As emergency response teams tried to reach victims of the 2012 Aurora movie theater massacre, their efforts were hampered by a lack of communication and a flood of 1,400 panicked moviegoers, according to a report released this week.
The report, commissioned by the city of Aurora, praises the emergency response teams' efforts, but also makes recommendations for a more comprehensive approach to chaotic situations.
Details of the tragedy
Just after midnight on July 20, 2012, lone gunman James Holmes opened fire in an Aurora, Colorado, movie theater during a showing of "The Dark Knight Rises," wounding 70 individuals and killing 12. Ten of the victims died at the scene, and two died later at nearby hospitals.
The first police unit arrived on the scene within two minutes of the first 9-1-1 call, but the first responders were not able to execute a coordinated effort to transport victims to hospitals amidst the chaos, the report found.
Ambulances trying to reach the theater were blocked by a maze of parked police cars and moviegoers so they did not arrive on the scene until 28 minutes after the first fire battalion. And without dedicated medical staff on the scene, police—who had nothing more than basic first aid training—took matters into their own hands and transported victims to hospitals in police cars.
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"The glaring omissions of a lack of communication between police and fire commanders, and the lack of a victim transportation coordinator, could have jeopardized having as favorable an outcome as was obtained," according to the report.
Moreover, response teams were not communicating well with each other. For example, police did not inform others when Holmes had been arrested, leaving responders unclear whether they were entering an active crime scene or a safe place. One police officer attempted to lead an ambulance crew to the victims on foot, but the crew refused to follow without information about their personal safety.
"Members of the theater audience had better cellphone communications with each other than did police and fire personnel," the report notes.
Overall, the "situation was complex and there were many challenges for first responders," the report says. The lack of coordination, however, did not result in any loss of life, the report says.
Moving forward, emergency response teams should establish a joint command center for mass casualties. In the Aurora case, a command area was not established until hours after the shooting.
"The city is aware of the lessons learned, and has already taken measures to implement changes. It is hoped the findings and recommendations will be useful to other jurisdictions as well," the report says.
The report does not address how the shooting could have been prevented but does discuss red flags in Holmes' history, such as his admission to a psychiatrist that he was having homicidal thoughts a month prior. The psychiatrist concluded that Holmes may pose a threat to the public, according to trial documents.