What Happened in Vegas? Grand Rounds Event-Todd Nicolson

What Happened In Vegas?

MESH Coalition Grand Rounds

Speaker: Todd Nicolson


The MESH Coalition recently hosted another great Grand Rounds speaker event, graciously hosted by Sidney and Lois Eskenazi Hospital. However, this Grand Rounds was special because we had such interest, that our speaker, Todd Nicolson, did his presentation at three separate locations. After completing his presentation at Eskenazi Health, he traveled to American Senior Communities (ASC) facilities in Kokomo and Columbus to present to over a hundred of passionate ASC staff and other local community partners. With the infamy of this tragedy, and the desire to learn from it, we worked with ASC to assure that best practices and lessons learned were spread throughout the state to professionals from various organizations. An extra special thanks to Eskenazi Health, Community Howard, and Columbus Regional for hosting this event at their respective hospitals, as well as a thanks to Health and Hospital Corporation for sponsoring the events.



For this Grand Rounds, the MESH Coalition was lucky enough to have Todd Nicolson, a Senior Public Health Preparedness Planner for the Southern Nevada Health District. Todd plans, develops, and implements the Southern Nevada District’s Public Health preparedness plans. His position provides direct input and review of the planning and technical support staff to support the District’s public preparedness and response plans. He also works with the State of Nevada on plan revisions, work groups, and exercises to fully evaluate the functionality of plans that impact the State and Clark County. Todd was actively involved in assisting and responding to the October 2017, Las Vegas Concert Venue Active Shooter that ended 58 lives and injured hundreds more.

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Las Vegas, Nevada, commonly known as a popular tourist destination, continued their status as such while hosting approximately 22,000 people (only 2,000 Vegas residents) at the Route 91 Music Festival. For an event that spanned 17.5 acres of open area, there were 50 personnel from the Las Vegas Metropolitan Police Department (LVMPD), 16 personnel for Community Ambulances, and 1 inspector from the Clark County Fire Prevention. Unfortunately, that night, the number of police, fire, emergency medical services, and public safety officials needed to be increased as an active assailant began to open fire on the innocent and blindsided crowd of patrons at approximately 10:05 p.m.

The active assailant was in a Mandalay Bay hotel room on the 32nd floor with dozens of high-powered weapons, countless rounds of ammunition, security cameras to watch the hallways, and barricades for the doors. From this vantage point, the assailant had an unfair advantage over responding officers and ultimately concertgoers to commit this heinous act.

Healthcare Surge and Patient Tracking

The shooting took place for approximately 10 minutes before the assailant took his own life. The true acts of heroism and courage were on full display in the immediate aftermath with first responders, hospital personnel, random strangers, and other supporting citizens doing whatever they could to assist in the situation. Taxi Cabs, Ubers, and other citizens’ random vehicles were used as temporary ambulances and transportation vehicles for the wounded victims.

One of the biggest challenges for a mass-shooting event is the surge that hospitals see in the following hours. From that night 619 citizens were discharged, and 58 succumbed to their injuries. With hundreds of casualties, the closest hospitals to the Route 91 Music Festival were utilized to the fullest extent as countless non-ambulatory transports were using Siri to guide them to the closest hospitals, regardless of services provided. This created resource and patient tracking issues as non-trauma healthcare providers were bombarded with gunshot victims and injuries from fleeing. Initially, there were 9 unidentified persons throughout the healthcare system and it ultimately took up to 72 hours to identify them. One non-trauma hospital discharged 103 patients throughout the night and ultimately 266 patients were seen in non-trauma healthcare settings. In comparison, 344 patients were seen at various trauma centers, with one trauma center receiving 212 patients.

The list below gives more insight into the patient tracking struggles:

·      Non-traditional evacuation (Non-EMS) 54% or approximately 334

·      EMS (Triage/Non-Triage Tags) 46% or approximately 285

·      Patients lacked Identification (ID, Cell Phone)

·      HIPAA challenges (understanding of HIPAA/Legal Exceptions)

·      Resistance due to inundation of requestors (LE, Media, Medical Surge Area Command (MSAC), FBI)

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Incident Command

Active Shooter training and exercises proved to be essential in how the Southern Nevada region established Incident Command Structure and utilized it throughout the event. The Las Vegas area is unincorporated so it is owned by Clark County instead of the city, which played a factor in how Incident Command was established. Ultimately, the Clark County Office of Emergency Management took the lead and activated the Multi-Agency Coordination Center (MACC), as well as the Medical Surge Area Command (MSAC).

MSAC Objectives:

·      Coordinates communication and decision-making related to medical issues

·      Develops Incident Support Plan to complement Incident Action Plans

·      Receives, consolidates, and recommends distribution of resources requested from hospitals, to state, and allocation to Healthcare Organizations

·      Monitor bed availability, assist in identifying patient destination for level loading in the healthcare systems, and receive updates on hospital statuses

·      Establish effective communications; assist in medical evacuations; demobilize

Healthcare Response Entities:

·      University Medical Center (UMC)

·      Member of Healthcare Facilities/Healthcare System

·      Southern Nevada Health District (SNHD)

·      Nevada Hospital Association

·      Veterans Affairs Southern Nevada Healthcare System

Additional First Responder Entities:

·      Clark County Office of Emergency Management

                 o   MACC

                 o   MSAC

·      Clark County Office of the Coroner/Medical Examiner

·      AMR/MedicWest/Community Ambulance

·      Clark County Fire Department

·      Special Weapons and Tactics (SWAT)

·      Las Vegas Metropolitan Police

As is common in most emergency incidents, things did not go according to the set plans and the Incident Command was forced to improvise. The MSAC ended up being managed by the SNHD instead of UMC. Furthermore, the SNHD was present in the MACC and MSAC, as well as having the Nevada Hospital Association available via phone.

Additional Notes and Information: 

·      Nearby airport shutdown for 45 minutes because of fleeing concertgoers running onto tarmac and the active assailant attempted to blow up fuel tankers at the airport

·      Only 2 full-time Emergency Managers in VA and UMC, the rest are part-time/dual hat positions

·      Had to establish temporary morgue for high amount of deceased and the large wave of concerned families and friends that came rushing to hospitals and healthcare provider locations

·      6 operational periods of 12 hours (shifts)

·      Joint Information Center was established

·      Coroner was responsible for Family Assistance Center

·      Las Vegas Hotels now doing 24 hour wellness check regardless of do not disturb signs

·      Mandalay Bay is a Closed Point of Dispensing location



Nicolson, T. (2018, June 21). 01 OCT 2017 Mass Shooting Incident Las Vegas. Lecture presented at MESH Coalition Grand Rounds in Sidney and Lois Eskenazi Hospital, Indianapolis.





Stephanie SullivanComment