Feature: Pooling Resources
Care Amid Chaos
By Doug Childers - Photo by Clement Britt

For the Southwest region of Virginia, April 16 was a day of shock and disbelief. But as the Virginia Tech shooting victims reached area hospitals on that wind-swept day, it also proved to be an example of the medical community working together to help others recover from what seemed too awful to believe.

It began that morning at 7 a.m. when Seung-Hui Cho, a 23-year-old Virginia Tech student, walked into the university’s West Ambler Johnston Hall, a 900-student freshman dormitory, and shot two people. Shortly afterwards, the Virginia Tech and Blacksburg volunteer rescue squads responded to the scene and requested that Carilion Patient Transportation Services send a helicopter to the campus to transport the shooting victims to Carilion Roanoke Memorial Hospital, a level-one trauma center. A nor’easter storm with winds gusting at 60 knots kept the helicopters grounded, though. So the Virginia Tech and Blacksburg rescue squads treated the victims and transported them to Montgomery Regional Hospital, a level-three trauma center that is a five-minute drive from the Virginia Tech campus.

“The first shooting victim was dead on arrival,” said Mike Hill, RN, director of Montgomery Regional Hospital’s emergency room. After stabilization, an ambulance from the Blacksburg Volunteer Rescue Squad transported the second shooting victim to Carilion Roanoke Memorial Hospital.

Police initially thought this first shooting was a domestic issue — a tragic event, but not one that threatened others on the campus. At 9:45 a.m., radio chatter in several medical facilities delivered news of the second campus shooting.

Cho had crossed the campus to Norris Hall, a classroom and engineering building, and chained and locked the main entrance doors behind him. Minutes later, he began shooting students and professors on the building’s second floor, going from one classroom to the next and sometimes returning to a classroom to shoot more victims. In nine minutes, he shot at least 174 rounds from two handguns and killed 25 students and five professors, as well as wounding several others. As police entered the building, he shot himself.

Flight Nurses for Carilion are Heather Menzies, RN (left) and Stephanie McKinney, RN (right).

At 9:50 a.m., the student-run Virginia Tech Rescue Squad arrived at Norris Hall and immediately called for mutual aid from the Blacksburg Volunteer Rescue Squad. At 9:55 a.m., the Blacksburg Volunteer Rescue Squad issued a mutual aid request that covered three counties, along with the city of Roanoke. The Virginia Tech Rescue Squad established EMS command as the first ambulances — from the Christiansburg and volunteer rescue squads — began arriving in response to the mutual aid request.

Carilion Patient Transportation Services also received multiple calls for helicopter services, but the winds still exceeded the limits set by the Federal Aviation Administration for safe helicopter flight.

If the storm had been weaker, said Paul Davenport, RN, program director for Carilion Patient Transportation Services, he would have sent Carilion’s two helicopters, plus three more from the area — one from West Virginia with a 30-minute estimated time of arrival (ETA), and two from the Virginia State Police bases in Abingdon and Lynchburg, each with a 40-minute ETA. “The medevac system in Virginia allows us to call the next closest aircraft,” he pointed out. But the helicopters from the other agencies confirmed they couldn’t fly in the high winds either.

Instead, ambulances from 14 agencies responded to the mutual aid request, 10 of them staffed by volunteers. Sid Bingley, who is chief of the Blacksburg Volunteer Rescue Squad as well as a staff nurse in Montgomery’s emergency room, said volunteer rescue squads played a critical role on the scene. “The entire crew of the Virginia Tech Rescue Squad — about 40 — responded. The Blacksburg Volunteer Rescue Squad responded with four ALS ambulances. Within less than an hour, Blacksburg had 50 people respond. Every piece of equipment we had was staffed by an ALS provider.”

Many of the ambulances traveled considerable distances to help. Heather Menzies, RN, a clinical team leader as well as a flight nurse for Carilion Patient Transportation Services, was in a critical care ground ambulance in Lynchburg when she got a message to head to Blacksburg for a multi-casualty incident at Virginia Tech. “We got most of our information through cell phone conversations with family and friends,” she said. “One of our crew members had a Blackberry, and he used it to get information from CNN.”

As ambulances converged on Blacksburg, the casualty reports from the Virginia Tech campus grew worse. In time, Cho’s attacks would be declared the worst shooting rampage in U.S. history.

Burruss Hall at the Virginia Tech campus.

