Victims rushed to wrong hospital
Chaos exposed crack in region’s response plans
LAS VEGAS – They found the couple sprawled across the warm asphalt outside the Route 91 Harvest festival. Blood seeped from bullet wounds, his near an elbow, hers on the head. Panicked concertgoers streamed past them.
David Hendrickson, an EMT who attended the concert Oct. 1, stopped and knelt beside the couple. The woman was growing woozy. Blood soaked through the shirt tied around her head. Hendrickson tightened it, then took off his own shirt and tied it around the man’s arm.
“We need to get these guys to the hospital,” Hendrickson told his girlfriend, Michelle Wolters.
There was no time to wait for an ambulance. The four climbed into Wolters’ Mercedes. Blood seeped into the leather seats.
Hendrickson started the car and inched through the crowd near Mandalay Bay. They had driven in from California, and nobody in the car knew the local hospitals, so Wolters pulled out her iPhone. Fingers shaking, she typed in “Vegas hospital.” Sunrise Hospital appeared at the top of the list.
“All right,” Hendrickson said, “we’re gonna go there.”
They had no way to know that Sunrise would soon become overwhelmed.
Every gurney was full as “red-tag” triage patients waited for care.
At the same time, the county’s most comprehensive trauma center, University Medical Center, barely 3 miles away, prepared itself for victims who never arrived.
Metropolitan Las Vegas has a trauma response plan designed to send manageable numbers of patients to each hospital. The plan dictates which injuries must be treated at a trauma center and which ones can go to a regular hospital. It splits Clark County into three areas and assigns each one a trauma center where patients should be taken.
The Route 91 Harvest festival stage was at a location designated for UMC.
But in the hours after the deadliest mass shooting in modern American history, that plan became impossible to follow.
Bystanders like Hendrickson and Wolters loaded victims into their cars and drove them to the first hospital they could find, bypassing the county’s transport system entirely.
Confusion and rumors swirled, partly because the county lacks the central communication system that emergency planners called for in 2009.
That resulted in an uneven rush of patients into hospitals all over Clark County. Sunrise, a Level II trauma center, treated 199 patients in a few hours. UMC, Nevada’s only Level I trauma center and the hospital President Trump visited after the massacre, took 104 patients. A handful of UMC’s beds remained empty as rumors it had closed its doors spread through the county.
Hundreds more patients filtered into smaller hospitals.
“Some places got hit hard,” UMC trauma director John Fildes said. “But that’s what happens when 500 people went down.”
City, county and hospital officials insisted their response to the shooting went as smoothly as possible.
“From an emergency response perspective, the event was very professionally managed,” Clark County Fire Chief Greg Cassell said in a statement.
No complaints have been filed with the state’s Health Department, and a spokeswoman for the Division of Public and Behavioral Health said she was not aware of any complaints about the emergency response.
“If it’s a problem, it needs to be addressed,” said John Hammond, the EMS and trauma system manager for the Southern Nevada Health District, about the imbalance of patients at hospitals. “But I don’t know if it’s a problem.”
Among the unanswerable questions from a night of terror is whether the Level I trauma center should have received more patients, potentially spreading the work more evenly among overburdened emergency workers.
The drop in care from a Level I to a Level II trauma center is minimal, experts said, and often disputed. Nationwide studies of their treatment have given mixed results.
It’s impossible to know whether the confusion caused any patients to receive lesser treatment. It at least created disparate levels of chaos at the region’s two largest trauma centers.
At Sunrise, the flow of patients seemed never to stop. Staff, space and resources ran thin. The hospital used up its entire supply of universally compatible O-negative blood, and at least one ER doctor said he worked until his brain couldn’t process charts anymore. Every gurney and wheelchair in the hospital held a patient. Some patients waited on the floor. Others with minor injuries walked out, not wanting to take up time or resources that could be used on more critical patients.
A few miles away, UMC’s trauma director wondered where the rest of the patients were. Around 1:45 a.m., Fildes counted nine empty trauma bays. Three operating rooms sat open.
