As mentioned, the most important thing is triage. In these situations, it becomes an "all hands on deck situation". I was involved in an MCI where my hospital received 50+ patients in 1-2 hours. (Unending appreciation and respect to the folks in LV who dealt with so much more.) For us, staff stayed late, surgeons (general, trauma, neurosurg, ortho) came in from home. Medicine emptied the ED and continued work-ups on the floors. Intensivists came down to the ED. Medicine folks who were able assisted in care. I expect that outside of such an event, I'll never see such cooperation between specialties again. Also, lets not forget the registration and house keeping folks who did a great job; they don't get the glory, but they can be crucial. On the scale of the LV event, patients necessarily need to be sent to other hospitals, even if not a trauma center. If the hospital has general surgery, ortho, and vascular, there is no real reason they cannot handle those patients. Any general surgeon should be able to handle trauma (sure, reality is that most do not want to do that if they had the choice, but they can open a belly, resect bowel, pack a pelvis, ligate bleeding arteries, etc.)
I'm still in awe of how well these hospitals handled this. What they did needs to be intensely studied - what worked, what didn't. I suspect lessons learned there will make it in to text books in the future.
