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| Dodging Bullets, a Medical Coordinator Responds to a Crisis | Dodging Bullets, a Medical Coordinator Responds to a Crisis |
| (about 1 hour later) | |
| About 10 minutes after the country singer Jason Aldean took the stage at the Route 91 Harvest music festival, a call went out for assistance at Gate 2A. A medical worker and half a dozen Las Vegas Metropolitan Police officers responded, to find an intoxicated guest and her fiancé. “We don’t need the cavalry, just a cab,” someone joked. | |
| The officers found the pair a ride and headed back toward the festival grounds along Las Vegas Boulevard. They heard a noise that sounded to one of them like power lines crackling. After looking around and seeing nothing, they continued walking. | The officers found the pair a ride and headed back toward the festival grounds along Las Vegas Boulevard. They heard a noise that sounded to one of them like power lines crackling. After looking around and seeing nothing, they continued walking. |
| “Then the noise went longer,” said Glen Simpson, the special events manager for Community Ambulance, which was contracted to provide medical services at the three-day festival. | “Then the noise went longer,” said Glen Simpson, the special events manager for Community Ambulance, which was contracted to provide medical services at the three-day festival. |
| Mr. Simpson dropped low as the police drew their weapons. “What is happening?” he said he had wondered. “What’s going on? Is this what we always talk about?” | Mr. Simpson dropped low as the police drew their weapons. “What is happening?” he said he had wondered. “What’s going on? Is this what we always talk about?” |
| The ensuing minutes and hours, as he ran diagonally across the sprawling lot under gunfire toward his teams, to help manage hundreds of casualties, were both everything he had planned for as an emergency responder and like nothing he had anticipated. “It was an immediate thought of just disbelief,” Mr. Simpson recalled in a phone interview on Tuesday. | The ensuing minutes and hours, as he ran diagonally across the sprawling lot under gunfire toward his teams, to help manage hundreds of casualties, were both everything he had planned for as an emergency responder and like nothing he had anticipated. “It was an immediate thought of just disbelief,” Mr. Simpson recalled in a phone interview on Tuesday. |
| On Sunday night, Mr. Simpson had stationed five ambulances on site and had 16 emergency medical workers at the concert, some of them staffing a white medical tent filled with Band-Aids, water and sunscreen. | |
| When he heard the gunfire, he started running back from the boulevard into the grounds. Mr. Simpson was wearing a polo shirt and cargo pants; he had no bulletproof vest or helmet. Assuming the shots were coming from one or more gunmen on the ground, he dived behind a bar at the southwest edge of the concert site, the area closest to Mandalay Bay Resort and Casino. He did not yet know the gunman was on an upper floor there firing down on the concertgoers. | |
| Mr. Simpson tuned his radio to the channel used for ambulance dispatch. “Shots are being fired,” he remembered telling the Community Ambulance dispatch center. “We’re going to have multiple patients. I need more ambulances now.” | Mr. Simpson tuned his radio to the channel used for ambulance dispatch. “Shots are being fired,” he remembered telling the Community Ambulance dispatch center. “We’re going to have multiple patients. I need more ambulances now.” |
| Then he switched the radio back to the channel that his emergency medical teams were using to communicate during the event. | Then he switched the radio back to the channel that his emergency medical teams were using to communicate during the event. |
| “Strike Team One, are you Code Four?” he asked. Are you safe? | “Strike Team One, are you Code Four?” he asked. Are you safe? |
| They were. He continued the roll call. Other teams did not answer. | They were. He continued the roll call. Other teams did not answer. |
| “Where are my people?” he said he had wondered. “I need to find my crews.” | “Where are my people?” he said he had wondered. “I need to find my crews.” |
| Getting no response, Mr. Simpson resolved to make his way to the medical tent on the northeast side of the property, clear across the fenced grounds. “Let’s do this,” he said he had told himself. “If I get shot, I get shot, but I’m not going to hide here, helpless.” | Getting no response, Mr. Simpson resolved to make his way to the medical tent on the northeast side of the property, clear across the fenced grounds. “Let’s do this,” he said he had told himself. “If I get shot, I get shot, but I’m not going to hide here, helpless.” |
| The next minutes blurred in his mind. Another burst of gunshots, seeming louder. Another bar. Patrons crying, asking him if they would be O.K. Empty chairs on the lawn. Sprinting across the grass. People taking cover. “Get up. Run. Get up,” he told them. | |
| At the medical tent, people lay everywhere. He saw his medical technicians applying pressure to chest and leg wounds, using tourniquets to try to stop the bleeding. | At the medical tent, people lay everywhere. He saw his medical technicians applying pressure to chest and leg wounds, using tourniquets to try to stop the bleeding. |
| “I saw my personnel checking for pulses, realizing the person did not have a pulse, and we literally had to push the body out of the tent and make room for another patient,” he said. | “I saw my personnel checking for pulses, realizing the person did not have a pulse, and we literally had to push the body out of the tent and make room for another patient,” he said. |
| People Mr. Simpson assumed were family members or friends begged the medical workers to perform CPR. But they were following principles of disaster triage, which, in the most extreme circumstances, call for bypassing those whose hearts have already stopped. So in some cases, family members began CPR themselves. | |
