When I arrived at ORMC, I was met by Carlos and Dr. Michael Cheatham, ORMC’s chief surgical quality officer. They briefed me on the situation at hand. Things were unfolding quickly. The emergency department and trauma bays were receiving an influx of patients. And worse yet, it was believed that more victims, potentially even more severely injured, would soon follow.
Recognizing the extreme circumstances, and the need for reinforcements, the decision was made to activate the Hospital Incident Command System (HICS) at 3:14 am. Before long, the HICS team had assembled in the ORMC board room, which serves as the Incident Command Center. Around a long, wooden table are a dozen black leather chairs — each assigned to a particular member of the HICS team. In front of each person was a phone with a designated phone line.
I would remain in the command center for the next several hours. As incident commander, I was physically separated from the unfolding events just a few hallways away. To remain focused on the details that needed to be worked through, I was intentionally insulated from the events themselves. Although it was an adjustment to the traditional incident command plan, I sent Carlos into the field as my eyes and ears. At that time, what I needed more than anything was information and perspective from a key operational leader. This turned out to be one of the best decisions for the team.
On the video screens in the command center, I was seeing what the world was seeing. The images showed our hospital with ambulances lined up and people rushing in and out. Outside, I could see multiple vans lined up. These were from the medical examiner’s office and were waiting to take the bodies of those who died shortly after arrival.
I watched as the stretchers came out from behind a privacy screen, one after the other. There were nine in total. White linens were draped over the nine young men and women. It was an image I’ll never forget.
By 6:30 am, I was ready to be among our clinical team. It was important to see for myself what was transpiring. Following protocol, I designated a member of the incident command team to temporarily assume my role as incident commander and then left the room.
I made my way toward the trauma bays. The effectiveness of our team’s efforts had gotten the patients upstairs and the bays were empty except for a single team member. She was on the floor, gathering the victims’ personal items. She was doing her best to keep personal items sorted, placing them into clear plastic “belonging bags.” Along the wall were dozens of bags lined up side by side. Bags filled with articles of clothing, jewelry, wallets and cell phones.
I returned to incident command deeply affected by what I had seen. But there was so much more to be done throughout the rest of the day.
As Mark and I began our incident commander handoff, we were both becoming keenly aware of the devastation and the world-wide response that was unfolding. The conversation was all business, an uncommon occurrence for two colleagues who had worked together over three decades. Listening to Mark’s handoff, I knew this night would be unlike any other I had ever experienced.
Once our handoff was complete and the new incident command team was in place, I briefed the team on the tasks and priorities ahead. One of the top priorities continued to be patient/victim identification. I remember receiving the list of patients and all of the names started with “Jane” or “John Doe” followed by a different city and state. This unique identifier that unknown patients received would be linked to each one, once we established their true identity. I had never seen a Doe list so long, and I began to realize what a daunting task we had that would carry us through the night. After the briefing was complete and the team got organized around the priorities, I said to myself, and then to the team, “We’ve got this.”
Our team knew there were hundreds of distressed family members and friends waiting for answers. Yet, as desperate as we knew they were, this was not a process we could afford to rush because we could not afford to be wrong. We had a system in place to request identifying marks — tattoos, birth marks, etc. — but this wasn’t enough to distinguish the patients as efficiently as we needed. We had to be more creative with our identification process, so we requested photos from the families.
Amy DeYoung, ORMC’s administrator for allied health professions, watched her inbox flood with pictures from loved ones who were clinging to hope. The photos showed young men and women with vivacious smiles and eyes full of life. It was difficult to see these young people during such happier times knowing full well, that if the individual was under the care of our team, they would likely be unrecognizable.
As we continued the task of identifying patients, ensuring adequate staffing, ordering supplies and completing all of the other tasks necessary for ongoing operations, someone delivered a police officer’s helmet. You could see the bullet hole in the helmet from a shot earlier that morning. The officer survived, thanks to the helmet. This gesture gave us all a fresh sense of determination.
Through the night, various physicians would come into the command center and just sit quietly awhile before returning to their duties. In the middle of the night, I temporarily turned over incident command and called for the patient care coordinator to accompany me on rounds. I needed to check on the staff and see how they were doing. I went to the ED, trauma ICU and other units, and the staff was amazing — concerned only about the patients and how their colleagues were doing. Many of them had been there the night before and were back again to provide care.
The board room walls were covered with photos of young men and women we had not been able to identify. One by one, we worked diligently to identify each and every patient. With each positive identification came tears of joy and also heartache. Joy for those who would learn their loved one had in fact made it out of the club and was under our care, but heartache for those whose hope dwindled a little more each time their loved one’s name was not called. It was heartbreaking, but we remained focused on the tasks at hand.
In the early morning hours of Monday, questions started being asked. Are we canceling elective surgeries? Are we on trauma diversion? What are the plans for daily operations today? We discussed it as a team and decided we were not going to compromise our responsibility to the communities we serve and the patients who place their trust in us. We were not on diversion, we were not canceling cases. It was going to be a full Monday schedule as planned. Most of the victims of the shooting were going to need multiple surgeries, so I met with the chief surgeon and we prioritized each patient’s return to the OR. We were able to accomplish this without disrupting the regular elective schedule.
As the night became morning, we had made great progress. Only one photo remained without a name, one young man who represented the last of the survivors. A room full of families stood anxiously as our team worked to identify this last patient. They understood the grim reality that if this was not their son or brother or friend, their loved one had not survived the shooting.
This image, this one last photo hanging on the board room wall, is something I will always remember. I can still picture his face clearly to this day.