What I learned treating the victims of a mass shooting

There’s a mantra in medicine—see one, do one, teach one. This mantra guides medical education within a hospital. Residents are expected to watch as a patient is assessed, treated, and admitted or discharged from the emergency room, then learn from that process, picking up on the nuances of medical treatment for future patients. Never has this mantra resonated more than the day of the San Bernardino shooting.

I was in the middle of a medical lecture on toxic gas poisonings when we heard the news. A faculty member rushed into the classroom on the Loma Linda campus where my fellow emergency medicine residents and I were taking notes and announced that there had been a mass casualty incident nearby. The hospital was unsure how many patients it was going to receive, and all available doctors needed to report for duty. Immediately.

I had trained for this moment. I am only six months into my residency as an emergency medicine physician, only six months out of medical school—but one of the first things emergency medicine residents learn is the protocol for the kind of horrific shooting that happened at the Inland Regional Center that day.

Within seconds of hearing the news, my co-residents and I ran from our classroom to Loma Linda University Medical Center. The hospital’s emergency room is a designated Level I Trauma Center, which means we’re equipped to receive everything from gunshot wounds to stabbings, car accidents to heart attacks—everything. Including mass casualty incidents.

Our systems are largely based on military battlefield triage, support, and response. Our battlefields have become our hometowns.

Before my colleagues and I had even gowned up, one shooting victim had arrived—the patient’s blood pressure was low, but a team was briskly cleaning and evaluating the wounds. Around us, the department was slipping on trauma gowns, facemasks, and gloves, and filling pockets with gauze, medications, and any other tools we thought might be necessary. To an outsider, the scene might have looked like chaos—but within that buzz of activity emerged a finely tuned and organized system, ready to receive the worst.

I watched teams of doctors, nurses, and technicians assemble into care units. I saw rooms being organized, supplies readied for any scenario. I also saw a few staff consoling colleagues who feared that friends and family members may have been injured.

What happened over the next few hours is a blur. Patients came in, and we began to execute our carefully laid plans. We fought back emotions when asking questions—Where does it hurt? What happened? We were a well-oiled machine. I had seen one and done one, and I could now teach one how to respond to a mass casualty incident.

In the weeks since the shooting, I feel saddened that our emergency room responded as capably as it did because of how well rehearsed we are for events like these.

When all the patients had been received and the emergency room eventually calmed, the teams that had assembled began to remove their gowns—and what I saw then struck me. Instead of wearing scrubs, colleague after colleague was wearing street clothes. These doctors and nurses and technicians, knowing what was anticipated at the hospital, had dropped what they were doing—they had left family and friends and the safety of home—to ensure that patients got the care they needed. The staff had come together without prompting to help care for those in need. I heard repeatedly that day, “I saw the news and knew I had to come in to help. I couldn’t sit around and do nothing while this was going on.”

Yet in the weeks since the shooting, I feel saddened by the fact that our emergency room responded as capably as it did because of how well rehearsed we are for events like these. Over the past decade, emergency room response systems have advanced by leaps and bounds out of sad necessity. From Sandy Hook to the Boston Marathon bombings, from Aurora to Colorado Springs—and now San Bernardino—our growing acceptance that these kinds of events are a part of life in this country is sickening. Our systems are largely based on military battlefield triage, support, and response. Our battlefields have now become our hometowns.

Inevitably, emergency medicine will continue to evolve and learn from previous mass casualty incidents, so that when the next event happens, my colleagues across the country will be ready to save as many lives as possible. I’m heartened to know that dedicated, selfless, and compassionate people will continue to arrive on the front lines to help. I wish we didn’t have to.

Jon Roper is an emergency medicine resident at Loma Linda University. He hopes to pursue a career in international disaster relief and response.