It Takes an Army to Manage a Medical Tragedy

Broken-out windows (lower right in image) on the 32nd floor of Mandalay Bay Resort and Casino on Las Vegas Boulevard from which a shooter rained bullets down on innocent concert-goers, killing 58 and injuring nearly 500.

By Dr. Sudip Bose, MD, FACEP, FAAEM

“The worst act imaginable often brings out the best of people.”

You’ve likely heard that phrase, probably often repeated, during the news coverage of the horrific mass shooting at the Route 91 Harvest Festival outdoor concert on the Strip in Las Vegas on Sunday, Oct. 1, as well as during the aftermath of hurricanes Harvey, Irma and Maria.

As a physician and especially as an emergency department doctor, we train for mass casualty situations on a routine basis, always hoping we never have to experience such an incident in reality. It’s a concept I accepted as a medical officer on the front lines of Iraq in the Army: We prepare in peacetime for wartime. When a mass casualty situation happens, that’s exactly what it’s like – you get thrust into a war zone immediately.

And it takes an Army to carry out the mission needed to try to keep casualties as low as possible.

At 10:05 pm Sunday night, shots rang out from the upper floors of the Mandalay Bay Resort and Casino on Las Vegas Boulevard. Initially most people thought what they heard might be fireworks associated with the concert. But all too soon, concert-goers realized that they were being fired upon as hundreds of rounds of bullets rained down on them. It didn’t take long for that “Army” to swing into action on the ground to start treating the wounded. First responders, as well as concert-goers themselves, immediately started do what they could to stop the bleeding of those hit. They had to get the injured stabilized and transported to hospitals. Las Vegas area hospital emergency departments quickly became saturated with patients. Victims – 5, 6, 7, 8 at a time – were piled into ambulances at the scene of the shooting and rushed away for treatment. Eyewitnesses to the shooting event also reported that gunshot victims were loaded into pickup trucks and civilian cars in some cases and transported to hospitals.

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The High Cost of Prescription Drugs in the United States

By Dr. Sudip Bose, MD, FACEP, FAAEM

Spending on prescription medications is higher in the US, per capita, than in any other country in the world, according to a recent Journal of the American Medical Association study. And, the report said, those costs are “largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index.”

An NBC News report noted that, “Paying for medicine can be the most expensive out-of-pocket health cost for Americans.”


If you look at the landscape of prescription drugs in America, you’ll notice there is nothing in place to keep drug prices low. There are no specific regulations to keep a ceiling on costs. The pharmaceutical manufacturers have the very tempting opportunity to charge whatever they think a drug’s demand and the market will bear. It’s simply possible for a drug company to charge high prices if they want to, just because they can. There’s nothing regulating whatever cost they want to charge. So the opportunity to charge more exists.

Drug companies will tell you immediately that their costs to research, develop and bring a drug to market are astronomical, and they have to cover those costs and make a profit to continue to stay in business and develop even more innovative prescription medications that will help save more lives. That’s a primary reason pharmaceutical companies will point to as a reason for escalating prices on all the medications they manufacture. And that’s true – to a degree.

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The Opioid Crisis in the United States

By Dr. Sudip Bose, MD, FACEP, FAAEM

“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency. It’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” President Donald Trump said yesterday.

It’s likely that President Trump was influenced by an interim report that was presented to him last week by the Commission on Combating Drug Addition and the Opioid Crisis, which compared the nation’s overdose death toll to the toll that resulted from the terrorist attacks on 9-11: “With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks,” the commission’s interim report noted. And the commission urged the president to declare a national emergency under either the Public Health Service Act or the Stafford Act.

President Trump and the commission are right in placing such an emphasis on this national crisis – and it is a national crisis. It’s the biggest epidemic to have hit our country since the HIV epidemic of years ago, so much so that in the emergency room as an emergency physician, I’m seeing patients come in dead from opioid overdoses. People are getting addicted and are coming into our emergency rooms and they’re dying from this. A couple of those instances I remember very vividly – one where a young girl went downstairs at her house to find her older brother and his girlfriend blue and not breathing; in another case a man looked out of the window of his house and saw a teenager lying still on his lawn. I know the stories, because the brother, the girlfriend and the teen on the lawn all came through my emergency room and all were dead from overdosing on opioids. You don’t forget those kinds of things.

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