Astroworld chaos started BEFORE gates opened at 9am - and security had lost control of the crowd by 10am: Police audio reveals cop radioed to report the crowd surge just minutes into Travis Scott's hour-long set
Chaos at Astroworld Festival on November 5 left nine people dead and hundreds injured, including 9-year-old boy who is in a coma
Police audio recordings reveal officers called for concert to stop during Travis Scott's set but he continued performance
Lawyers announced they are filing 90 lawsuit on behalf of clients claiming to be injured during the crowd surge
Personal injury attorney claimed organizers of the festival had no plan in place and the situation got out of control as early as 9am
Fire department logs show a lieutenant requested riot gear at 8.15am; by 10.15am, attendees breaches gates and checkpoints, and damages fences
Audio recordings of police communications from the night of the Astroworld Festival disaster reveal that officers on the scene called for the concert to stop because people were being trampled in the crowd, but Travis Scott carried on with his performance.
A crowd surge at the sold-out festival of 50,000 people on November 5 left nine people dead and hundreds injured, among them a 9-year-old boy who remained in a medically induced coma.
Concertgoers have described the packed crowd growing dangerous hours before Scott appeared on stage at 9pm, and seeing people collapse while the rapper performed. Scott’s attorneys have said he did not know about the deaths and injuries until after the show.
Houston Police Chief Troy Finner has placed the blame on Scott for not canceling the performance after his officers were caught on video milling about next to the stage and recording the rapper on their cellphones after a 'mass casualty event' (Abstract
Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a high-volume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.
Keywords: mass casualty, multidisciplinary, mass shooting )
Introduction
A mass casualty event (MCE) is characterized by multiple fatalities and a sudden temporal surge of injured patients necessitating emergency services.1 Emergency resources are saturated within hours as critically injured patients arrive to the nearby hospitals. Current MCEs are an epidemic culminating from mass shootings, bombings, or other atrocities against human life. In the United States (US), mass shootings are the most common and most closely tracked type of MCE.2 Also referred to as “mass killings”, this type of MCE is rather defined as three or more killings in a single event, while others reference it as greater than four.
Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a high-volume of injured patients. Accurate triage is essential in these circumstances of multiple critically ill patients with limited resources. Those hospital facilities closest to the incident may receive a disproportionate share of injured patients, and although MCEs remain infrequent to daily healthcare systems, emergency departments (ED) and trauma centers worldwide are establishing protocols to prepare for such events. Our objective is to review and discuss emergency response, hospital preparedness, and the multidisciplinary approach necessary to provide immediate emergency care to the injured during a critical incident following a mass shooting.
Mass Casualty Team Collaboration Local hospital operations require a team leader to effectually coordinate and communicate with various healthcare disciplines and hospital departments. The broad support and operational plans outside the hospital include emergency medical service (EMS), local law enforcement, government agencies, and city officials. Integrated clinical-alert system through community healthcare systems enhance the response of all neighboring hospitals. Following any type of MCE, internal and external communication with community leaders and partners (EMS, healthcare personnel, public health officers, law enforcement and government agencies) is essential. Interfacility communication in conjunction with management systems help coordinate all participating team members to help optimize acute care needs. This multidisciplinary team (MDT) collaboration strengthens the emergency response to optimize the delivery of life-saving care. All patients presenting via EMS will be rapidly triaged. Commonly, surgical intervention is required for the critically injured. Operating room personnel should not only anticipate an acute surge of patients directly from the ED but also prepare for multiple and simultaneous procedures. Collaboration with the anesthesia team, OR staff, and surgical specialist (ie, trauma team, vascular and orthopedics) is crucial for improved outcomes. An MDT approach to a polytrauma patient can provide a reduction in anesthesia time, maximize OR availability, and shorten overall hospitalization. Coordinated surgical care with surgeons operating in parallel provides operating room efficiency and surgical stabilization of the injured.3
Emergency Response and Triage Historically, triage methods during wartime conflicts improved patient outcomes and survivability. The field triage process effectively utilizes acuity levels for the injured at a designated area. Optimal field triage by first responders requires pre-incident training. The goal is to identify and prioritize the injured before emergency transport. Traditional mass casualty triage systems involve Sort, Assess, Lifesaving Intervention, Treatment/Transport (SALT) and Simple Triage and Rapid Treatment (START) triage methodologies. Triage systems commonly assign each victim to green (minimal), yellow (delayed), red (immediate), or black (dead) categories. These colored designations can be changed at any time due to clinical status; however, focus should remain on a rapid assessment. Primary triage systems are not built for determining resource allocation.4 First responders should transfer stable patients to an ancillary or non-hospital facility for immediate resource allocation to critical patients. Smaller hospitals experiencing a nearby MCE may not be able to care for all patients, especially outside the urban metropolitan area. Below is a brief summary of notable mass casualty shootings, and Table 1 demonstrates the world’s deadliest mass casualty shootings in the last 35 years.
