‘Is this real?’

7 hours of chaos and brav­ery pushes Las Ve­gas hos­pi­tal to lim­its

The Arizona Republic - - Front Page - Alden Woods

LAS VE­GAS - Dr. Kevin Menes had pre­pared for this mo­ment, when ter­ror came to his city and his hos­pi­tal, but once it ar­rived he couldn’t be­lieve it was true. A ra­dio used to alert the hos­pi­tal to in­com­ing ca­su­al­ties was blar­ing. Menes strained to un­der­stand. He heard some­one say: Pre­pare for a mass-ca­su­alty in­ci­dent.

“Hey, is this real?” Menes asked, turn­ing to a po­lice of­fi­cer pass­ing through the emer­gency room. Maybe it was an­other drill meant to look real, with fake blood and scream­ing ac­tors. Or one more false alarm, one more night Sun­rise Hos­pi­tal pre­pared for a panic that never ar­rived. “Yeah, man,” the of­fi­cer replied. Menes sprinted to­ward his car.

Menes had triaged 199 pa­tients and sta­bi­lized more than he could num­ber.

Menes, 40, chose to work the week­end night shifts in Sun­rise Hos­pi­tal’s emer­gency room be­cause they of­fered the great­est op­por­tu­nity to save a life, to see a per­son come into the hos­pi­tal dead and leave alive. He also vol­un­teered as a medic with the Las Ve­gas Metropoli­tan Po­lice De­part­ment’s SWAT team, and kept a po­lice ra­dio in his car.

In the park­ing garage, he lis­tened in as of­fi­cers swarmed the Strip.

Au­to­matic fire, he heard them yell. Con­cert.

How many peo­ple did that mean? Fifty? A hun­dred? A thou­sand? There was no way to know.

Menes didn’t know that 6 miles away, a gun­man had shat­tered his ho­tel win­dows and opened fire on 22,000 fans at the out­door Route 91 Har­vest fes­ti­val. He couldn’t know that al­most 600 pa­tients would flood into hos­pi­tals across the city — an un­prece­dented rush of gun­shot wounds into Amer­i­can hos­pi­tals. Fifty-eight would die.

Menes sprinted back in­side, where three other emer­gency doc­tors waited, and told them, “We’ve got to get ready.”

Sec­re­taries started down the first branches of phone trees, call­ing whomever they could into the hos­pi­tal. Nurses cleared the emer­gency room and threw open the cur­tains to trauma bays. A trauma sur­geon pulled on scrubs in his of­fice. House­keep­ers rushed to find enough clean linens.

For years Menes had imag­ined th­ese mo­ments. Theirs was a city of crowds, of fes­ti­vals and con­certs and other tar­gets of ter­ror­ism, and he wanted his re­sponse to be au­to­matic. He quizzed his emer­gency-re­sponse team and built plans in his mind.

Menes de­cided he would stand in front of the hos­pi­tal, where the life-and­death de­ci­sions would be made.. A doc­tor out­side could fil­ter through waves of pa­tients and en­sure a hos­pi­tal’s re­sources went to the most crit­i­cally in­jured.

Menes sent the other ER doc­tors to the di­ag­nos­tic area, a group of hal­f­rooms just be­hind the wait­ing room. The trauma sur­geon, Dr. Dave MacIn­tyre, put crash carts in the trauma bays, four cur­tained-off ar­eas that took up two walls in the ER.

Doc­tors in place, Menes found a sec­re­tary at the front desk and told her to call ev­ery sur­geon and scrub tech she could find. “I need ev­ery op­er­at­ing room open,” Menes said. MacIn­tyre di­rected six sur­gi­cal res­i­dents there to stand ready.

As prepa­ra­tions locked into place, the ru­mors of a mass shoot­ing ric­o­cheted through the hos­pi­tal: At first there was one shooter, then two. They caught the shooter. The shoot­ers got away. No­body knew for sure.

“I’m wor­ried some­body’s go­ing to come here and start shoot­ing at us,” Menes told a po­lice of­fi­cer. He knew ter­ror­ists some­times moved to hos­pi­tals to cause the most dam­age.

“I’ve got you, Doc,” the cop replied. “We’ll get some of­fi­cers over here.”

Soon a string of po­lice cars ar­rived, draw­ing a flash­ing line be­tween the chaos out­side and the quiet in­side.

Sun­rise Hos­pi­tal had five trauma doc­tors in the build­ing and hun­dreds of pa­tients on the way, piled into pickup trucks, am­bu­lances and the back seats of po­lice cruis­ers.

