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Strength in tragedy, and the preparation that came first

Sarah Farley had just left at the Sauganash July 4th parade with her family around 10:30 am when she got a text message from a family friend who lives in Deerfield and who had attended the Highland Park parade.

“Just so you’re aware, there’s a shooter at the Highland Park downtown parade,” was all it read.

Sarah Farley is manager of emergency preparedness and management at Highland Park Hospital and the Regional Hospital Coordination Center (RHCC) for region 10. Credit: North Shore University Health System

Farley texted back, “Are you okay?” Her friend said she was fine but that many others were hurt.

That was all Farley needed to hear. She told her family she needed to go into work.

Farley is the manager of emergency preparedness and management at Highland Park Hospital and the Regional Hospital Coordination Center for region 10. She describes it as a “tiny but mighty” region that includes 10 hospitals, among them Highland Park Hospital.

Farley agreed to discuss with the RoundTable the events of July 4, 2022, and what it was like to be on the inside of a hospital that day, with doctors, nurses, administrators and support staff dealing with the aftermath of a massacre in which a gunman killed seven people and wounded dozens more.

“Even though this event happened, it didn’t break us,” she said of that day. “We are stronger, we are prepared and we are willing to serve.”

The training kicks in

Had the staff at Highland Park Hospital not practiced what to do if they faced a mass casualty event, Farley is confident the outcomes of the shooting on July 4 would have been worse.

Part of preparing for such emergencies, she said, is cultivating muscle memory on a grand scale.

“We train in emergency management when you are responding to an incident, you always have your badge on you,” Farley said of driving up to the hospital that day. “At that point, I knew our campus and Highland Park was under lockdown. So I would not be permitted entry without a badge. I was stopped by the police blockades. I showed my badge and told them who I was and who I worked for. … They redirected me around.”

At the entrance to the hospital, she needed to show her badge again even though the person guarding the entryway knew her. Once she was inside, she would remain there for the next eight or nine hours.

Farley said she immediately reported to Gabrielle Cummings, the president of Highland Park Hospital and incident command.

“What do you need from me?” Farley asked her.

She got an update from Cummings about what had already been done and how many patients they had already received. Incident command had already been activated and the hospital was on lockdown. Social workers and other professionals were on their way. Farley got to work.

Chairs line Central Street for the Fourth of July Parade that was never held due to a mass shooting in nearby Highland Park. (Photo by Richard Cahan) Credit: Richard Cahan

“We have an incident command at each hospital that is activated,” she said. “And then, in addition to that, we have an area command, and that area command is basically all four of our incident commands that report up to one incident commander, Sean O’Grady, president of the north region for NorthShore University HealthSystem. ”

Within the NorthShore system, the four legacy hospitals (Highland Park, Evanston, Glenbrook and Skokie) each set up an incident command and were prepared to pitch in if needed. All four hospital campuses were on lockdown.

Additionally, a text message was sent to all employees at the four hospitals notifying them about the lockdown and making sure they were aware and safe.

Incident command consists of four distinct units: operations, planning, logistics and finance. The logistics branch is responsible for staffing, and soon after the event occurred, a notification went out to the first tier to report to the hospital. It was not a blanket request for any able-bodied employee to come to work but instead was directed to this first tier, according to Farley.

The scene in the hospital

Then things began to progress.

“A lot of people started to walk into Highland Park’s emergency department with traumatic injuries from the incident. At that point in time, we have an internal trauma code that any person or patient that presents with the trauma, that code is activated, and when that code is activated, that sets off certain actions,” Farley said.

“It alerts our trauma physicians and our trauma nurses to let them know that they need to pull the correct supplies. It notifies certain staff to report to the emergency department to be ready to treat traumatic injuries,” she said.

A press staging area set up outside the Highland Park Fire Department headquarters. Credit: Alex Harrison

As for the other patients coming into the hospital, those who show up on their own, called “self-transport,” would be treated, but the hospital can request that ambulances and other transports bypass the facility. Any other transports that day would be rerouted to other hospitals in the region.

While Highland Park was on lockdown, patients were rerouted to Glenbrook Hospital, Evanston Hospital and Northwestern Lake Forest Hospital.

“In addition, at Evanston hospital, an emergency physician received a phone call from a friend and fellow physician who was at the parade in Highland Park,” Farley said. “The friend called to say there was a shooting going on at the parade. ‘Be prepared, you may receive patients.’”

At Evanston Hospital, Farley said that ER doctor “notified the charge nurse at the time of the event to say we need to prepare for the possibility that we are going to have incoming patients from the event. We should consider the possible activation of our trauma codes. So they were preparing for the code (though) they did not officially activate that code until they were notified from the EMS that they were receiving trauma patients.”

As patients started arriving at the hospital, Farley was in contact with the head of the emergency department at Highland Park and with colleagues at outside agencies including the Illinois Department of Public Health, the Lake County Health Department, the Cook County Health Department and the Illinois Emergency Management Agency.

She said that a few times she stopped into the emergency department to see if anyone needed anything in the way of emergency preparedness supplies, but they did not. Mostly she was on her feet at incident command.

Farley said there was no chaos in the emergency room at the time.

“I can only describe the atmosphere as calm and extremely supportive,” she said. “Everybody was helping each other and everybody was ensuring that the patients were receiving the best care.”

She said the reaction tracks with what she knows of her colleagues.

“At NorthShore, we operate as a family. A lot of our doctors and our nurses live in the community we live in, we work in the community that we serve … it really speaks to that culture that we had doctors and nurses at the parade whose first thought was, ‘I need to call the hospital and let them know this is happening. And I need to then report to the hospital to ensure that I’m able to help.’

After the fact

All four of the NorthShore legacy campuses remained on lockdown until the shooter was captured. Once the staff guidance received from the police department that it was safe to leave, the lockdown was lifted.

But the day’s work was not finished. Incident command held an initial debriefing, called a “hotwash” in industry parlance, with her team. It is the first initial after-action report done while everything is still fresh.

Memorials in downtown Highland Park to the seven killed and more than two dozen shot at a Fourth of July parade. (Wendi Kromash) Credit: Wendy Kromash

“The hotwash is done before the Incident Command is deactivated,” Farley explained. “So we did a hotwash on July 4 with everybody that was present for the event and Incident Command. I did a debrief with my emergency preparedness team specifically on July 5, and then we did a full incident debrief with all departments that were present for the event the next week on July 11.”

The official after-action report will not be ready for many months. They have not yet done a debrief with the Highland Park Police Department since the case is still active. But Farley was able to share some early observations.

One of the first takeaways was how prepared the staff were.

“The staff responded effectively and heroically because of the preparedness measures and training that they’ve had,” she said. “I don’t ever want to undervalue the importance of training education. Our staff truly were called to serve and they did so because they’re heroes and because they have the training and preparation for this as well.”

Farley also noted how Highland Park’s concierge, environmental services and food services staff “jumped into the fray just as much as our clinical staff did.” She said “they were truly heroes on that day as well.”

And Farley said that she feels the employees have been well-supported.

“I have noticed NorthShore has done a wonderful job of giving staff and employees opportunities to seek out mental health resources and well-being resources,” she said. “I will also tell you that I’ve seen staff simply hug each other. There are resources out there for us to be able to use and I think staff are working through those one day at a time … allowing ourselves to grieve and supporting each other in that manner.”

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