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AT THIS HOUR WITH BERMAN AND MICHAELA
Press Conference at Orlando Regional Medical Center. Aired 11- 11:30a ET
Aired June 14, 2016 - 11:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[11:00:00] DR. CHADWICK SMITH, TRAUMA SURGEON, ORLANDO REGIONAL MEDICAL CENTER: There were quickly thereafter probably four to five patients that came in that we were unable to say. And then there were several that came in and that need operation almost immediately, and they got taken up. And I believe Dr. Lube stayed up in the Operating Room, and Dr. Havron was up in the Operating Room and they would just operate. And as soon as the room was done, they would move the patient to the Intensive Care Unit and send me another one. And I would walk around the Emergency Department and try to determine just by looking at their vital signs, their wound pattern, and how awake they were where they needed to go. And I tried to keep everybody that need to go to the Operating Room in the trauma bay. If someone was brought in from the emergency -- from the street, they were quickly assessed. If they did not have immediate life-threatening 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 didn't 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 that's when the 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 can't 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 it's very fortunate we have the team to pull together like we do.
UNIDENTIFIED FEMALE: Dr. Ibrahim, do you want to talk about what kind of injuries you guys saw that night?
DR. JOSEPH IBRAHIM, TRAUMA MEDICAL DIRECTOR, ORLANDO REGIONAL MEDICAL CENTER: I'm 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 we're 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 have all kinds of nursing, respirator 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 mentioned, general surgery, but the 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 heard Mr. Colin (ph) talk about with his. So again, the full gambit of injuries.
UNIDENTIFIED MALE: And the O.R., there were special cases as you can imagine. (INAUDIBLE).
Try that mic.
Dr. Sandy -- can you hear?
[11:05:32] UNIDENTIFIED PHYSICIAN: Dr. Sandy, anesthesiology that was on call. I would like to first thank my colleague, Dr. Mark Nagajima, the anesthesiologist that was on call with me that morning. I'd like to thank all the nurse anesthetists, all the Operating Room staff, the nurses and the techs.
As was described earlier, the situation rapidly escalated from the first victim that came up. I'd 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 life- threatening, 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 wasn't a question of coming. They came as soon as they were notified and I thank them for that.
UNIDENTIFIED FEMALE: Thank you.
Dr. Havron, 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?
DR. WILLIAM HAVRON, GENERAL SURGERY PROGRAM DIRECTOR & TRAUMA SURGEON, ORLANDO REGIONAL MEDICAL CENTER: Sure. I'm William Havron, 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 we're used to seeing gunshot wounds, we're 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 can't 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, 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 moment's notice to help take care of folks in need I think speaks volumes of them, and I couldn't be prouder.
UNIDENTIFIED FEMALE: Dr. Cheatham, do you have any final words before we open it up for Q&A?
[11:09:37] DR. MICHAEL CHEATHAM, TRAUMA SURGEON, ORLANDO REGIONAL MEDICAL CENTER: 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 an outcome. 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 need.
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. Mukherjee 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 we've had the outcomes that we have with these victims, that we've 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. We're 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.
UNIDENTIFIED FEMALE: We're going to open it up for questions. And I'm going to try to bring a little bit of order to it. We'll go into three sections. And one, two, three. And we'll take questions from this section
UNIDENTIFIED REPORTER: Angel, you are surrounded by the love of your family. How are you feeling? How are you beginning to cope with this?
ANGEL COLON, ORLANDO ATTACK SURVIVOR: If it wasn't 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 weren't here, I don't know how I would be right now.
UNIDENTIFIED REPORTER: And how are you feeling?
COLON: I'm doing pretty well. I still can't walk, but as long as I have a smile on my face and I have that love that I feel, I'm OK.
UNIDENTIFIED FEMALE: Can you tell us who you're with?
UNIDENTIFIED REPORTER: (INAUDIBLE). 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?
HAVRON: 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 can't 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 third-year resident in one case. In addition, one of our critical care fellows. As far as cardiothoracics, 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 don't believe that any cardio thoracic services were required.
[11:15:51] UNIDENTIFIED REPORTER: It is Nurses Week. Congratulations to all the nurses that participated.
Dr. Cheatham, could you talk about the expertise of the trauma nurses, the surgical nurses in this case.
CHEATHAM: I will tell you we have the best nurses in the world. There is no question in my mind --
CHEATHAM: 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 women's 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.
UNIDENTIFIED FEMALE: Do any of you remember treating Angel that night? And now seeing him, how do you feel?
I see people crying in the back.
Can we get you a microphone?
UNIDENTIFIED FEMALE: I don't know if Angel remembers me.
MEGAN NOBLET, NURSE, ORLANDO REGIONAL MEDICAL CENTER: Hi, I'm 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 remembered he's a medic whose name was also Angel, and he was also helping out with you. I don't know if you remember him and also Vicky (ph). 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.
UNIDENTIFIED REPORTER: Angel --
COLON: I love you guys.
UNIDENTIFIED REPORTER: Obviously, a lot of your family is here for you, but there's 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?
COLON: I have been getting calls and messages all day every day. They're 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 --
UNIDENTIFIED REPORTER: Have you been hearing it from folks back home? A lot.
UNIDENTIFIED REPORTER: Can any of your family members say something?
UNIDENTIFIED REPORTER: 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 frequency they were coming in?