The Aftermath: Social Services and Family Support
A community’s ability to handle any MCE depends on the critical demand and capabilities of the treating healthcare facility. Lessons learned from previous MCEs include the aftermath support necessary to guide and inform the victims, their families and all professional personnel involved during the incident. Following the 2013 Washington, D.C., Navy Yard shooting, the after action report highlighted the necessary notification and communication process for victim families and advocated for the collaboration and structured processes during a critical incident.25 Establishing a family assistance center (FAC) in the aftermath of an MCE is crucial to hospital strategic planning in the aftermath of an MCE. This platform provides social workers, counselors, and volunteer community support groups to those in need of assistance. Similarly, the after action report of the 2013 Boston Marathon bombing recommended that a plan FAC be established prior to any MCE so that jurisdictions can quickly establish necessary services for victims and their families.26 The San Bernardino terrorist shooting incident report advocated for a FAC location where amenities such as food, water, and charging stations were provided for victims while they waited to receive updated information.27 Mass shootings are associated with negative psychological outcomes in survivors and community members. FACs may also offer assistance with mental health, pastoral care, and a variety of short-term and longer-term needs for affected family members. This interdisciplinary team provides the skills and services by both medical (MSW) and occupational (OSW) social workers. MSWs will care for patients and families who have encountered a life-altering trauma, while OSWs use similar skills to act in response to mental health needs of their healthcare colleagues that may arise following the disaster response.28 The mental health consequences, including post-traumatic stress, require a coordinated effort to arrange readily accessible mental health services for those affected. Immediate interventions may include psychological debriefing, community outreach and coping strategies in an effort to diminish any psychological repercussions extended to the community.
Blood Bank Preparedness
MCEs challenge the utilization of resources at all levels, with blood being no exception. Damage control resuscitation (DCR) has become a key concept that has been adopted from military to civilian practice.31,32 These principles include hemorrhage control (ie, the use of tourniquets,tranexamic acid) within the first 3 hrs and transfusion of 1:1 or 3:2 ratios of red blood cells to fresh frozen plasma.33–35 While crystalloid was initially the product used in resuscitation, blood products are now considered the gold standard in DCR even in pre-hospital settings.36
While patient outcomes have improved with the use of blood, the logistics of obtaining, storing, and supplying blood are much more complicated than intravenous fluids. While crystalloids can be given to any patient, blood must obviously be group O until the patient’s blood type is known. Moreover, crystalloids can be stored for years, while blood products have a limited shelf life. Finally, the administration of blood, unlike crystalloid, is limited by its availability, which is tested during MCEs as many patients require the use of massive transfusion protocol. Based on prior MCEs, the highest demand for blood is during the initial 4 hrs when the most gravely injured patients are brought to the hospital, using two-thirds of the total blood transfused.36–38
There is no standardized protocol for the preparation of blood products in MCE; however, several countries have published their individual experiences and subsequent recommendations. Israel has experienced over 1600 terrorist attacks between 2000 and 2005, finding that 6.7 units of blood and 4.5 units of components were needed per one moderately or severely injured patient. The National Blood Services in Israel is a national, non-profit organization that manages the supply and distribution of blood and has been successfully able to provide products as needed with the development of a national preparedness blood program.39 A study using a computerized simulation model of a UK major trauma center found that even small volume MCEs could overwhelm trauma centers’ blood supplies and restocking would be necessary. The authors also suggest a central supplier for blood as a solution for the massive demand for blood during MCE.37,38
Review of the Las Vegas mass shooting showed that over 500 units of blood were used. Local stock in the treating hospitals along with United Blood Services and American Red Cross contributions allowed for an adequate amount of transfusion products without the need for public donation.14 As MCEs increase in number and lethality, the ability to provide blood products in the pre-hospital and hospital setting is of paramount importance to reduce mortality. Creation of national, or even international, protocols may help create a more organized system for storage, delivery, and utilization of blood during MCE. For now, relying on the blood banks of local hospitals as well as national organizations appears to be universal practice.
