When trauma comes home

Emergency personnel need emergency care, too

By Michele Dula Baum
CNN.com Writer

(CNN) -- For doctors, nurses and other hospital workers involved in caring for students and families whose lives are shattered by gunfire in U.S. schools, the silence afterwards is also a killer.

"It took us a total of 54 minutes to process and disposition all the young people who came through," remembered Tom Hambly, emergency department manager at McKenzie-Williamette Hospital in Springfield, Oregon, where a dozen victims were treated after shootings at Thurston High School on May 21, 1998. "At the end, there was this empty, painful silence as we looked at all that was left -- the bloody clothes, the medical equipment used during resuscitation. People didn't know what to think or feel."

Thurston freshman Kipland Kinkel, then 15, was sentenced to life imprisonment for killing his parents and then two others at the school. Twenty-two students were injured.

"The staff is trained to deliver emergency resuscitation and health care to anyone, in any situation, who comes through our doors," said Hambly, a registered nurse who was on duty that day. "It matters not to the trauma system how they come to be injured."

Because of disaster drills and emergency-preparedness exercises -- one just the previous year involving a laboratory-explosion scenario with multiple casualties set at Thurston and including student volunteers as "victims" -- the staff at McKenzie-Williamette was ready for the professional demands on their system, he said. They were not so prepared for calamitous needs that came in waves.

GALLERY Images of the aftermath of the Santana High School shooting in Santee, California    VIDEO A friend of the suspect says she thought she knew him and, according to CNN's Anne McDermott, now feels betrayed Play video (QuickTime, Real or Windows Media) CNN's Frank Buckley talks with a student photographer who witnessed the shootings Play video (QuickTime, Real or Windows Media) More Video   AUDIO Santana High School student John Schardt gives his account of the shooting 1.3MB/62 sec. AIFF or WAV sound A female student gives her account of the shooting on Monday at Santana High School 1.3MB/62 sec. AIFF or WAV sound   RESOURCES List of victims Timeline of recent school shootings Risk factors for school violence Talking about school violence Santee, California, and Santana High School profiles Gallup Poll: Parents on school shootings   ALSO Florida mom finds gun missing, calls school Maryland school district adds guns safety to curriculum Suspect captured within 6 minutes of first report Risk factors for school violence   MESSAGE BOARD Violence in America

"First it was the kids arriving," said Hambly. "Then friends and family members flooded our hospital campus. None of the parents knew where their kids were. And the third wave was the media."

Inside the trauma department, workers were calm and focused on doing their jobs. Outside, it was pandemonium.

"We prepare for disasters as a Level 1 trauma care facility," said Dr. Rick Saladino, chief of emergency medicine at Children's Hospital of Pittsburgh, Pennsylvania. "You have to activate a system that enables you to handle an abrupt increase in the number and acuity of patients."

It doesn't have to be a shooting or major airplane crash, such as the wreck of USAir flight 427 in 1994, which killed all 131 people aboard, noted Saladino. "It's anything that puts stress on the situation."

On a certain level, those who work in the country's major trauma centers are accustomed to stress, said Dr. Arthur Kellerman, an attending emergency physician at Grady Memorial Hospital in Atlanta, Georgia.

Grady sees "85 percent of the victims of gun violence in metro Atlanta," said Kellerman, who also is emergency department chairman at the Emory University School of Medicine. "Invariably, we are a mass-casualty destination, whether it's shootings in Buckhead or the bombing at (Centennial) Olympic Park."

Despite this, even the most dedicated and focused professional sometimes needs support, and it is up to hospital managers to see that workers have psychological, psychiatric and social-service resources, say those who deal with such trauma every day.

"We have debriefing meetings where we bring everyone together who has been involved in the care of these kids and just talk," said Kellerman. "It allows people to ventilate feelings, frustrations and fears."

In Jonesboro, Arkansas, emergency department staffers participated in numerous debriefing and counseling opportunities -- as a group and individually -- in the aftermath of shootings at Westside Middle School on March 24, 1998, said Dr. Robert Beaton, medical director at St. Bernard's Medical Center.

In that case, Mitchell Johnson, then 13, and Andrew Golden, then 11, were charged with ambushing students and teachers who were called outside for a fire drill. Five died and 11 were wounded. All of them went to St. Bernard's.

"We're a small community, just 50,000 people," said Beaton. "We were fortunate in the time that it happened -- just before noon -- because we had all of our surgical personnel finishing up morning cases, and the afternoon cases hadn't happened."

As a result, "we had access to all of our surgeons and surgical personnel," the physician said. "Once the patients started coming in, we started segregating them according to injury."

Chest specialists treated chest wounds in one area of the emergency department, while neurologists cared for head wounds in another. Orthopedists dealt with injuries to the extremities and gastroenterologists treated abdominal wounds, he added.

"The whole scene lasted approximately 45 to 50 minutes, maybe an hour, and after that, all the critical people left" the emergency department for operating suites or critical-care units. "That's when it hit emotionally," Beaton said.

Some hospitals equip emergency response teams, including paramedic and special-tactics police units, with medical specialists.

"I think Columbine got a lot of folks' attention," said Dr. Jim Creel, director of the emergency department at Erlanger Medical Center in Chattanooga, Tennessee. "One of our trauma doctors is a SWAT surgeon."

Chattanooga's Special Weapons and Tactics unit also carries a surgical equipment pack and has a specially assigned EMT, Creel said.

Still, preparedness only goes so far.

And every time another school becomes a scene of gun violence, emergency personnel go through it all over again.

"I was talking to one of the nurses yesterday after it (the San Diego shooting) happened, and she said 'I remember the dress I was wearing that day,'" said Jonesboro's Beaton. "She said 'I've got it in my closet, and I can't ever wear it again.'"

Emotionally, the toll of the Jonesboro shootings will be "there forever," the physician said. "It never goes away. Our town will survive, and San Diego will. It's just a shame that we have to repeat this."

Hambly will always remember the bravery of students in Oregon who, though gravely injured themselves, pleaded with nurses and doctors to see to their friends first.

"We need to celebrate the bravery that we saw in those kids (in California)," Hambly said. "I'm sure that the medical facility in the San Diego area that received these kids experienced the same thing we did -- an onslaught of injured kids responding in mature, heroic ways."

Emergency workers in hospitals and trauma centers across the country respond in mature, heroic ways every day, said Kellerman.

But the will to stop the violence must come from all of us, the physicians agreed. And it must come now.

Friends of suspect won't be coming back to school
March 6, 2001
Detroit high school shooting injures 3
February 2, 2001
Student dies after shooting outside Baltimore high school
January 17, 2001
Suspect in custody after school shooting in Oklahoma
December 6, 1999

Scripps Mercy Hospital
Children's Hospital of Pittsburgh
Erlanger Health System - Chattanooga, Tennessee
Grady Memorial Hospital

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