Surgeons: Lessons from Orlando, Las Vegas saved lives after Squirrel Hill attack

Though Robert Tessler and Crisanto Torres have trained to be emergency trauma surgeons now for three and five years, respectively, when they got the alert Saturday that an active-shooter incident in Squirrel Hill could result in multiple victims coming to them at UPMC Presbyterian, they confessed there initially was panic.

“This is the first actual mass-casualty situation that we’ve been involved in,” Dr. Torres, a fifth-year resident and senior resident on the acute care service side of the emergency room, said Wednesday. “This is something you hear about and train for, but you hear about in other cities.”

The first estimate on the number of injured at Tree of Life Synagogue that the hospital might see was 20.

And though the call went out to residents and attending doctors all over the Pittsburgh area, Dr. Tessler said his initial fear was that “it would outstrip our services as a hospital because there could be a lot of patients who needed an operation.”

But quickly, two factors changed that fear, doctors involved in the response said in interviews outside of an in-house conference to go over the aftermath of such a traumatic event.

First, it became clear early on that many of those who were shot did not survive. In all, 11 of the 17 people who were shot died. And then, plans that Presbyterian officials had crafted in the six years since a gunman opened fire at Western Psychiatric Institute and Clinic, killing one and injuring five more, were put into action.

“We were prepared then” when the 2012 shootings at WPIC occurred, said Raquel Forsythe, a trauma surgeon who oversaw the more than 20 residents who came to the hospital from their homes Saturday morning. “But we are better prepared now than we were then” because of the updates to their plans since 2012.

Those plans established who did what and how decisions would be made, much of it written in a book of cards that outlined each step, steps that doctors and nurses have repeatedly gone over during mass-casualty drills. Part of the plans have been refined even more recently following discussions at conferences with trauma surgeons who worked at mass shootings in Orlando, Fla., and Las Vegas.

All of that allowed the emergency room to operate “seamlessly” as each new patient came in from Squirrel Hill, said Matthew Rosengart, a trauma surgeon who oversaw Presbyterian’s mass-casually triage on Saturday.

Dr. Rosengart, who is Jewish and lives about six blocks from Tree of Life, got the call to come to the hospital just after 10 a.m., and nearly simultaneously heard the sirens of police and paramedics speeding to the scene of the shooting.

Wednesday’s conference, held in a hospital auditorium, was attended by about 100 people, many of them the residents, doctors and nurses who helped treat the five people who were brought to Presbyterian on Saturday. A sixth victim was treated at UPMC Mercy.

Many of those in attendance talked with panelists the Rev. Liddy Barlow, executive director of Christian Associates of Southwest Pennsylvania, Rabbi Aaron Bisno of Rodef Shalom Congregation, and David Caplan, a former Pittsburgh Police sergeant and current safety and security coordinator for Shady Side Academy, concerning the anger they felt about the shooting, and their anxiety that there would be another such incident sooner rather than later.

Though the staff at Presbyterian on Saturday quickly learned that the injured were all Jewish members of the congregations that meet at Tree of Life, Dr. Rosengart said he did not learn until he returned home Saturday night that the shootings were part of what the FBI called a hate crime against Jews. But that would not have mattered to him emotionally, he said, despite his own faith.

“No, not at all,” he said. “We focus on our organization, focus on what the community needs.”

And the result, he said, “was a beautiful ballet of health care providers.”

Not only were teams being formed at Presbyterian, but at the UPMC Mercy, Montefiore and Shadyside hospital emergency rooms.

“I really believe we were able to take care of up to 50 people in the system if we had to,” Dr. Rosengart said.

In addition to the planning and drills at the hospital. Dr. Rosengart said he believes that community training the hospital staff has done with first responders — including police — played a major role in saving lives.

A program called “Stop the Bleed,” that is in part led by Dr. Forsythe, has trained about 27,000 people in the region on how to properly use tourniquets to stop bleeding from traumatic injuries.

Several patients brought to Presbyterian on Saturday had properly placed tourniquets that likely saved their lives, he said.

“You saw individuals who came in [Saturday] who demonstrated that outreach efforts by Dr. Forsythe and others really worked,” Dr. Rosengart said.

One part of the injuries they could not have done anything to prevent was the severity, which was greatly increased by the type of weapon the shooter used Saturday, an AR-15, the civilian version of the U.S. military’s main combat rifle.

“We take care of gunshot wounds here regularly,” said Dr. Tessler. “But they’re usually from handguns.”

“Use of a high-velocity, high-caliber weapon like this is substantially more destructive,” he said, and the injuries they saw among their five patients demonstrated that. “Our bodies are not capable of absorbing that much energy transfer [from an AR-15 bullet] without sustaining significant damage.”

One of their fellow residents who helped organize Wednesday’s conference, Christof Kaltenmeier, grew up in Germany and went to medical school there before coming to do his residency here. He pointed out that in his four years of medical school in Germany working in emergency rooms he saw “zero” gunshot cases.

“And here, I see them all the time,” he said.

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