Lessons Learned
The intensifying epidemic of violence resulting in mass casualty incidents has promoted the development of effective and coordinated response protocols. Affected centers have published their institution’s debriefing and analysis of quality improvement recommendations. These personal accounts provide not only a platform for the development of institutional mass casualty response protocols but also offers a component of experience to those that have not been faced with such an event. Acknowledging the pros and cons of tactics employed in the face of an MCE also helps other facilities prevent similar mistakes. Lessons learned from previous incidents include, but are not limited to, securing the emergency department, using remote damage control approach to guide resources, evaluation of the complex trauma patient, and management of the aftermath.40–43 It is essential to fundamentally appreciate the magnitude of these high-pressure, high-volume events in order to develop an institutional response protocol.
Establishment of a partial lockdown early in the response is essential to maintaining the efficiency and safety of the response system.41 Complete lockdown prevents entry of medical personnel; however, it is important to consider ambulances as a potential threat. As these vehicles are capable of carrying up to 4000 pounds in explosives, designated ambulance checkpoints a safe distance from the hospital are recommended.41 A facility’s ability to receive or provide information may be inhibited by overloaded or shut down telephone systems in law enforcement’s attempts to prevent remote detonation of an explosive.41,42 Real-time communication may be provided to hospital personnel through social media at predetermined time intervals.41 Prearranged teams of medical personnel should be stationed within the emergency department with back-up teams at a distance, in the event the primary team is compromised. Consideration of primary and secondary blast effects should be based on the building’s architecture when planning evacuation.41 Furthermore, the chain of command should be well established and easily referenced, as one facility identified disruption of patient flow as multiple “leaders” tried to implement simultaneous and potentially contradictory plans.41
Coordination of care of the critically injured patient in immediate need of intervention is supply and personnel intensive. The appropriate triage of high volumes of injured patients is essential for resource allocation after a mass casualty incident. Evaluation of complex injury patterns includes concomitant blast and crush injury, penetrating and blunt visceral injury and neurologic and orthopedic injury. Rapid triage, anticipated clinical course and complications of this injury complex are best determined by mature judgment.41–43 Reviewing and continued reassessment of the patient, management plans, and imaging helps optimize patient care and prevent complications associated with missed injuries.40 Mass transportation of those patients not requiring immediate life-sustaining interventions to nearby facilities clears the responding trauma centers for critically ill patients.43 This maintenance of clinical capacity is essential to the MCE response. A designated individual (ie, trauma medical director) should coordinate all operating room personnel, cancel all elective cases, prepare for simultaneous operations and need for delayed second-look operations.40
It is essential to maintain close supervision and documentation of time limits in provider care. Hospital staff may experience physical and emotional exhaustion in caring for injured patients in a crisis.40 Residents who served at Orlando Regional Medical Center during the Pulse Night Club Shooting experienced burnout, major depression, or post-traumatic stress disorder (PTSD) lasting 6 months after the crisis had ended.40 On November 13, 2015, Paris suffered four suicide bomber attacks within 40 mins resulting in 495 wounded and 130 dead.40 Providers followed 840 firefighters with a psychological check-up within 4 weeks of the incident, 1/3 followed up 3 months later, all underwent repeated PTSD screening.40 Furthermore, facilities should anticipate media attention and plan accordingly. Recommendations include establishing regular conferences, creating an official website, setting up a call center with a hotline and designating a family gathering area.40 This organized response to anticipated media attention and its consequences prevents distractions from the care of patients and ensures a unified hospital message.40
