Quickly assessed. If they did not have immediate lifethreatening injuries, they were moved elsewhere in the Emergency Department and cared for by our colleagues in Critical Care medicine. We had emts that would drop a patient off that would start putting in lines in other patients. We had, you know, Environmental Services would have the bay where patients would go cleaned in about 30 to 45 seconds with sharp objects, with bloody towels, with all kinds of stuff done. Everybody was doing it safely. I just cannot say enough about how much we increased to the increased our resources to the level of need, you know, within a very short period of time. After we got that initial wave about probably 20 to 22 patients stabilized or sent to the operating room, we had kind of if you would call it a lull while the shooter was barricaded inside. At this point we had used basically everything in the Emergency Department, and our suppliers got stuff from central supply, brought stuff over from Arnold Palmer hospital, from Winnie Palmer hospital such that we didnt need for anything. We had used it all but we had it replaced basically immediately. Then we got word from opd that there would be another 20 to 25 patients continuing to come, and thats whenhe second wave started to come, and it was basically a repeat of the first. We had gotten some of those patients out of the operating room to the intensive care unit and we just kind of started doing it all over again, putting the patients that needed to go to the operating room in the trauma bay or moving people that did not out to the other parts of the Emergency Department, and i just cant thank my partners, my colleagues, my colleagues in nursing, respiratory therapy, Environmental Services, the support staff did a great job. I think it is very fortunate that this happened two blocks away, and its very fortunate that we have the team to pull together like we do. Dr. Ibrahim, do you want to talk about what kind of injuries you guys saw that night . Im joseph ibrahim, the trauma medical director here at orlando health. So upon entering the trauma bay as dr. Smith described, it was somewhat of what you would think of a war scene. Trauma bay was very full. We had patients in every corner. We saw the full gamut of wounds from wounds to the extremities, wounds to the chest, wounds to the abdomen and pelvis area as if they were shot from below, which is what has been described to me by some of the ems people. It varied in the size of the wounds from small caliber wounds to very large caliber wounds which the larger ones left a significant amount of tissue destruction which is something that were not as used to seeing, something more from like a rifle, something you would expect with that. And as you would expect with the large soft tissue wounds, you also had large wounds inside cavities whether it be the chest or the abdomen. So we had, again, the full gamut. But, again, we had the full team come together. We had all kinds of nursing, respirato respiratory therapists, everybody come together. The Orthopedic Surgery Team was very helpful even in the Emergency Department. I had orthopedic residents come with me to help triage patients, removing tourniquets, things like that. Again, we mention e. D. , general surgery, but ortho team was instrumental in that as well. They would take the patients that were maybe not as emergent after we have taken care of the critical ones and take care of the orthopedic injuries as you his. So again, the full gamut of injuries. And the o. R. , there were special cases as you can imagine. Try that mike. Dr. Sandy can you hear . Dr. Sandy, anesthesiology on call. I would like to first thing my colleague, dr. Mark nagajima, all the nurse aanesthetists. As was described earlier, the situation rapidly escalated from the first victim that came up. Id like to personally thank the calm, heroic demeanor and the professionalism that was exhibited by everyone that morning. I appreciated my surgical colleagues. We rapidly opened up the operating rooms in the face of potentially lifethreatening, horrific injuries. I appreciate the calm demeanor and how things were handled and how it was triaged. We literally went from operating room to operating room so much so where i believe we were on our 13th procedure approximately at 6 00 in the morning. I just want to just express my thanks and gratitude for what was exhibited in the operating room from every member that was there that morning. The cases continued throughout the whole day. There was never any down time. We rapidly opened up as many operating rooms as was needed. I appreciated all the responders from the nurses, from our nurse anesthetists that came in that morning. It wasnt a question of coming. They came as soon as they were notified and i thank them for that. Thank you. Dr. Hadron, you told a compelling story the other day about your experience going from one o. R. To the next o. R. Can you explain that today . Sure. Im william haveron, the general Surgery Program director here and one of the trauma surgeons. As dr. Smith alluded to, i got a phone call and immediately came into the hospital and was asked to proceed directly to the operating room. You know, as everybody said here with a busy Level One Trauma Center were used to seeing gunshot wounds, were used to seeing a multitude of injuries each and every night but this was somewhat of a surreal experience. You know, we were just given patient after patient after patient. The o. R. Would fill with a patient. We would proceed with operative intervention, whatever was needed, and then would literally walk from that operating room to another operating room and do it again and again. I, as everybody has already spoken, i cant say enough about how great this institution was. The resources, everything that was needed was immediately available. Everybody flexed up and made sure that operating rooms were available, icu beds were available, step down beds were available, nurses were here, techs were here. Every service worked together, and