Dr. Kathleen Anderson had just started her shift at Sentara Virginia Beach General Hospital on Friday, May 31, when the police officer stationed in the emergency room heard the buzz over his radio.
It was just after 4 p.m., and police were responding to an active shooter at the city’s municipal complex.
With 20 years of experience as an emergency physician, Anderson knew to be skeptical at first. Often, the initial information that comes over the police radio doesn’t pan out. She and her colleagues waited 11 minutes, unsure of what to expect.
Then the confirmation came: seven dead on scene.
Immediately, Anderson and the hospital staff initiated the mass casualty incidents protocol. She quickly discharged the few patients she’d picked up at the beginning of her shift and helped lock down the department, clearing up space and resources for the shooting victims. She and her colleagues called ambulances with less critical patients and diverted them to nearby hospitals. An alert was sent out to off-duty emergency physicians in the area, asking them to come to the hospital ready to help.
Even departments outside the ER switched into crisis mode. All elective surgeries stopped; administrative workers cleared their workloads to focus on registering the shooting victims; the blood bank and hospital labs were directed to put all other work on hold and prioritize the needs of the critical patients about to come in.
The atmosphere in the ER that day fell somewhere between the chaos of urgency and the calm steadiness that comes with following protocol, Anderson said.
This wasn’t the first time Anderson handled a mass casualty incident. There was an airplane crash a couple of years before, a carbon monoxide poisoning at a hotel several years earlier and a few times when Beach Week went awry, landing multiple injuries in the ER at once.
It was one of the reasons she decided to specialize in emergency medicine two decades earlier. She liked the variety and the mystery that each case presented. She enjoyed being the first doctor to treat a patient in crisis and loved the opportunity to heal and give hope.
But with the excitement came a sense of foreboding. Every day she went into work, she didn’t know what to expect. Just a month earlier, the hospitals in the region had gone over their mass casualty plans before 35,000 people flocked to Hampton Roads for the Something in the Water Music Festival.
Anderson had been thinking about the mass shooting at a country music festival in Las Vegas in October 2017 — the deadliest in modern U.S. history — where nearly 60 people had died and 1,000 had been injured. She’d read about how overwhelmed the hospitals had been and marveled at how they’d managed to treat people wherever they could with whatever they had. By May 31, there had already been nine mass shootings in the U.S. in 2019.
When the medical residents that she worked with would come to her, itching for an exciting case, she would warn them, “be careful what you wish for.”
She knew it was only a matter of time.
Within 33 minutes of that first warning from police, EMS had called in five alpha trauma alerts — a signal to ER staff that they would be fighting for the patients’ lives.
Whenever one of these patients comes into a trauma center, like Virginia Beach General Hospital, an overhead page is sent out and everything stops.
“This is what’s done as a trauma center,” Anderson said. “This is the protocol. We get trauma alerts on a daily basis — a lot of bravos, some alphas. Some days more than others.”
But May 31 was not a regular day. Five alphas in such a short time frame would test the ER’s limits, Anderson thought.
She was prepared for the worst. Now all she could do was wait.
Finally, at 4:52 — 48 minutes after the police radio alerted the hospital staff to the shooting — the victims began to arrive.
There was a scramble to coordinate where to send each patient and how to treat them.
Anderson quickly assessed two of the patients. Just before putting a tube down one of the victim’s throats to help him breathe, she asked him if he had any allergies.
“Bullets,” he said.
Three of the patients were rushed into surgery. Two others came in with CPR in progress. They were tagged black — no hope of survival.
Within three hours, the dust began to settle. All of the surviving patients had been moved out of the ER to surgery or the ICU.
Four hours into her shift, Anderson took a deep breath and wiped off her sweat before facing the reporters. She did a live phone interview with CNN from the nurse manager’s office and then walked across the parking lot to the hospital’s education center where local reporters were waiting to be briefed.
“We rapidly triaged patients, stabilized them, resuscitated them as best we could. ... Our hearts go out to the patients and the families after an incident such as this,” she said, according to a video of the briefing.
The shooting had caught national attention. With 13 people dead, including the shooter, it was the deadliest mass shooting in the country this year.
But Anderson had little time to process the day’s events. She had more patients to see. It wasn’t until her drive home 2:15 a.m. that she allowed herself to feel something — nauseated and a bit teary.
The hospital held a debriefing the next day, but Anderson couldn’t make it. She had to work.
A few days later, she visited the patient with the bullet allergy in the ICU. She wanted him to know how much his dark humor had touched her. It’s one of the ways that ER doctors cope with the near constant morbidity they face, she said. It helps them feel human.
In the month since the shooting, Anderson has watched her community grieve. She’s visited the memorial in honor of the victims. But she’s felt overwhelmed by the national focus on the shooting.
Although the shooting was remarkable in its number of victims, Anderson said that the tragedy surrounding it is all too familiar.
“We see very serious things in the ER on a day-to-day basis,” Anderson said.
Tragedy is in the job description. But so is healing.
Anderson feels confident that intensive training and the hospital’s mass casualty protocols helped her and her colleagues be prepared to save the lives that they could. It’s something the hospitals continue to review and improve.
The better prepared they are, the better chance they have at saving lives.