Simulation Exercises
There have been many suggestions about ways to improve the performance of providers and hospitals during an MCE. One thing that can be helpful is simulation exercises and drills. Advantages of these practices include identification of deficiencies, developing and implementing solutions, and increasing confidence in practiced and learned strategies.44,45 After the Sandy Hook shooting, the Hartford Consensus conducted a number of surveys and released reports focused on enhancing survivability from both active shooter and MCEs. One key point was that simulation and training events can help to avoid delays in reaction time. In addition, all simulation exercises should include both practice and conversations about evacuation policies and procedures.46 Recent reviews of the events after the Boston Marathon bombing identified planning and simulation exercises as a key part of the successful triage and treatment of victims.44,47 SimWars is one example of a simulation exercise that focuses on teams participating in an identical and observed mass casualty exercise followed by a group discussion and debrief. Participants are assigned roles and are tasked with triaging patients while observers complete a checklist on each patient. Results show that both participants and observers develop new understanding about how to triage patients in MCE.48 Another technique is to utilize one hour computer-based simulations to assess management and self-efficacy. By the end of multiple sessions, participants exhibit improved abilities to triage and treat trauma and in-hospital patients.49 Another recent simulation involving an active shooter in a hospital showed a 70% improvement in knowledge and preparation for an MCE.50 Overall, simulation exercises provide many advantages to first responders. They improve knowledge of emergency activities and improve competence and confidence in a potential MCE.51 One major advantage to simulation exercises that has been seen across multiple studies is the ability to identify gaps or limitations in plans, protocols or procedures so that solutions can be implemented. Simulation exercises have been shown to produce stress in participants, with the most stress being seen with those responsible for triage. Despite this stress, participants have performed effectively and efficiently despite any reported higher stress level.52 Long-term retention of skills learned during simulation exercises is an area that is both lacking and conflicting in current research. This is most likely only due to difficulties in longitudinal follow-up; however, it remains an area of concern. Overall, there are different options for simulation exercises that exist and there is little doubt that these are helpful in the setting of a real MCE.
was declared.
On Friday, lawyers for 200 victims of tragedy announced that they were filing another 90 lawsuits against the promoters of the festival.
Personal injury attorney Alex Hilliard said during a press conference that the organizers of the event did not have a plan in place, and the moment the gates at NRG Park opened at 9am on November 5, 'things were out of control.'
Another lawyer representing a further 150 alleged victims released fire department logs on Friday, which showed that a lieutenant requested riot gear nearly an hour before the festival got under way.
Scott was only minutes into his hour-long set when at least one Houston officer radioed over a police channel that the main stage had been compromised by a massive crowd surge.
Recordings of police radio traffic, obtained by the Houston Chronicle, reveal how quickly law enforcement became aware of the mounting danger in the throng of concertgoers shortly after the rapper began performing.
'Looks like folks are coming out of the crowd complaining of difficulty breathing, crushing-type injuries,' one official said over the police radio around 9.21pm, according to the audio. 'Seems like the crowd is compressing on itself.'
Scott kept performing his set. The newspaper reported that officers spotted people leaving the crowd but that their voices remained calm through the first half hour.
