crosses grieving. That was very difficult, and that made it harder to move on as well.”

In all the suffering that Kreutzer saw firsthand, In addition to reaffirming to her that trauma had been the right area of focus for her, there was one validation that left an indelible mark in her mind.

“I guess through this whole thing, the whole tragedy, one thing that it just has shown me-- that even after such a terrible tragedy, how everyone was able to find strength and compassion and come together and rise above. I think we have a very strong trauma team, including the emergency room, the trauma ICU nurses or trauma step-down nurses, the physicians. Our whole trauma team in general is a very strong, knowledgeable group, and I am so proud to be a part of that, and from that experience it really showed how well we all can work together.”