When the first victim rolled in, the senior ED resident and I were there to meet him. I vividly remember the resident and I exchanging shocked glances at the size of the bullet wound on his back. That was our first indication of the enormity of the situation we were facing. He had arrived with very little warning -- only two minutes passed between hearing the EMS call and them rolling the patient through the trauma bay doors. He was sitting up, conscious and apprehensive. The trauma team had not had time to make their way into the Emergency Department so the resident and I were performing his initial evaluation. When we asked the patient to lean forward so we could assess his back for further gunshot wounds, we were not expecting to see a crater big enough to fit an entire hand inside. It was in that moment we began to grasp the severity of what was ahead.


Only a minute or two earlier the call went out over the Emergency Department loudspeaker. “X-ray, RT, trauma room, 1 minute.” I made my way from the back of the department toward the trauma room, mentally preparing for resuscitation. “Gunshot wound,” the nurse informed me as I walked into the room and grabbed my personal protection – a gown, gloves and facemask – standard attire for each trauma resuscitation we performed.


It started out as a pretty routine trauma alert with the trauma team trickling in and all of us tackling our assigned tasks. Each trauma alert is a well-choreographed dance, one we had all performed countless times. I recognized one of the transporting paramedics as he occasionally worked in the emergency department as a side gig. He chimed in, “At least 20 more headed your way.” Within minutes of his announcement, more patients started arriving. The next 4 to arrive would be some of the most critically injured. Normally the senior resident and I would handle all of the trauma alerts ourselves, however, with now 5 patients arriving all within a few minutes of each other, we called the rest of the residents and the second ER attending to the trauma bay to assist in resuscitations.


Two of the first five patients were without vital signs on their arrival and we quickly initiated CPR, prepped for intubation and set up for chest tube insertions. The wounded were arriving rapidly -- two or three at a time in the back of police pickup trucks and ambulances. Staff in the ambulance bay would pull them from vehicles and place them on a stretcher, then wheel them into the emergency department. Patients quickly began lining up in the hallway, waiting their turn to be assessed and resuscitated in the trauma bay. It rapidly became apparent that we were going to need to start triaging and prioritizing our efforts. This was one of the hardest things for us to come to terms with as a team. We were accustomed to putting full efforts into each and every patient, but this was impossible due to the sheer numbers of injured.


As each patient entered the trauma bay, our team descended upon them, placing IVs, assessing injuries, calming nerves. Many required emergent procedures – chest tubes, central lines and intubations. Some were taken almost immediately to the operating room or intensive care unit while others were stabilized and moved to rooms in the general ER to make room to triage new patients. The rest of the first wave of patients passed in a blur of activity with only a few snippets standing out in my memory -- a young woman crying out for help from her ER stretcher, a young man struggling to breath begging us to help him, a high heel peeking out under a white sheet. After the first wave cleared, we started reassessing patients, repeating bedside ultrasounds, rechecking vital signs, reprioritizing those still in the emergency department.


Prior to receiving the second wave of patients, I was standing in the trauma bay with staff and two of the surgical attendings when we suddenly heard “Code Silver” announced over the intercom. This means there is an active shooter on campus or in the hospital. I remember turning to one of the other physicians and saying, “I didn’t come to work to get shot tonight.” We made the decision to barricade ourselves into the trauma bay and continue resuscitating our patients. We placed a heavy portable x-ray machine in front of each set of doors and continued with our efforts. Over the next 20 minutes, we were unsure of what was going on outside the trauma bay doors. The scene of mass violence was only a couple of blocks from the ED, and the scope and number of shooters was unknown. It was a reasonable assumption that such violence could spread to the ED, so we all breathed a sigh of relief when it was announced overhead that the code silver was canceled.


The second wave of patients began with an injured police officer. Amidst radio calls of “officer down, officer down” we prepared for the task of resuscitating one of our own first responder community. He had received a gunshot wound to the head but was extremely lucky that his helmet stopped the bullet and he was left with only a small contusion to his forehead. Watching him walk out and high-five the staff remains as one of the few bright spots of the morning. We started up our process again, assessing and stabilizing each patient as they presented to our department and trauma bay.


The entire event lasted only a few hours. By the time the next shift arrived at 7:00 am, only a handful of patients remained in the emergency department. The trauma bay was cleaned and prepared for the next patients who were unlucky enough to grace its stretchers. Half-empty supply shelves and stray blood splatters were the only indications of the turmoil of the night before. But those of us who were there will never forget the chaos and anguish of those early morning hours.