DR. GARY PARRISH, DIRECT, EMERGENCY DEPARTMENT, ORLANDO REGIONAL MEDICAL CENTER: 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. It's a lot different. When you have folks that are acting like they're ill, it's a lot different than the real patient coming through the door with large injuries.
[11:20:10] UNIDENTIFIED REPORTER: Do you still have a great need for blood? People are still lining up to donate?
PARRISH: I'm sure there is a need for blood.
UNIDENTIFIED REPORTER: I'm just wondering if you've -- (INAUDIBLE).
COLON: This person had to be heartless, heartless, ruthless. I don't know how you could do something like this. Seeing all these bodies everywhere and this person is just enjoying doing this. There's no way -- I don't know how.
UNIDENTIFIED REPORTER: How do you know he was enjoying it?
COLON: I have heard from others that he was laughing in other rooms. I heard that he was calm, just doing his thing.
UNIDENTIFIED REPORTER: What would you say to his family?
UNIDENTIFIED REPORTER: We now know that he was using a high velocity AR-15 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?
UNIDENTIFIED MALE: Dr. Ibrahim?
IBRAHIM: 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 we've seen that as well.
UNIDENTIFIED REPORTER: Would you say small caliber - and large caliber, that means he was using both the rifle and the handgun?
IBRAHIM: It would seem so, yes, sir.
UNIDENTIFIED REPORTER: First of all, congratulations to all of you.
(SPEAKING FOREIGN LANGUAGE), Miami.
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)
SMITH: 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.
UNIDENTIFIED REPORTER: (SPEAKING FOREIGN LANGUAGE)
COLON: (SPEAKING FOREIGN LANGUAGE)
UNIDENTIFIED REPORTER: (SPEAKING FOREIGN LANGUAGE)
COLON: (SPEAKING FOREIGN LANGUAGE)
UNIDENTIFIED REPORTER: (SPEAKING FOREIGN LANGUAGE)
COLON: (SPEAKING FOREIGN LANGUAGE)
UNIDENTIFIED REPORTER: (SPEAKING FOREIGN LANGUAGE)
UNIDENTIFIED REPORTER: I am (INAUDIBLE). 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?
SMITH: 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 couldn't express how -- it's 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.
[11:25:42] IBRAHIM: Can I say something real quick first on that also?
To your note about debriefing and things. We've 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 we've implemented as well.
UNIDENTIFIED REPORTER: Angel, the world is watching. What do you want the world to know about Orlando's LGBT community, the city of Orlando, the Latin community? What do you want the world to know?
COLON: I want the world to know that our community is -- we are together. We are helping each other. We're getting through this together. I have seen so much love from everyone. Not to only me but to the other victims, to the families, and we really have each other's backs in these situations that happen.
UNIDENTIFIED REPORTER: It is concerning to hear you say you would be surprised -- wouldn't be surprised if the death toll rises. Of the six who are critical in ICU, can you give a sense of how severe these injuries are? Are you concerned there may be one or more people who won't walk out of here if they do get better?
CHEATHAM: Yeah. I think you've summed it up exactly right. Of the six patients that are still in the ICU and we were making rounds on them earlier this morning, many of them are recovering. They remain critically ill. There are one or two of those six that I would consider to be profoundly ill. I think the big question is what their long-term outcome will be once we get them out of the hospital. I think they may well survive. In fact, I suspect that they will survive, but my concern is that they will have lasting impact from this with regard to their functionality.
UNIDENTIFIED REPORTER: Paralysis?
UNIDENTIFIED REPORTER: Angel, Angel --
CHEATHAM: It is not a paralysis issue, no.
UNIDENTIFIED REPORTER: (INAUDIBLE) Ensalada (ph), 7 News in Miami. Have you ever seen this man there before and how do u feel about ports that he's been there among folks there at pulse and danced and drank with you guys?
COLON: I have not seen him before, but it scares me knowing that someone like this was constantly in that club. Like how do I know he hasn't been into all the other LGBT places that we've been in? It scares me a lot, and I just be there at all times definitely.
UNIDENTIFIED REPORTER: When you leave here, will you feel safe and can you also identify some of the folks here with you?
COLON: As of now, I really don't want to step foot back into a little bit because it will bring back memories that I have. And these are my brothers and sisters behind me.
UNIDENTIFIED REPORTER: Angel, and the doctors who had to treat these terrible wounds, what is your message to the political leaders who are now engaged in an argument over whether restricting guns would help prevent these sorts of things happening?
COLON: I really do think in order to have a gun you have to have a reason. I don't think you should just have a gun just to have a gun. I mean, I believe in protecting yourself and all that, but if it's that easy to just bring two guns, huge guns like that, into this place that easy, there's just -- there's something wrong.
UNIDENTIFIED REPORTER: Angel, there's some talk about this shooter being at the bar earlier in the night. Did you see him at all earlier in the night?
COLON: I don't remember. I don't remember.
UNIDENTIFIED REPORTER: Did you see his face during the shooting?
COLON: No. I was -- when he first shot me, I was facing the other direction, and I just fell face forward, so I never saw him.
UNIDENTIFIED REPORTER: What city are you from?
COLON: I'm originally from Boston, from Puerto Rico though, but I live here now though. Yeah.
UNIDENTIFIED REPORTER: Where?
COLON: I live in Polk County actually.