Just as Alan Tyroch, MD, sat down to breakfast in Las Vegas on the morning of Aug. 3, celebrating his mother in-law’s 90th birthday, a gunman walked into a Walmart hundreds of miles away in his hometown of El Paso and opened fire, ultimately killing 22 people and injuring 24 more.
“I got a text (alert) that said: active shooter at Walmart,” the surgeon told Texas Medicine about two weeks after the shooting. “I immediately called my AOD (administrator of the day) and said, ‘Is this real? What’s going on?’ He said, ‘Yeah, it’s real.’
“I ran to my hotel room and told my wife to get me on the next flight to El Paso. As she was making the flight arrangements, I was on my way to the airport.”
Over the following minutes, as shooting victims were rushed to hospitals throughout El Paso, Dr. Tyroch – chief of surgery and trauma medical director at University Medical Center of El Paso – was coordinating and delegating duties via text to the hospital’s numerous surgeons, physicians, residents, and other health care professionals.
Being so far away turned out to be “a blessing in disguise,” he said looking back on that day. “If I would’ve been [in El Paso], I’d be trying to direct things and I’d also be trying to clinically manage patients. But being removed from the action allowed me to direct things, so I had good clarity of thought.”
University Medical Center is the only Level I trauma center within a 280-mile radius of El Paso..
It has handled multiple injuries before, Dr. Tyroch said, but never to the scale of what it would see that day: 14 victims, each with multiple gunshot wounds. Only one person died in the trauma bay, a woman who came in under cardiac arrest.
When he finally touched down in El Paso that afternoon, the hospital’s surgeons had completed six operations, and two orthopedic surgeries were still in progress.
Texas Medicine talked to Dr. Tyroch about how he and his team handled the incident. Below are more of his answers.
What was your experience on that day?
I texted all my trauma surgeons and said, “We have an active shooter, we’re getting four or five victims, maybe more, I don’t know. I need all of you to come to the hospital.” Then I contacted my three chief surgery residents and said the same thing: “I need every surgery resident in the hospital.”
When I texted back, they said we’re going to get at least 10 [patients], so I made more texts and activated other surgeons in the department.
We were told we were going to get a bunch of kids, so I texted my pediatric surgeon and said, “You’re going to be in charge of the kids. I don’t have to worry about that, that’s your domain.” I texted the guy in charge of the blood bank and said, “I need you in the hospital to manage blood utilization.” I was texting the CEO and trauma program director. Then I contacted the mid-levels, my nurse practitioners, saying, “I need you.”
I got here around 3 pm., immediately jumped off the plane, received an update, did a press conference, and then helped the team out.
What were the extent of the injuries?
Most of the injuries were to the torso – either shot in the thoracic cavity or abdominal cavity or both. Many of those patients required tube thoracostomies to drain hemothoraces and/or pneumathoracies.
The bullets came from a high velocity weapon that resulted in extensive damage to soft tissue, bones, and internal organs. I removed a deformed slug from a patient’s leg that was bigger than the size of a quarter. Surprisingly, it did not cause a fracture. Thankfully nobody had a brain or spinal injury.
We were able to run four ORs [operating rooms] simultaneously with plenty of OR crew. I think the most I’ve ever seen us do emergently is three laparotomies for trauma.
One of the things that was really impressive was environmental services. They were able to clean the rooms, get us into another room right away, or clean the bloody trauma bay for the next victims. Those are people who really don’t get credit in situations like this, but they were key members of the trauma team that day.
Was your facility adequately prepared for such a traumatic event?
All hospitals have to do regular disaster training, and we had a city-wide mass-casualty disaster drill last October that was a simulated shooting incident at the airport. So we practiced that not that long ago.
I have to be honest. I am usually the loudest critic at our disaster drills, but after our initial debriefing from this event, I must say that it went surprisingly well. Likewise for the El Paso trauma/EMS system.
There were a lot of good leaders in our trauma center that day; not just the physicians and surgeons but also the other health care providers. I always say that trauma is a “team sport.” The team was outstanding that Saturday and in the subsequent days.
Tex Med. 2019;115(10):6-7
October 2019
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