'I’m at the medical tent,' one officer radioed in around 9.30pm. 'There’s a lot of people trampled and they’re passed out at the front stage.'
A second officer is heard on the recording saying of the unfolding crisis: 'that crowd is super thick, super dense. if you go in there, this could possibly turn into an officer rescue situation.'
Later, another officer says: 'we’re getting multiple reports of people getting injured. We have another report of cardiac situation with CPR by the stage.'
As the crowd surged, officers at the site grew increasingly alarmed at what they were seeing, with one radioing in: 'they have to stop the show because there's people trampled... they're not breathing.'
A registered nurse who gave her name only as Sophie told CBS Mornings on Friday that she was near the stage when fell onto another concertgoer and then two other people fell on top of her.
'And at that moment I kind of just told myself: if this is the way that I go then this is the way that I go,"' she recalled. 'Thankfully, some guy helped me up.'
After getting to her feet, Sophie went used her medical training to try and help victims, but the first three people she aided were already dead. Then, she came across a festival attendee named Arturo who was still alive but had a very faint pulse.
'I think he would have died if I didn't get there at the time that I did,' Sophie said.
Sophie recounted witnessing what she described as 'disregard for human life,' with concertgoers allegedly stealing clothing and electronics left behind by victims.
The nurse wondered how Scott, who was just 10-15 feet away from her up on the stage, could not see people begging for his help.
On Thursday, Scott’s representatives said in a statement that he was distraught and has been trying to connect with the affected families to share condolences and provide them aid.
Police Chief Finner said on Wednesday that police told organizers to pull the plug on the performance when fans in the crowd were administered CPR.
Authorities gave word around 10.03pm that the concert was in the process of shutting down, but witnesses say Scott and Drake, who took the stage toward the end of Scott’s set as a special guest, kept performing.
Finner repeatedly refused to provide timelines, saying the case was still under investigation. He said more than 500 officers were working the festival, more than double the number assigned in 2019 when the festival was last held.
But Finner said festival organizers had not provided clear records of how many private security guards were working the show, describing what they turned over as 'just not good.' It was up to Live Nation Entertainment, the show’s promoter, to secure two mosh pits in front of the stage, Finner said.
Scott’s attorneys on Wednesday pointed to an operational plan for the event that states only the festival director and executive producers have the authority to stop the show, 'neither of which is part of Travis’s crew.'
John Duff, whose clients include the family of 9-year-old Ezra Blount who remains hospitalized in a coma, said concertgoers in a section to the right of the stage would have had to go through thousands of people to access the main medical tent. He said a week later, the festival grounds are still littered with piles of bloody clothes, shoes, cellphone cases and bags.
'There was probably 1,000 pairs of shoes out there. It seems like a lot (of) people left barefoot or without clothes,' he said. 'You kind of felt a heavy presence out there.'
Tony Buzbee, the attorney representing the Acosta family and more than 150 alleged Astroworld victims, released internal Houston Fire Department logs, which reveal that at 8.15am, before the gates at the venue opened, a lieutenant requested riot gear.
An hour later, police requested medical help for four people.
By 10.15am, concertgoers had breached gates and checkpoints, and damaged fences.
'These logs demonstrate that as early as 10 am in the morning, security had lost control of the crowd,' Buzbee stated. 'Things got progressively worse as the day progressed. The organizers, promoters, security, medical staff, and performers had ample opportunity—literally hours of notice—to cancel the concert before anyone was injured. This is criminal.'
Buzbee indicated that he will file a lawsuit on Monday seeking more than $500million.
On Friday, personal injury attorneys Ben Crump and Alex Hilliard held a joint press conference in Houston to announce that they were brining 90 lawsuits on behalf of 200 clients claiming they were injured during the festival.
The filing follows at least 50 other suits that have been brought against producer Live Nation Entertainment Inc and Scott over the deaths and injuries related to the concert.