Menes turned to Deb­bie Bow­er­man, an emer­gency-room nurse who had fol­lowed close be­hind. “Come on,” Menes said, lead­ing Bow­er­man out­side. “Let’s go.”

They walked through the slid­ing doors of the emer­gency room and sat on a gur­ney, lis­ten­ing as a wall of sirens drew closer.

Sun­rise Hos­pi­tal’s staff of­ten calls it “the busiest ER in Ne­vada.”

It takes the brunt of Ve­gas trauma: gun­shots, bro­ken legs, con­stant al­co­hol poi­son­ing. Gang shoot­ings and car crashes end up at Sun­rise. Mem­o­ries of the 2015 night a drunken driver plowed through dozens of peo­ple on a side­walk linger.

More than 300 pa­tients flow through its ER on an av­er­age day. Some­times that num­ber surges as high as 350, and Sun­rise feels the swell.

On Oct. 1, that same ER treated 199 pa­tients in six hours.

There was no way to pre­pare for the vol­ume. Sun­rise runs mass-ca­su­alty in­ci­dent drills at least twice a year, but no hos­pi­tal had ever taken in hun­dreds of gun­shot vic­tims at once. There was lit­tle time for pro­ce­dure. There was only time to re­act.

The USA TO­DAY NET­WORK pieced to­gether that re­ac­tion in in­ter­views with more than a dozen doc­tors, nurses, hos­pi­tal ad­min­is­tra­tors and other Sun­rise staff in the days after the dead­li­est mass shoot­ing in mod­ern Amer­i­can his­tory.

Sun­rise brought more than 100 doc­tors and 200 other staff into the hos­pi­tal after the shoot­ing, claw­ing for more man­power and re­sources to keep up with the de­mand. Five chap­lains stood by, hop­ing against the dis­mal rit­ual of death.

Then the sirens ar­rived, car­ry­ing their wounded.

The staff ’s col­lec­tive at­ten­tion shifted to the ER. Trans­porters pushed pa­tients in­side, where they met doc­tors and nurses car­ry­ing spare gloves and IV bags. Be­hind ev­ery­body trailed a squadron of en­vi­ron­men­tal-ser­vices staff, who ripped off blood­ied bed­sheets and mopped up trails of blood.

A hos­pi­tal phar­ma­cist un­locked the stock of drugs used to in­tu­bate pa­tients. Nurses stuffed the medicine into the pock­ets of their scrubs, along with the blood bank’s en­tire sup­ply of O-neg­a­tive.

There was no time to build med­i­cal records or cre­ate charts, so doc­tors wrote notes di­rectly on pa­tients’ bodies. Pa­tients who couldn’t tell a doc­tor their name took on a new iden­tity. First names were as­signed al­pha­bet­i­cally, like hur­ri­canes. All shared one last name, a silent fam­ily brought to­gether by bul­lets.

Deb­bie Trauma: Fe­male, gun­shot wound to the chest.

Ed­die Trauma: Male, gun­shot wound to the head.

Fred­die Trauma: Male, gun­shot wound to the belly.

6 miles away

Rob Weiss and his wife, Beth, had looked for­ward to the Route 91 Har­vest fes­ti­val for months. They splurged on VIP tick­ets, and their teal wrist­bands en­sured a good view and a place to sit. They pre­ferred the young artists on the “Next From Nashville” stage, but when Ja­son Aldean took the main stage, they found their seats in Zone A.

Aldean played his hits, one after an­other. Then the band slid into “When She Says Baby,” and the house lights dropped. Ev­ery­thing went dark. Weiss saw the band scram­ble for cover. Peo­ple in the crowd started to fall.

Weiss, a physi­cian as­sis­tant at Sun­rise, rec­og­nized the crack­ling over his right shoul­der as gun­fire. He and his wife hid be­hind their seats, wait­ing for a mo­ment to scurry down the steps. When one came, they worked their way to the ground.

“I need to get to the med­i­cal tent,” Weiss told Beth. But the tent was tucked into the op­po­site corner, across the fes­ti­val grounds.

They sprinted through the crowd, weav­ing through the peo­ple press­ing against the edges and try­ing not to look at those left be­hind, stop­ping only at the sound of bul­lets. Each time the shots started again, Weiss pushed his wife be­hind some­thing solid and cov­ered her body with his.

Four times the bul­lets re­turned. Four times he threw him­self over her.

In­side the med­i­cal tent, Beth dug through med­i­cal sup­plies meant for sprained an­kles and sun­burns. Rob ex­am­ined ev­ery per­son he could find.