On the Virginia Tech campus, paramedics from the Virginia Tech and Blacksburg rescue squads began moving victims from Norris Hall to a triage center a few hundred yards away. There, with help from several agencies, they assessed injuries and established which victims needed the most urgent attention. Ambulances lined up nearby, waiting to transport patients. In all, 27 ambulances responded to the mutual aid request provoked by the second round of shootings, and volunteer agencies transported many of the victims to area hospitals.

Ironically, the first victim to arrive at Montgomery’s emergency room didn’t travel by ambulance. “He caught a bus, and the driver took him right to the door of the hospital,” said Loressa Cole, Montgomery’s chief nursing officer. “He’d jumped from the building and broken his leg. The bus had ‘Hospital’ on its marquee when it pulled up to the student.”

The student arrived at the hospital at 10:05 a.m. At 10:14 a.m., ambulances delivered two more victims to Montgomery Regional Hospital. Eventually, the hospital’s emergency room would receive 17 victims from the second shooting, all but four of them suffering from gunshot wounds. (Two students suffered injuries jumping from second-floor windows, one student experienced asthmatic breathing difficulties and another suffered burns.) Doctors at Montgomery transferred one patient from the second round of shootings to Carilion Roanoke Memorial Hospital.

While Montgomery received the majority of the shooting victims in its emergency room, other hospitals responded to the shootings. In all, four hospitals in the region received 26 patients from the shootings. Among them were 22 suffering from gunshot wounds. In addition to Montgomery Regional Hospital, the hospitals whose emergency rooms cared for the Virginia Tech shooting victims were Carilion New River Valley Medical Center, which is 18 miles from the Virginia Tech campus; Lewis-Gale Medical Center, which is 33 miles away; and Carilion Roanoke Memorial Hospital, which is 35 miles away from the Virginia Tech campus. Other hospitals in the region were either too far away to offer support or are rural hospitals that don’t handle trauma patients.

When the two victims of the first round of shootings arrived, Montgomery Regional Hospital had only four nurses in the emergency room. But the number of nurses temporarily increased with the shift change, and in response to callbacks as well as the pervasive news coverage of the second round of shootings, nurses began arriving to help.

“Of our approximately 40 emergency department nurses, 30 responded back to the hospital,” Cole said.

Because it was a Monday, all but one of the hospital’s surgeons were in the building, and a surgeon from Montgomery’s sister hospital, Lewis-Gale Medical Center, drove over to help as well. In all, more than 40 staff members were on hand in the emergency room to care for the victims, along with 12 doctors, nurse practitioners and physician assistants.

By 10 a.m., Montgomery was in condition green. By 10:15 a.m., it was in lockdown, and the staff diverted routine EMS traffic to other hospitals. It also canceled all elective procedures scheduled for that day to free up rooms and surgeons. In addition, the medical staff set up a secondary emergency department in the outpatient surgery unit for the less severely injured patients, in accordance with the hospital’s emergency operations plan.

“Our strategy was to get them into a trauma room, then move them to the next appropriate location as quickly as possible to free up a trauma room for the next patient,” Cole said.

Montgomery’s Bingley recalled that while he was triaging, a surgeon stood behind him, assessing patients until he had to leave to offer assistance himself. “There was always an empty bed and a team of a nurse and a doctor waiting to receive a patient,” Bingley said. “Things seemed to flow amid the chaos.”

Montgomery’s emergency department nurse staff suggested things flowed smoothly for a simple reason: They had routinely run practice drills to prepare themselves for precisely this type of demand.

“When things settled down, everything looked like it had every time we did a drill,” Bingley said. “The practice paid off.”

Competition among hospitals is often a topic of discussion today, but the medical community’s response to the Virginia Tech shootings was notably cooperative. Montgomery Regional Hospital’s Mike Hill recalled trying to call Joyce Yearout, the emergency department director at Carilion New River Valley Medical Center, every 20 or 30 minutes to ensure that both hospitals were aware of breaking developments, for example.

Maintaining those lines of communication was crucial, said Gary Meadows, RN, clinical team leader in the Carilion New River Valley Medical Center emergency department. “A lot of what we initially got was rumors. Mike [Hill] had a good idea of what was going on at the scene. It made the information more valuable. We essentially became one big facility by having good communication. In this region, when you have a disaster, the job title goes off the door. There is no Carilion or HCA. Our job is to make sure these people get care.”