August 13, 2019

For staff at University Medical Center of El Paso, the hours after the shooting were a time of "heroics in the face of violence," Gina Kolata writes for the New York Times, recounting the team's efforts to save 14 victims of the shooting.

From shootings to hurricanes: How can hospitals prepare for disasters?

The shooting

On the morning of Saturday Aug. 3, a gunman entered a Walmart at a shopping center in El Paso armed with an A.K.-47-style rifle and began firing, killing 22 people and injuring at least 24. Police have one suspect, Patrick Crusius, 21, in custody.

According to Greg Allen, chief of the El Paso Police Department, officials are exploring potential capital murder chargers for Crusius, who surrendered to police.

Inside the hospital

On the day of the shooting, emergency vehicles transported 14 victims to the University Medical Center of El Paso, the only hospital in a 270-mile radius of the shooting that's prepared to treat complex trauma patients, according to Kolata.

When University Medical Center staff caught wind of the situation, they sprang into action, Kolata reports. One surgeon, Alejandro Rios Tovar, had just returned home from a 30-hour shift when he received a text from Alan Tyroch, chief of surgery at the hospital, directing him to come back to the hospital. 

"Active shooter. Anybody available return to the hospital immediately," the text read. Tovar arrived back at the hospital 15 minutes later. Another doctor, who was about to leave for vacation, rushed back to the hospital and, with no time to change into scrubs, operated in jeans and a T-shirt, Kolata reports.

The first patient arrived in a police car. After that, ambulances brought more patients, the majority of whom had multiple injuries, usually to the intestines and chest. Other injuries included shattered bones in the pelvis, arms, or legs. Most of the victims had multiple injuries and required multiple surgeries, Kolata writes.

One patient treated in the hospital was "shot through and through," Susan McLean, a surgeon and the director of surgical critical care, recalled, while another patient's heart stopped until doctors shocked her heart into beating again, Kolata reports.

The staff "discovered a small miracle in the carnage: No patient had a brain injury or spinal cord injury," Kolata writes. One victim, who suffered a shot in the chest, died in the ED from blood loss. The rest of the 14 victims survived, Kolata reports.

Nancy Weber, an ED physician, evaluated and stabilized patients as they came in. In the critical care area of the ED, which was steps away from the OR, doctors were able to transfuse 109 units of blood—about 11 bodies' worth.

Overall, the immediate response effort required four general surgeons, a cardiac vascular surgeon, three orthopedic surgeons, and three surgeons in other specialties, as well as the housekeeping staff, who had to clean and prepare the ORs for the next patient.

Follow-up surgeries

But the response did not end the day of the shooting, Kolata writes.

On Sunday, Aug. 4, the day after the shooting, Tyroch said he spent three hours on one patient's second operation. That same day, three patients were taken to general surgery so doctors could repair damage to soft tissue and their abdomens, and orthopedic surgeons operated on two more patients.

Six days after the shooting, doctors were still operating on some of the surviving patients, Kolata reports. On Friday, eight patients were still in the hospital and two in the ICU.

In the days ahead, even stable patients are at risk of pneumonia, infections, and blood clots, Kolata reports.

Doctors relive the experience

The story of the medical staff who cared for the victims "is one of heroics in the face of violence," Kolata writes. However, she noted that in the wake of care the doctors and nurses "struggled to live with the horror of what they had experienced."

McLean said that, when she made rounds the next day, she noticed a lot of the medical staff were in tears. "It's unreal what these patients went through," she said.

The day of the shooting, Tyroch managed to keep from crying until he drove home. Weber said she barely made it to her car before she started sobbing. "There is a sense of relief when they say, 'OK, there aren't going to be any more victims'—that's the first time you take a deep breath," she said. "Then you go home and you cry and you pray and you hug your loved ones."

But the first day is only the beginning, Weber said, adding that some of her colleagues may suffer from PTSD after the emergency. "Doctors and nurses are not immune," she said. "We see trauma and very traumatic deaths every day. But we don't see 14 people in an hour" (Kolata, New York Times, 8/9).

From shootings to hurricanes: How can hospitals prepare for disasters?

Hospitals must be prepared for myriad disasters that can stress health care systems to the breaking point and disrupt delivery of vital health care services.

Advisory Board has compiled step-by-step procedures for various threats your facility may encounter—though we hope you'll never need to use them.

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