Had they been shot? Where? Belly wounds were the worst, be­cause they bled out the fastest. How crit­i­cal were they? Did they need a hos­pi­tal now, or could they wait a few min­utes? Was there even any room in the hos­pi­tals?

Blood spat­tered across his T-shirt and shorts. He knelt to work in crim­son pools, and it dripped down his legs.

Weiss sent the most crit­i­cal pa­tients, those with di­lated pupils and a slow pulse, straight to Sun­rise. He sent them in what­ever ve­hi­cles he could find, work­ing the tent un­til ev­ery per­son had left.

Then he checked back in with Sun­rise. The staff was over­whelmed. He told them he was com­ing.

He had parked in Man­dalay Bay, which wasn’t al­low­ing cars to come or go. There was only one way out. Weiss and his wife climbed into the back of an empty am­bu­lance, strapped them­selves in and rode the empty streets to Sun­rise.

‘How many more?’

The wounded ar­rived in waves. First came the po­lice cruis­ers drop­ping off two at a time. Then the pickup trucks and two-door sedans, back seats stained with the blood of as many they could hold. Am­bu­lances that aban­doned pro­to­col, bring­ing five at once, no time for back­boards or stretch­ers. The walk­ing wounded, stag­ger­ing through the slid­ing doors.

“How many more can you take?” a com­man­der from the Clark County Fire De­part­ment asked ev­ery few min­utes.

“Ten more,” Di­rec­tor of Emer­gency Ser­vices Dorita Son­dereker al­ways told him.

Kevin Menes met each one out­side the ER. He stood in the al­ley lead­ing to the am­bu­lance bays, bathed in flash­ing lights as he and Deb­bie Bow­er­man pulled peo­ple out of ve­hi­cles. They worked in a strange still­ness, a quiet shock that filled the am­bu­lance bays.

“Where are you shot?” Bow­er­man asked each pa­tient. Menes felt for a pulse and looked into their eyes, as­sign­ing each a color based on how long they might live.

Green tags were peo­ple shot in the arm or leg, able to sur­vive hours with wa­ter and pain med­i­ca­tion. They sat on plas­tic chairs or on the floor, fill­ing the crevices of an emer­gency room crammed full.

Yel­low tags had been shot in the chest or torso and would die within an hour. Menes put them in cur­tained-off rooms next to the trauma bays. A squad of nurses waited for them, watch­ing for any drop in vi­tal signs.

Red tags had min­utes to live. They were sent straight to the hos­pi­tal’s four trauma bays.

And at least 10 pa­tients emerged from their makeshift am­bu­lances without a pulse.

Black tags.

Un­der the trauma sys­tem, peo­ple who die be­fore reach­ing a hos­pi­tal are given black tags and di­rected to the morgue, where they won’t take time or re­sources from pa­tients who might still live. But Menes con­vinced him­self ev­ery life could be saved, so he sent each one into the ER with a red tag.

Dy­ing pa­tients are typ­i­cally the small­est group in a mass-ca­su­alty in­ci­dent, and Sun­rise’s trauma bays were built to hold one red tag at a time. But pa­tients kept com­ing. They kept crash­ing. Trans­porters slid pa­tients into place like Tetris pieces, push­ing as many as six to­gether and cap­ping them with gur­neys at their head and feet.

“Make a path!” trans­porter Stephen Hooker yelled over the crowds, rush­ing pa­tients through hall­ways lined with peo­ple who sat wher­ever they could find room.

“Am I go­ing to die?” one pa­tient asked him.

“Hey man,” Hooker replied, keep­ing his voice low, “you’re do­ing re­ally good. Just keep breath­ing. The doc­tor’s go­ing to come see you as soon as they can.”

Pa­tients were scat­tered ev­ery­where. Bleed­ing pa­tients slumped in plas­tic chairs. They draped gun­shot-rid­dled arms and legs over desks and ta­bles as nurses re­minded them to keep the wounds el­e­vated.

A thick line of blood traced their move­ments. Blood on the walls. The metal­lic scent of blood in the air. Blood that clumped on shoes and fresh blood that made the floors slick.

Thirty pa­tients came. They’ll han­dle

it, Menes told him­self. He kept scat­ter­ing them through­out the hos­pi­tal. The num­ber climbed higher and higher. He lost track.

“Menes!” some­body screamed. He spun around and saw a nurse stand­ing just out­side the slid­ing doors. “Get in­side here, now! They’re fall­ing be­hind!”

