Post Brown University shooting, this doctor ran RI Hospital’s ER
Emigh, a native of Ontario, Canada, quickly summoned the hospital’s eight other trauma surgeons, including one who was in Boston. They frantically began working on the young patients.
This interview was edited and condensed from a longer conversation and steered clear of questions that would reveal personal information about patients.
Q: Where were you when you received word that there had been a mass shooting, and what were you doing?
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A: I was doing an operation. Every Level 1 trauma center has a trauma surgeon, just like myself. There’s nine of us here, so one of us at all times, 24 hours a day, is here. And so I was in the operating room doing a much more routine, very more typical, weekend case. I was just about finished — and the operating room was only one floor above where the emergency department is — and my phone started ringing, and my pager started going off, and my circulating nurse read the message to me. And so we got things wrapped up pretty quickly, and I headed right downstairs.
Q: What did the message say?
A: The message said, mass, or report of, shooting on [Brown University’s] campus, potentially 20 to 30 victims coming.
Q: What’s the first thing you did in the emergency department when you got word of the shooting?
A: Well, remember, I wasn’t in the ED. I was up in the operating room. I had about two minutes to myself to kind of think about things. We have a text group for the trauma surgeons. They had heard about this as well. So the first thing I said to my partners was — because they were immediately saying they’re coming in — the first thing I said to them was, “Let me just, let me just go and see.” The reason I said that is because it’s not uncommon for those to be false alarms. So my first thought was let’s just hold our horses. Let me make sure that things are what they say they are. But as soon as I turned the corner in the ED and I saw, you know, the first wave of patients arriving in the rooms, I pretty much took up my phone. I said, “Come.”
Q: So how many doctors came in?
A: I would say, across all disciplines, upwards of 200 people.
Q: Two hundred doctors?
A: I would say, probably 75 doctors. The rest are nurses, respiratory therapists, you know, ICU staff or assistants, that sort of thing.
Rhode Island Hospital on Saturday night, not long after the mass shooting at Brown University.Mark Stockwell/Associated Press
Q: How does Rhode Island Hospital prepare for a mass casualty event?
A: So the hospital has an active, constantly evolving, and updating mass casualty plan. It is a requirement, and a very strict requirement, of being a Level 1 trauma center. We conduct drills. The idea is to sort out wrinkles before these things occur. There are elements of our mass casualty plan that were put in place back in 2003 from the reflections and the results of The Station nightclub fire [in West Warwick, R.I., that killed 100 people]. Interestingly, and totally coincidentally, this has been something that we have especially focused on recently, because we are preparing for the world to arrive next summer for the World Cup.
Q: Given how many patients suffered gunshot wounds in this incident, it struck me as remarkable that nine people survived. How do doctors treat gunshot wounds?
A: You’d be amazed at the importance of those very simple things we learn about or hear about, even in first aid training, the idea of ABC: airway, breathing, circulation. The number of lives that can be saved with just those basic principles is really quite profound. Why? Because those issues with those components, they cause people to die, and they can die very quickly. Practically speaking, what that could look like is something like an ER doctor putting a breathing tube in to make sure someone’s airway is intact, or a surgery resident putting a chest tube in to reinflate someone’s lung, or evacuate blood to help them breathe.
Q: How long did it take to stabilize patients once they got to the hospital? Can you give me a range?
A: Maybe from 30 minutes to eight hours.
Q: Has treatment of gunshot wounds evolved in the past 20 years? Is there something that doctors and nurses do now that has improved chances of survival?
A: Absolutely, immensely. And the biggest thing, in my opinion, is the [practice] of what we call damage control surgery in trauma. And so what that means is saving the life first, and not going and simply fixing all of the injuries. Practically speaking, it means things like getting the bleeding stopped or temporarily controlled or temporarily diverted. It means controlling things like contamination from injured organs on the inside. It means stabilizing the patient’s physiology, meaning improving their blood pressure, and then it means returning later for definitive management, or a phrase we use is “living to fight another day.”
Q: How important is it to surgically remove a bullet in the emergency department when you have a gunshot victim?
A: Amazingly, not important at all. It is very often thought to be, but retained bullets very uncommonly cause problems, and a lot of the time it’s safer to leave them in place, because it would cause a lot of tissue destruction and injury and bleeding to get to it. There are a few circumstances where we’ll remove them, for example, if a bullet is lodged in a joint or if it’s sitting in the middle of a blood vessel or a nerve. But it is quite uncommon that we actually do remove the bullets, and we certainly don’t remove them in the emergency department.
Q: How long did you and your fellow doctors work that day and night?
A: There are lots of doctors, myself and my team included, that worked over 24 hours.
Q: What was it like to see so much carnage?
A: It would be a lie for me to say that we don’t get caught up in the emotion of it. There’s a quote from a very famous book in medicine [the 1978 novel by Samuel Shem called “The House of God”] that says, “In a code, the first pulse you check is your own.” And that’s something that I live by as a trauma surgeon and as a leader, because I need to be calm, so my residents are calm, so our nurses are calm. We all play off one another. In a situation like this, where it is a very emotional moment, I guess you check your pulse, of course, figuratively speaking. And the other thing was looking at the patients’ faces. And putting it out of your mind, just even for a moment, of trying not to think about evil and carnage and thinking about it as an individual. And when you do that, it immediately leads you into starting to work the problem, which is really what we’re doing.
The ambulance bays at Rhode Island Hospital.Lane Turner/Globe Staff
Jonathan Saltzman can be reached at jonathan.saltzman@globe.com.
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