that is the most instrumental thing in taking care of patients in this situation. Second, i would say i cannot be more proud of this team, especially my our surgical residents. They work very hard as it is. Lots of demands put upon them. To answer the call at 3 30 in the morning, some of which were on vacation, some of which were, you know, tired and had already been working all week, to come in on a moments notice to help take care of folks in need i think speaks volumes of them, and i couldnt be prouder. Dr. Cheatham, do you have any final words before we open it up for q a . Yeah. You know, disasters are something that we plan for. All Trauma Centers around the world do this. You can never prepare adequately for an event such as this. But we had spent quite a bit of time over the years working with all of our colleagues in all of the departments to have a plan of how we would address this, and we have a tiered approach based on the number of victims that we anticipate. This was the largest disaster that we probably could have imagined. And we went ahead and we implemented the plan that we had designed over the years and perfected through practice, and i think it worked. I think that the fact as gary parrish already alluded to, that the victims were literally three or four blocks away made a tremendous difference in their outcome. We know that getting to a Trauma Center improves lives, improves survival, and they were able to get here many of them within minutes. The second wave much victims was obviously delayed because it was an active shooter situation and the police were trying to get the victims out of the building, but as soon as they could rescue them, again, they were immediately brought to us by whatever transportation was available. The reason that we were never at want for anything is because of the support from our entire team. You know, you can think about the medical side of things. You think about doctors and nurses and respiratory therapists saving lives, but there are so many other parts of the team that are also there to save those patients lives. So while we as the surgeons were in the operating room with our anesthesia colleagues or working with our emergency medicine colleagues, the nursing staff, the respiratory staff, et cetera, in the Emergency Department or operating room, there was a much larger team of administrators, of our support personnel that were behind the scenes constantly communicating with us to know what we needed. So as dr. Smith mentioned, when we had literally exhausted the supplies that were in the emergency room, i was literally able to get that information from him, turn to our colleagues in logistics, and literally within minutes more supplies were being brought to the scene. So there was never a time that we were without anything that we needed. When i went to dr. Mukergi early in the course of this as we were beginning to recognize the magnitude of it, we spoke in the operating room, and my hat is off to sandy and his team. They rapidly escalated from two operating rooms to six operating rooms literally within about 30 to 60 minutes. I doubt that anybody could have done it faster, and i really we need to commend them for that. The entire team worked together, and i think that is why weve had the outcomes that we have with these victims. Were pleased that weve not had anybody succumb to their injuries as yet. I have to caution everyone that there are six people in the hospital right now from this event that remain critically ill, and as i said the first day, i would be surprised if we do not see the death toll rise from this. Were doing everything that we possibly can to pull them through this, but they are critically ill as a result of their injuries. I know that those patients and their families would ask for your prayers and your thoughts for their rapid recovery. Were going to open it up for questions and im going to try to bring a little bit of order to it. Three sections. One, two, and three and well take questions from this section first. Angel, you are surrounded by the love of your family. How are you feeling . How are you beginning to cope with this . If it wasnt for them, i would not be able to have a straight mind. They put a smile on my face. They made me laugh. If they werent here, i dont know how i would be right now. And how are you feeling . Im doing pretty well. I still cant walk, but as long as i have a smile on my face and i have that love that i feel, im okay. Can you tell us who youre with . Congratulations to your whole Medical Center staff. You mentioned the surgical residents. Could you tell me a little bit in general how many residents accompanied and operated each attending and were cardio thoracic surgeons called in for the chest wounds . So we have five five people here who are here with us for five years plus an additional six interns who are here for one year. Numerous residents were called in. I cant tell you i know that i had one resident with me through every one of my six cases, and that resident alternated. I mean, i went from chief residents to fourth year residents and the thirdyear resident in one case. In addition, one of our Critical Care fellows. As far as cardio thoracics, you know, specialists were called in when the need was there. I think that depended on the variability of what cases were involved. We had vascular involved. I dont believe that any cardio Thoracic Services were required. It is nurses week. Congratulations to all the nurses that participated. Dr. Chooeatham, could you talk about the expertise of the trauma nurses, the surgical nurses in this case. I will tell you we have the best nurses in the world. There is no question in my mind [ applause ] if you think that doctors are important, keep in mind that and for those of you who have been patients, you know this, doctors come by for perhaps 15, 20 minutes a day. You have a nurse for 24 hours, so the nurses are the true caregivers. They are the ones carrying out the physicians orders. The nurses did a phenomenal job. We had nurses