When the doctors and nurses at Sunrise Hospital in Las Vegas found themselves inundated with victims of October’s mass shooting at a country music festival there, their heroic efforts to save lives and stem the carnage relied heavily on expertise developed by a renowned New Orleans surgeon.
The late Dr. Norman McSwain, who for years headed the trauma center at Charity Hospital in New Orleans, pioneered many of the techniques put to use in the chaotic hours after the shooting, said Dave MacIntyre, a trauma surgeon at Sunrise.
“I’m telling you, you guys had the best here teaching you,” MacIntyre said of McSwain, who died in July 2015. The trauma center at University Medical Center in Mid-City is named after him.
MacIntyre and Dorita Sondereker, director of emergency services at Sunrise, came to UMC on Wednesday to talk to its doctors, nurses and other staff about the lessons they learned treating hundreds of patients that night.
Stephen Paddock — who was found dead of a self-inflicted gunshot wound after police broke down his barricaded hotel-room door at the Mandalay Bay Casino on Oct. 1 — managed to kill 58 people and wound about 850 others during 10 minutes of shooting into the crowd at the nearby concert.
Sunrise treated 214 patients and 124 gunshot wounds that night, performing 58 of its 83 surgeries during the first 24 hours.
MacIntyre, who trains other surgeons on the techniques used in military combat zones, said he attended many of McSwain’s seminars and studied his books on trauma care outside of hospitals — training that formed the backbone of the Las Vegas staff’s approach as it was almost immediately overrun following the shooting.
“That’s what we did at Sunrise,” he said. “We did military triage, and that’s why we were successful.”
The sheer number of victims that night made traditional trauma care impossible. Breathing tubes were inserted, often with an incision and a doctor’s finger, in the hallways.
Patients who had stabilized were taken to one or another makeshift unit based on which part of their body had been shot.
Those who hadn’t stabilized were rushed to the operating room, where surgeries were performed quickly and with two goals: to stop the bleeding and prevent contamination.
Anesthesiologists worked as nurses. Medical cleaning crews battled to soak up the blood and used snow shovels to clear debris.
“People were just finding things to do,” Sondereker said.
MacIntyre and Sondereker said the local cellphone network was quickly overwhelmed, making only texting possible, and most medical equipment was in short supply.
“You guys aren’t going to have enough monitors. You have to do systolic pressure by pulse,” Sondereker said, noting there won’t be enough wheelchairs, gurneys or ventilators either.
She said there was another trauma center a mile closer to the shooting site, but many people were using the Apple's digital assistant, Siri, on their phones to find a hospital and were directed to Sunrise because it is on the same side of the Las Vegas Strip.
Sondereker said gridlock on the roadways outside a hospital can also cause problems. Some victims at Sunrise ended up not just at the wrong entrance to the hospital but at other buildings entirely.
MacIntyre noted the proximity of the Tulane and Veterans Affairs hospitals in New Orleans to UMC, which could create mix-ups if arrivals aren’t properly directed.
“People die in their cars on the street, unfortunately,” he said.
Documentation was a particular problem, and keeping track of what had been done to patients was extremely difficult, they said. Doctors were writing on stretchers and victims' clothing.
MacIntyre said he came up with one idea after it was all over: Instant cameras could have been used to take pictures of the patients, with notes written on the back.
The massacre highlighted how important small details can be. MacIntyre said simply putting empty stretchers out with the head elevated can prevent volunteers from putting patients on them backward. He said he was forced to reverse the position of several severely injured victims by himself.
Sondereker said off-site counseling should be available for staff members, who suffer from the effects of dealing with so many severely wounded patients so quickly.
The second, third and fourth days, spent dealing with family members of the deceased, were difficult as well. There has been stress-related turnover.
“I’m calling it compassion fatigue, and I’m struggling with what to do,” she said.
James Aiken, UMC’s medical director for emergency preparedness, said the hospital’s existing mass-casualty plan has been in effect for years, and it was notably used to respond to the crash of a pickup into a crowd at the Endymion parade last year in which 32 people were injured.
Nevertheless, he said, “there is no substitute for hearing from people who lived through an event that we can only imagine going through.”
Aiken said accommodating patients who arrive in private vehicles, communicating with first responders in the field and being able to do triage in front of the hospital were key lessons from Sunrise.