| Oscar Monterrosa, a Community Ambulance paramedic who was stationed in the tent, and had worked as a former Army combat medic in Iraq, said that those patients had gone into cardiac arrest after losing too much blood. Even if multiple medical workers had applied chest compressions and inserted a breathing tube, and moved the patients to gurneys, to ambulances and to a hospital for blood transfusions, “the chance of them being resuscitated is very slim.” Still, he said, “situations like that were very heartbreaking for me, especially when the families were involved.” | |
| Off-duty paramedics, nurses and doctors carried patients into the tent and went to work treating gunshot wounds to the chest, back, abdomen and extremities. The medical tent lost power and went dark. Cellphone flashlights illuminated the area. Supplies quickly dwindled. People turned to using belts, clothing and stethoscopes as tourniquets. Workers pushed down cowboy hats and baseball caps over the faces of the dead. | Off-duty paramedics, nurses and doctors carried patients into the tent and went to work treating gunshot wounds to the chest, back, abdomen and extremities. The medical tent lost power and went dark. Cellphone flashlights illuminated the area. Supplies quickly dwindled. People turned to using belts, clothing and stethoscopes as tourniquets. Workers pushed down cowboy hats and baseball caps over the faces of the dead. |
| The principle of color-coding patients to keep track of those who require different levels of care in a mass casualty event “went out the door,” Mr. Simpson said. “There was no attempt at tagging.” | The principle of color-coding patients to keep track of those who require different levels of care in a mass casualty event “went out the door,” Mr. Simpson said. “There was no attempt at tagging.” |
| Rumors spread. There was a gunman at New York-New York Hotel & Casino. There was one at the Tropicana. Mr. Simpson took out his cellphone, assuming it would not work. He called his parents. His mother answered. She had been sleeping. “Mom, if you turn on the news, you’ll see what’s happening. I love you. I can’t stay on the phone right now. I love you. I’ve got to go.” | |
| Mr. Simpson made his way past a gate to Giles Street, where his ambulances were parked. He crouched behind a police vehicle, applying tourniquets, thinking shots were still being fired. Patients were lying everywhere. It was time to move them, to transport “the critically injured patients that still had life in them,” he said. | Mr. Simpson made his way past a gate to Giles Street, where his ambulances were parked. He crouched behind a police vehicle, applying tourniquets, thinking shots were still being fired. Patients were lying everywhere. It was time to move them, to transport “the critically injured patients that still had life in them,” he said. |
| They filled the five ambulances within about 15 minutes, one with half a dozen patients, including one person in the front seat. “Just go, get out of here,” he told the ambulance driver. | |
| A man with a tourniquet on one leg, who would normally have been put on a gurney with his leg raised, was squeezed in on an ambulance bench. | A man with a tourniquet on one leg, who would normally have been put on a gurney with his leg raised, was squeezed in on an ambulance bench. |
| People who were able to walk were told to keep running. Cars pulled up. “Take this one,” he would say. Many patients were loaded in the back of a pickup truck. | People who were able to walk were told to keep running. Cars pulled up. “Take this one,” he would say. Many patients were loaded in the back of a pickup truck. |
| “I don’t know where to go,” one driver said, in tears. | “I don’t know where to go,” one driver said, in tears. |
| “Take your phone and plug in Sunrise Hospital,” he told her. | “Take your phone and plug in Sunrise Hospital,” he told her. |
| The idea of distributing patients to the most appropriate hospital was impractical during the early minutes. “It was, ‘I don’t care if it’s a trauma center, I just need to get them to a physician. I need to get these people stabilized,’” Mr. Simpson said. | The idea of distributing patients to the most appropriate hospital was impractical during the early minutes. “It was, ‘I don’t care if it’s a trauma center, I just need to get them to a physician. I need to get these people stabilized,’” Mr. Simpson said. |
| Patients with gunshot wounds looked up at him and said, “Don’t worry about me. Take care of somebody else,” he recalled. “You almost had to fight some people. No, no, let’s go. We’re going.” | Patients with gunshot wounds looked up at him and said, “Don’t worry about me. Take care of somebody else,” he recalled. “You almost had to fight some people. No, no, let’s go. We’re going.” |
| Eventually — Mr. Simpson could not recall how long it took — reinforcements were allowed into the area. Ambulance after ambulance showed up on Giles Street, weaving through dense groups of people. Hours later, workers from the coroner’s office showed up with a big refrigerated truck to collect the bodies of the dead. | |
| Last Thursday, the day before the Route 91 Harvest music festival began, Mr. Simpson had joined other organizers at an office in one of the venues, the Las Vegas Village, for a final briefing. It ended with an hourlong discussion of safety and security. A representative from Live Nation, the event’s sponsor, raised the possibility of an active gunman. | |
| “They were telling everyone, ‘No one likes to talk about it, but we have to deal with it. It’s the reality of today,’” Mr. Simpson said. “We talked about evacuation procedures. We talked about the medical plan, what we have on site.” | |
| Mr. Simpson said that planning and exercising for mass shootings are essential. And not just among officials. “I can’t tell you how many people I told, ‘Take your hand and apply pressure,’” he said. “What would it look like if we started training people just on those simple tactics of applying pressure and elevating wounds, similar to how we teach bystander CPR?” He added, “We have to have those conversations.” | |