October 3, 2017 - Reflections on Las Vegas Shooting: Deadliest Mass Shooting in Modern US History

BY Allan Chrisman, M.D., NC Disaster Committee Chair and Don Buckner, M.D., NCPA President

Just as the disaster operations for Hurricanes Harvey and Irma were closing and those for Hurricane Maria were ramping up, the unexpected happened-- a mass shooting at a popular, family-friendly, outdoor country music concert.  Twenty-two thousand people were in attendance at the Route 91 Harvest Festival in Las Vegas, aka The Entertainment Capital of the World. In four minutes, 59 people were killed and more than 500 wounded (at last count) by automatic gunfire from a lone gunman shooting from the room of a nearby hotel overlooking the event. 

Chaos and panic pervaded the scene while almost simultaneous coverage through social media communication and video footage broadcast the carnage. Although the active shooting quickly ended with the suicide of the gunman, the repercussions had only begun. 

How does one distinguish differences between a natural disaster and acts of terrorism/mass violence? What are the psychological implications for impact on individuals, families and communities?  Below is a table taken from Responding to Victims of Terrorism and Mass Violence Crimes-  Coordination and Collaboration Between American Red Cross Workers and Crime Victim Service Providers.


What does this mean for mental health practitioners and psychiatrists? 

Although resilience is expected for most, it is not necessarily so for patients who are already receiving treatment for many disorders and who will be vulnerable to acute stress reactions and/or relapse in their conditions. These symptoms can include fears about safety, hypervigilance, flash backs, being easily startled, disrupted sleep, feelings of panic and helplessness and depression triggered by images of the shooting. Dissociation and experiences of disorientation are often more serious indications for prolonged or difficult outcomes.

What about the psychological effects of witnessing a terrorist act?

A recent commentary by Scott N. Romaniuk & Emeka T. Njoku in the Geopolitical Monitor July 2016 notes:

“Helplessness and fear are the most dominant impacts on witnesses of terrorism. This feeling can be pervasive and extend from one individual to another, permeating entire communities. Given that terrorism is a random occurrence (at least to the victims or to those targeted), fear can easily be strengthened by a number of aiding factors such as population size, density, diversity, and history. A sense of belonging or being part of a community may strengthen an individual’s resolve, aid in the healing process, or diminish the effects of witnessing or being a part of a terrorist act, but it cannot necessarily shelter an individual and prevent her from being affected.”

Our roles as psychiatrists means that we need to be vigilant to the distress of all in our professional and personal lives. Our leadership and support for the enhancement of resilience in our practices and communities is more important than ever.

Regrettably there will be more violent acts of terror. Let us at NCPA know what you feel is needed to provide support to you and your practice.

In the meantime, visit the disaster resource center for tips and guidance on helping your patients and their families.