But the waves were still com­ing. His train­ing told him to stay out front, but in­side peo­ple were dy­ing. He grabbed Bow­er­man by the shoul­ders.

“You’ve been watch­ing what I’ve been do­ing, right?” he asked. Cars and gur­neys streamed around them. Bow­er­man nod­ded.

“I have to go. You got this?” “Yeah,” she said. “Go in­side.” Menes changed his gloves and sprinted to­ward the trauma bays. All he saw was blood.

Into surgery

Dave MacIn­tyre, the trauma sur­geon, knew his pa­tients only by their red tag and their tem­po­rary iden­tity. He fil­tered them fur­ther, group­ing them by the lo­ca­tion of their gun­shots: heads, chests and bel­lies.

A gun­shot to the head kills 90 per­cent of its vic­tims, but a bul­let to the stom­ach can kill in min­utes. MacIn­tyre, 51, placed a sur­gi­cal res­i­dent in each of

Sun­rise’s six op­er­at­ing rooms and sent belly wounds there for dam­age-con­trol surgery.

To com­pletely re­pair one pa­tient’s in­jury would be to let an­other bleed out, so Sun­rise’s sur­geons did the bare min­i­mum: Find the hole, stop the bleed­ing and seal the in­ci­sion with a sponge. There was no time for sta­ples or stitches.

Hos­pi­tal sec­re­taries called down the list of on-call and backup sur­geons. They lit up the pagers of plas­tic sur­geons and pe­di­atric spe­cial­ists, of or­tho­pe­dic and ear, nose and throat sur­geons. They called the chief of neu­ro­surgery, Dr. Michael Seiff, who fol­lowed a po­lice cruiser through the traf­fic.

MacIn­tyre stayed in the trauma bays to sta­bi­lize the other pa­tients.

“What’s your name?” he asked each one. If a pa­tient an­swered, MacIn­tyre propped them up and moved on.

Pa­tients who didn’t an­swer, who ei­ther weren’t breath­ing or had suf­fered brain dam­age, were moved through a fast-tracked sys­tem for sta­bi­liz­ing trauma pa­tients.

MacIn­tyre in­tu­bated pa­tients who weren’t breath­ing and con­nected them to a ven­ti­la­tor. In­stead of in­sert­ing IVs, he used a bone-drilling ma­chine called an in­traosseous catheter, which in­jects drugs straight into the tibia. From there, med­i­ca­tion flows through the blood­rich cen­ter of the bone and heads to­ward the heart.

Then he sent them to wait for an op­er­at­ing room: Chest in­juries went to the car­dio­tho­racic unit, and head in­juries to the trauma in­ten­sive care unit. Sur­geons were on their way.

Dr. Keith Blum sped un­der­neath red lights, lis­ten­ing for de­tails over talk ra­dio. He called his wife, who didn’t know much more. A sec­re­tary reached him, the on-call neu­ro­sur­geon, a few min­utes after the shoot­ing started, but he lived a half-hour’s drive from the hos­pi­tal. The traf­fic made it longer.

“They’re all here,” MacIn­tyre told him as he walked in, point­ing to­ward the trauma ICU where he had sent 10 pa­tients shot in the head. Blum walked from pa­tient to pa­tient with a pen and a sheet of pa­per, check­ing each one for brain func­tion and the holes in their skull.

Most mass shoot­ings end with a small per­cent­age of gun­shots to the head. Shoot­ers fire from the ground. Their bul­lets lodge into backs and but­tocks as peo­ple flee.

This shooter fired from above, cra­ter­ing rounds deep into the top of peo­ple’s skulls.

There was time for only the briefest of ex­ams: Neu­ro­sur­geons leaned down to each pa­tient’s bed­side and shined a small flash­light into their eyes. If their pupils were fixed wide and black, there was lit­tle they could do. They dug a key un­der­neath pa­tients’ fin­ger­nails. They hooked a fin­ger and jammed it into the notch of each pa­tient’s eye socket, watch­ing for a re­ac­tion to the pain.

Pa­tients who reacted took pri­or­ity in the op­er­at­ing rooms, where six neu­ro­sur­geons even­tu­ally scrubbed in. Blum op­er­ated on one pa­tient, a 27-year-old woman who had been shot through the right eye. He re­moved the eye and parts of her skull. She sur­vived.

In the ICU, Blum worked through the pa­tients quickly. We’re just deal­ing with one in­ci­dent, at one time, he thought. They had been trained to toe the line be­tween life and death, to make the cold anal­y­sis of who could be saved and who was al­ready gone. But no hos­pi­tal could train for this.