Crump said any one of several concert officials could have prevented deaths and injuries by stopping the show and turning on the house lights when the chaos in the crowd became apparent.
'Nobody should ever die from going to a concert,' said Crump. 'So this lawsuit is not just about getting justice for them, but it's about making sure that the promoters and the organizers know that you cannot allow this to ever happen in the future.'
Hilliard lashed out at what he described as the organizers' 'criminal behavior,' which he claimed started weeks prior to the concert when no safety plan had been put in place.
'At 9am when the gates opened, everything was out of control,' Hilliard said while standing beside some of his clients. 'As soon as the first person gets injured, if there's no plan, chaos ensues. The chaos grew, and grew, and grew until multiple people...lost their lives.
Hilliard described what transpired at the concert venue as '45 minutes of torture,' with people being unable to breathe or move, and having to witness fellow attendees dying in front of their eyes.
'And when you do finally escape that war zone and you get out of that crowd, you see multiple bodies on the floor,' he said.
The lawyer contended that medical personnel at the site were 'egregiously short-staffed' and lacking sufficient life-saving equipment, such as defibrillators, to resuscitate all the victims.
Hilliard argued that based on evidence gathered by his experts on the scene, the concert should have never been approved.
'We're talking about the largest organizer and promoter of festivals and concerts in the world,' he said, referring to Live Nation. 'And when that happens, a failure of epic proportions on this type scale, it is criminal. It is nothing but criminal.'
He added: 'sadly, a lot of our clients didn't even understand when they were buying their tickets - how could they - that they were buying their own death certificates.'
Travis Scott and Drake could pay 'billions' in damages after a lawsuit involving 150 people injured in the deadly crush at the Astroworld concert was announced.
Powerhouse Texas attorney Thomas J. Henry, father of Liam Payne's girlfriend Maya Henry, says that he is being contacted by more people 'by the hour.'
Eight people were killed at the NRG stadium on Friday night, more than 300 people received treatment at an emergency field hospital set up there, 11 others went into cardiac arrest and dozens more were knocked unconscious.
'More and more injured victims are contacting my firm by the hour,' said Henry. 'I believe the damages suffered by its victims could total in the billions.'
Among his clients is 23-year-old concertgoer Kristian Paredes whose complaint accuses Scott and Drake of 'inciting mayhem' at the event.
Texas-resident Paredes says he was left 'severely injured' and is demanding $1 million to cover the costs of his healthcare treatment.
He 'felt an immediate push' at the front of the general admission section as Travis Scott got on stage, the complaint said.
'Many begged security guards hired by Live Nation Entertainment for help, but were ignored.'
The suit, filed in Houston's Harris County court, claims Scott 'had incited mayhem and chaos at prior events' and that 'defendants knew or should have known of (Scott's) prior conduct.'
The suit also accuses Canadian rap superstar Drake, who joined Scott's headline set, of contributing to the surge.
'As Drake came onstage alongside of Travis Scott he helped incite the crowd even though he knew of Travis Scott's prior conduct,' the complaint charges.
He continued to perform even as the 'crowd became out of control' and the 'crowd mayhem continued,' it added.
High-profile attorney Ben Crump announced Sunday he had also filed suit against Scott and Astroworld.
Crump has represented the families of police killing victims George Floyd and Breonna Taylor.
He and co-counsel Bob Hilliard filed suit Sunday on behalf of 21-year-old concertgoer Noah Gutierrez, who described 'a scene of chaos and desperation.'
The lawyers said they expected to file suit on behalf of other concertgoers during the week.
'We are hearing horrific accounts of the terror and helplessness people experienced - the horror of a crushing crowd and the awful trauma of watching people die while trying unsuccessfully to save them,' Crump and Hilliard said in the statement.
'We urge others who suffered physical or emotional injury or witnessed the events of that day to contact us.'
I'm
funkin done with these people....
peel back an onion huh?
What do you think?
here's the linx..