When it’s not a drill…..

Connally Memorial Medical Center

Wilson County Texas

• Wilson County Population – 81,661 • Sutherland Springs Population - 600

Wilson County Response

Teams

EMS• Wilson County Volunteer Ambulance

Association

• ESD#2

• ESD#3

Fire/First Responders • Stockdale Fire

• Floresville Fire

• La Vernia Fire

• Eagle Creek Fire

• Other small volunteer Fire

Connally Memorial Medical Center

• 44 bed Medical/Surgical Unit

• 4 bed ICU

• 10 bed Emergency Department

• 2 Surgical Suites

• Wound Care/Hyperbarics

• Inpatient Rehab

• Level 4 Trauma Designation

• Level 3 Stroke Center

CMMC Emergency Department

6 beds in Bay 4 Critical Beds

Trauma Room

Level 4 Trauma Designation

• CMMC Utilizes Medcom Criteria for

appropriate trauma transfers

• STRAC and Medcom assist in getting one of

the 2 Level 1 trauma centers to accept

patients

STRAC – MEDCOM CRITERIA

ADULT TRANSFER CRITERIA PEDI TRANSFER CRITERIA

Staffing in the Emergency Department

• average daily patient volume 38 patients

• 7a-7p two Registered Nurses – one charge and one triage

• 8a-8p LVN

• 1p-1a LVN or RN

• 11a-11p ER Tech

• 8a-6pm Ward Clerk

• 7p-7a two Registered Nurses – one charge and one triage

• 6p-4a Ward Clerk

Sunday November, 5 2017

Timeline

Sunday November 5, 2017

• quiet Sunday in the Emergency Room

• 6 patients seen from 8a-11a

• 11:20am – on my way to San Antonio to meet family for lunch.

• 11:36am – stopped for gas at local gas station, received call from Charge Nurse stating that Wilson County Dispatch just toned out for a possible shooting in Sutherland Springs. Advised Nurse I would get gas and call back.

• 11:40am- called Charge Nurse back, she advised there are multiple shooting victims and that I should come in to stand by.

Sunday November 5, 2017

• 11:42am – arrived at CMMC. Latest update was multiple gun shot victims at First Baptist Church Sutherland

Springs.

• Immediately Dr. Kingdon and I notified STRAC Med-Com, Blood Bank, and activated our Emergency Response

Plan

• Security was notified to lock down hospital, local law enforcement were called to come standby for any possible

threats

• Dr. Morehead (General Surgeon), Dr. Krause (Orthopedic Surgeon), Dr. Ogden (ER Medical Director) and

anesthesia group notified.

• Called in additional staff close to hospital . 5 ER Nurses and 1 ER Tech arrived within 15 min of activation.

• Dr. Kingdon and I started preparing rooms, resources, IV’s, tourniquets, etc.

• Administration verified they were on the way for ancillary support

Sunday November 5, 2017

• 11:50am- Incident Command on scene requests all resources in the county and to start requesting mass casualty

resources from Bexar County.

• 12:00pm- started receiving reports that there were greater than 20+ wounded patients including children.

• 12:05pm- EMS and Air transport crews started transporting most critical victims to level 1 trauma centers

• 12:15pm- received first call from EMS that they were inbound with a small child multiple GSW

• 12:25pm- first patient (pediatric) arrived in trauma bay with approx. 5 gun shot wounds, shattered femur and hip,

multiple wounds to abdomen and extremities. Had large exit would that exposed spine and hip. ER Physician and

ER Tech immediately packed wounds with quick-clot and stabilized patient. She received crash blood and

medications.

• 12:35pm- Med-Com auto accepts patient to University Hospital – notified them we are receiving more

• 12:50pm- received 3 adult patients from EMS, multiple extremity GSW’s.

• 12:53pm- received 2 more from EMS, abdominal and extremity GSW’s. Semi-stable

• 13:08pm- POV adult patient arrives with GSW to leg

• 13:16pm- POV adult arrives with head injury sustained in shooting

• 13:50pm- last patient transferred to University Hospital – 4 in total transferred to level 1

• 3 patients remaining in ER were in stable condition

• 15:10pm- the final patient to be treated was released in stable condition, one patient went to OR and admitted

Immediate Support

• Within 20 min of receiving the first patient there were multiple Physicians, Nurses, and church members from

around the County ready to help where needed

• Church Clergy visited and prayed with every patient. Most of them saw their family members die in front of them so

they were alone, some didn’t know where their family was

• Staff and clergy stayed with Pedi patient to give support and comfort

• 2 hours after shooting the food and drinks began to pour in. Sports teams stopped tournaments to cook hamburgers

and bring it to our staff.

• Food, drinks, desserts came by the dozens to the ER. We had so much that we fed everyone who came to the

hospital including visitors

• Church clergy stayed all day to pray with staff

• Media frenzy started – mass phone calls were coming in from all over the world. ER and Marketing could not keep

up with calls. CEO started answering calls from reporters and family members who wanted to know if their loved

ones were alive.

• Identity and names were not being released from the scene until all victims could be identified. This took over 24

hours. Continued calls and visits to ER by people frantic to find their loved ones.

Investigation

• Late afternoon we finally received confirmation that the suspect was found dead in his truck. The threat of any

additional harm was cleared.

• Local law enforcement, Fire, EMS, Texas Rangers and Investigators started their official investigations at the scene

and the ER. This process went on for days. One patient has a .223 bullet removed from leg that was confiscated

• Final count of fatalities were 26 including an unborn child

• Final count of living wounded were 20

So now what?

• After the “action” calmed down and the reality of what happened sunk in, we looked at each other and said “now

what?” How do we handle something of this magnitude? How do counsel? How does staff cope?

• The next morning we started with scheduled counseling sessions by local pastors who were willing to listen and

pray. This was much relief to the staff. Being in a small town, we knew all the victims and their families. This was a

hard process for the staff members. These weren’t strangers. These victims were neighbors, relatives, coaches, etc.

• Additional professional resources started contacting us to set up professional counseling for staff.

Community

• Prayer vigils started by community members

• Stroke Coordinator and husband who run local church opened the doors to community as a safe zone for grieving and praying

• Once names and bodies were identified, counselors were on scene to help assist

• Continued support of food and money donations from all areas of the world.

• ER started receiving phone calls of encouragement and support from Nurses and Physicians in Vegas and Boston.

Healing starts

• New days come and go, kids return to

school, staff returns to work

• Community members start to work on

fixing the church up for a healing

center

• EMS/Fire/First Responders/Staff visit

the church for closure

• Counselors brought into schools to talk

to students about the trauma

• To this day there are daily counseling

sessions at the church to include play

therapy, equine therapy, and art

therapy for children as well as adult

counseling.

Outreach

Vegas Strong Press Conference

Reviewing and Rebuilding

• While the community and church were

rebuilding, we started having meetings to

review processes and focus on what things

could have been handled differently.

• We found two areas that created road

blocks.

• Phone tree process

• Media process

• Community wide response education- stop

the bleed initiative and continued education

Questions?