Trauma medicine re­lies on a con­cept called the Golden Hour. If a crit­i­cally wounded per­son can get to the hos­pi­tal and into an op­er­at­ing room within an hour, their chances for sur­vival spike. After the first hour, in­juries worsen and pa­tients start to crash.

The Golden Hour had passed when Menes ran into the ER. He had pushed more than 50 red tags to MacIn­tyre, but now his yel­low tags were fad­ing to or­ange.

He con­sid­ered him­self a “res­cus­ci­tol­o­gist,” a spe­cific breed of doc­tor who finds dy­ing peo­ple and brings them back. He couldn’t re­move bul­lets. He couldn’t re­pair holes in skulls or or­gans. All he could do was keep peo­ple alive un­til they reached the top of a sur­geon’s list.

“This one’s go­ing down!” a nurse screamed, and Menes launched into the un­steady rou­tine of trauma: In­tu­bate, in­sert a chest tube, push blood. The pa­tient sta­bi­lized, and Menes scanned the room, search­ing for the pa­tients clos­est to death.

The am­bu­lance dropped Rob Weiss at Sun­rise just be­fore mid­night. He pulled Beth through the mass of peo­ple and di­rected her into a small of­fice by the ER’s front desk. He promised to check on her as of­ten as pos­si­ble and ran to the ER, work­ing on pa­tients who saw his teal wrist­band and knew he had been there with them.

Into the morn­ing

On and on Sun­rise went, in­tu­bat­ing and sta­bi­liz­ing un­til 4 a.m., after a city of lights had fallen asleep in dark­ness.

Fi­nally, the emer­gency room started to slow. The red tags had been shuf­fled into and out of surgery. Al­most ev­ery yel­low tag had been sta­bi­lized. The morn­ing shift of ER doc­tors started to ar­rive, treat­ing the green tags that re­mained.

House­keep­ers swept through the emer­gency room, col­lect­ing de­bris and re­plac­ing linens. They mixed buck­ets of chem­i­cals and pushed their green mops along the hall­ways, clean­ing streaks of blood.

Six­teen peo­ple were de­clared dead at Sun­rise. Hos­pi­tal staff gath­ered the bodies near the op­er­at­ing room, be­cause the morgue couldn’t hold them all.

Hun­dreds of peo­ple started to fil­ter out of the hos­pi­tal. Weiss found his wife, still in that tiny of­fice, and they took a Lyft home. Blum drove him­self home in si­lence. Tears blurred his vi­sion.

Bow­er­man sat at the am­bu­lance win­dow for the last few hours of her shift. MacIn­tyre scrubbed in and op­er­ated on two pa­tients with belly wounds. When he fi­nally went home, the guilt of leav­ing al­most sent him back.

Menes stayed in the ER, tak­ing re­main­ing pa­tients to CT scans. Around 5 a.m., Menes opened one more set of re­sults. The words blurred to­gether. He put an eye drop in each eye and tried again. Still, he couldn’t read any­thing.

It had been seven hours since a man opened fire on an un­sus­pect­ing con­cert crowd. Menes had triaged 199 pa­tients and sta­bi­lized more than he could num­ber. I can’t be­lieve we moved that many peo­ple, Menes thought.

He walked out of the now-empty emer­gency room and through the park­ing lot that had been full just a few hours ear­lier.

He drove to­ward the Strip, where the SWAT team had set up a com­mand post by Man­dalay Bay.

There was no need for a medic, the of­fi­cers told him, and fi­nally he pointed the car to­ward home.

As he turned down Las Ve­gas Boule­vard, away from Man­dalay Bay and the con­cert stage, the city’s famed Wel­come

to Fab­u­lous Las Ve­gas sign came into view. There was no crowd, no line of peo­ple wait­ing to take a pic­ture. No­body had yet thought to bring can­dles or flow­ers.

Menes parked his car in the empty park­ing lot. The gold tow­ers of Man­dalay Bay rose be­hind the sign. He stepped onto the ar­ti­fi­cial turf and took a photo of him­self.

Las Ve­gas had never been so quiet, and he wanted to re­mem­ber the feel­ing.


Top: Sky­lar Car­son, 23, left, gets a hug from Midge Elkins as they visit a me­mo­rial. Above: Dr. Kevin Menes was on duty at Sun­rise Hos­pi­tal and Med­i­cal Cen­ter on Oct. 1.


Deb­bie Bow­er­man is a nurse at Sun­rise Hos­pi­tal.

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