ER Docs Offer Lessons From Aurora Shooting

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In the hours immediately following the Aurora theater shootings in July, chaos reigned. But amid the blood, sirens and confusion, there were brief moments of clarity, moments when people made critical decisions that prevented more lives from being lost.

That’s what a panel of doctors and a nurse who treated shooting victims told an audience of their peers yesterday. CPR Health Reporter Eric Whitney has this report from a special session at the American College of Emergency Physicians’ annual conference, happening this week in Denver.

This is a transcript of the story

REPORTER: It doesn’t take much to stir up memories of the night most people in Colorado would rather forget.

POLICE RADIO AUDIO: We got another person outside, shot in the leg, a female, I got people running out of the theater that are shot.

REPORTER: Six doctors and a nurse who were on duty at hospitals that night in July re-lived the events again yesterday to try and help their colleagues learn from the experience that they all said was like nothing they’ve ever been through, or want to go through again.

Dr. Austin Johnson, who was still in residency training at the time of the shooting, offered a thumbnail sketch of most of the victims in the order they arrived at local hospitals.

JOHNSON: A 19-year-old female, she was shot in the neck, and some shrapnel to the chest, and ended up getting a chest tube initially. We then realized that she had an expanding neck hematoma, once she told us that her voice started to sound funny. She was fiber optically intubated, went to the ICU, went to surgery the next morning with vascular, and did well after her bilateral carotid injuries, which I’m amazed that she lived from.

We had a 17-year-old male brought in by the police, shot in the chest, the abdomen….

REPORTER: It took Johnson the better part of an hour just to touch on each victim’s medical challenges in a very clinical, matter of fact delivery. His presentation reflected how doctors and nurses dealt with what would become the most horrific scene many had ever witnessed. They relied on their training to remain calm, assess the situation and do what needed to be done. The enormity of what they were witnessing wasn’t obvious all at once.

JOHNSON: We had a 27-year-old female – and I think this was first patient when I realized, this was not my normal night - this was a 27-year-old female who was brought in by police, was shot in the abdomen, and had a completely eviscerated abdomen. Obviously a weapon that I normally, I’ve not been in the military, but this was not the kind of wound I would normally see.

REPORTER: Dr. Barbara Block had a moment of clarity that helped University Hospital successfully treat the 23 shooting victims who would eventually arrive there. At the moment, no one had any idea how many seriously wounded people were coming. No one expected nearly two dozen. But Block paused in her medical assessments long enough to ask a patient, what happened?

BLOCK: This patient had minor injuries, but she described the scene in the theater, which was horrific, and I realized that, with the shooter actively shooting even as she left the theater, that these victims were trapped, and we were going to get multiple victims, and in my mind, it was an oh my God moment, and, we need to prepare for something bigger.

REPORTER: The knowledge that University was likely to get more than just the handful of shooting victims they’d seen at that point helped it get and deploy extra doctors and nurses, to prepare operating rooms and start locating supplies likely to run low.

Another moment of clarity came at the scene of the shooting, when police were just starting to realize how many people had been shot. Here’s the emergency radio tape of that moment.

POLICE RADIO: Do I have permission to start taking some of these victims via car? I got a whole bunch of people shot out here, no rescue.

Yes, load ‘em up, get ‘em in cars, get ‘em out of here!

REPORTER: Ambulances weren’t immediately available because protocol at shootings is to let police secure the area before medical help is called in, to protect paramedics. But in the rapidly evolving and chaotic scene at the theater, the decision was made to not burn precious minutes bringing in ambulances that were staging nearby, and most victims went to hospitals in police cars.

Dr. Gilbert Pineda, who treated shooting victims at the Medical Center of Aurora, and is medical director for Aurora’s emergency medical responders says he knew at the time that the decision would be controversial.

PINEDA: What’s going to upset me the absolute most, is someone’s going to throw a rock at how things were managed in the field, and I know that an outstanding job was done, and critical decisions were made that saved lives.

REPORTER: Pineda says the most difficult thing he has to deal with in the shooting’s aftermath is that he’s not allowed to rise to the defense of the people who made split-second decisions in the heat of the moment. That’s because there’s a broad gag order imposed by the court that’s trying the suspected shooter, James Holmes.

The other doctors say they’re still coming to terms with what happened that day, too. They say that even though they’re hardened to seeing brutal trauma regularly as emergency room doctors, what they witnessed that day got to them, and they expect to still be trying to come to terms with it for months or years in the future.

[Photo: MVerlee/CPR]