coming to us from our we have a Pediatric Hospital and a Womens Hospital on our campus. So the nurses from those two hospitals were coming over to help. We had nurses from our icu that came down to the trauma bay again to help. We were never without the need for man power, and the nurses did a phenomenal job, our respiratory therapists did a phenomenal job. We had pharmacists in our trauma bay with us. Everyone came together and met the patients needs. Do any of you remember treating angel that night . And now seeing him, how do you feel . I see people crying. Can we get you a microphone . I dont know if angel remembers me. Come on up. Im megan. Noblet. I think, angel, i think you were my second patient because i got the call at like 3 00 a. M. And i came right in, and he was very brave, and i just remember his name was angel, and we have a medic whose name was also angel, and he was also helping out with you. I dont know if you remember him and also vicky. It was a very chaotic night, but all of us as a team worked together and we were really able to do a very good job. Angel i love you guys. Go ahead. Obviously a lot of your family is here for you, but theres so many more back home who are thinking of you and we told them your story. Is there anything you would like to say to them . I have been getting calls and messages all day every day. Theyre very concerned about me, but i have let them know that this hospital, you guys have all been taking care of me very well, and have you been hearing it from folks back home . Yes. A lot. Can any of your family members Say Something . I would like to ask dr. Parrish a question. I know you have mass casualty drills. How did that differ from reality when you have pickup trucks, loads of patients coming in with the frequence they were coming in. As dr. Cheatham said, it is something we practice frequently. We do this a lot, and when we plan for and hope not to get but do spend a lot of time planning for the infrastructure, what we have to do if we have these patients. But it is different. Its a lot different. When you have folks that are acting like theyre ill, its a lot different than the real patient coming through the door with large injuries. Do you still have a great need for blood . People are still lining up to donate . Im sure there is a need for blood. Im just wondering if youve [ inaudible ]. This person had to be heartless, heartless, ruthless. I dont know how you could do Something Like this. Seeing all these bodies everywhere and this person is just enjoying doing this. Theres no way i dont know how. How do you know he was enjoying it . I have heard from others that he was laughing in other rooms. I heard that he was calm, just doing his thing. What would you say to his family . We now know that he was using a high velocity ar15 rifle. Were you able to tell, was there any commonality here, were these through and through wounds, did they appear to be close up . Could you tell anything about the nature of this and was he aiming for any particular part of the body . I was going through that with some of the detectives yesterday. So there was a variety of things. You could tell both small caliber and large caliber and you could tell proximity based on the amount of injury. We had some that had massive soft tissue loss that we assume after talking with the detectives they were more in close proximity as opposed to some that were running away that maybe the bullet had less tissue. We did see through and through injuries that we have to make somewhat difficult you have to determine the course. The small caliber ones can kind of bounce around inside cavities and cause multiple injuries which weve seen that as well. And large caliber, that means he was using both the rifle and the handgun . It would seem so, yes, sir. First of all, congratulations to all of you. Dr. Smith, i guess, you have 44 patients that are alive today and with caution as the doctor said. On a personal note, how does that make you feel . [ speaking Foreign Language ] thank you. Sure. Thank you. I can only say that, and i said this yesterday, you know, with all of the stuff that the victims, the families, the loved ones have been through and all that the our team members have been through, i can say that i am extremely proud of ems, nursing, respiratory therapists, the doctors, all of those support staff and our entire community. It was singularly the worst day of my career and the best day of my career, and i would think that this is probably the same for every person you see standing up here. [ speaking Foreign Language ] [ speaking Foreign Language ] [ speaking Foreign Language ] i was wondering if you guys can say how you guys are feeling and are you guys doing any debriefings and how are you going to deal with this as time goes on . So the hospital the hospital has set up team member grief counseling. I believe every two hours. I went to it last night and heard a lot of stories from some of the team members that were there that night. Some of the team members that came in later to kind of take over sunday afternoon. I tried i shared with them how i was feeling. I was on call again last night, and i was walking out of the hospital and walking out i saw team members walking into work crying, and i just couldnt express how its hard to describe how you feel, but i know how they feel. They know how we feel, and when the task comes to end, you just do what needs to be done. Can i Say Something real quick first on that too . To your note about debriefing and things. Weve also been in contact with programs in boston who have been through similar situations. They actually reached out to us, the world response to this has been amazing. People from oklahoma who had gone through the Oklahoma City bombings have reached out saying what they went through, what they felt was advantageous to team members who needed some sort of debriefing, counseling, some of the things that helped them and we thank them for that. So that was some of the things weve implemented as well. Angel, the world