Even two months after the shooting, nobody has determined exactly why patients stopped arriving at UMC. In the immediate aftermath, rumors spread by word of mouth and on social media that UMC had closed its doors.
Multiple emergency workers and hospital staffers told The Arizona Republic they heard during the evening that UMC had stopped taking patients.
Representatives of two ambulance companies heard it. Two Sunrise staffers said they heard it. Two medics working at the concert venue received texts about it. None of those people could identify the source of the rumor.
“So many injuries that UMC hospital having to divert to other hospitals,” Las Vegas blogger Christy Oldenkamp wrote on Twitter. Other accounts tweeted similar rumors.
It wasn’t true. UMC didn’t close, and nothing similar appears in an audio recording of Clark County Fire Department dispatchers in the first hour after the shooting.
Fildes recalled telling somebody at Sunrise that he had room to take excess patients. He remembered asking for them to come three at a time, so his teams could focus on the most critical patients.
In an email, Fildes said he couldn’t remember how many more arrived.
The Southern Nevada Health District’s trauma plan, most recently updated in February 2015, dictates that a patient must be taken to a trauma center if he or she has certain injuries, including a “penetrating injury to the head, neck, torso or the extremities proximal to the elbow or knee.”
It then divides Clark County into three segments: Trauma patients injured in an eastern area should be taken to Sunrise, which is northeast of the Strip. Patients in an area to the south should go to St. Rose Dominican Hospital, Siena Campus, in nearby Henderson. Patients found anywhere else in the county go to UMC, which is northwest of the Strip.
The Route 91 concert stage was in a part of the county for which UMC was responsible.
The plan allows for exceptions if bad traffic or dangerous weather make the designated hospital too difficult to reach in time. It’s designed to make first responders, ambulance drivers and other emergency personnel work in unison, all following the same strategy to move people to hospitals.
It does not mention how to handle a mass of gunshot victims transported in pickups and strangers’ backseats.
When it came time for the plan to be implemented, confusion ruled the moments after the shooting. Emergency responders weren’t sure whether it was safe to head toward the festival grounds. False reports of multiple shooters circulated. One man on the Clark County Fire Department dispatch radio kept repeating reports of a man in Army fatigues climbing into a van.
Audio recordings obtained by The Arizona Republic show the dispatch feed flooded with requests for ambulances.
“The ambulances do not have enough units to transfer all the gunshot wounds,” one responder reported.
“We are out of ambulances, and we still have a couple more criticals,” another said.
“Chief, we’re currently loading patients into private vehicles. We have no more ambulances,” still another said. “We’re getting pickup trucks full of patients coming in.”
In 2009, a study of the region’s trauma plan concluded that Clark County needed a centralized communication center to handle emergency situations, rather than relying on a patchwork system of dispatchers and hospitals. That center was never created.
“We’ve been trying to fix that problem for a while,” the health district’s Hammond said, noting that the initial setup of a system could cost upward of $1 million. “Not just for large events, but for everyday movement of patients within the system, a centralized system would be better.”
The streets were jammed when Hendrickson pulled his girlfriend’s car off the Strip. He and Wolters tried to introduce themselves to the strange couple in their backseat, searching for some way into a conversation.
They reached a red light. Hendrickson blew through it. A truck filled with bleeding people sped past them, clambering over the median and through a turn lane. A 6-mile drive took 10 minutes.
Finally, Hendrickson pulled into the curve behind Sunrise’s emergency room. Hospital staffers had filled the ambulance bays with as many wheelchairs and gurneys as they could find. An ER doctor and nurses worked in a hurried quiet.
A small group crowded around the Mercedes. “Backseat,” Hendrickson told them. He and Wolters watched as nurses pulled out the couple and helped them onto gurneys. Then they disappeared into the crowded hospital.
“We’ve been trying to look for them and see if they’re OK,” Wolters said. “It does kind of bother us that we don’t know how they are.”
At Sunrise Hospital, every gurney and wheelchair held a patient. A few miles away at University Medical Center, the trauma director wondered where the rest of the patients were.