Eight days after the mass shooting at Annunciation Catholic Church in Minneapolis, two children are still in the hospital. Ten-year-old Weston Halsne is recovering well after surgery on Wednesday to remove a bullet fragment from his neck. A funeral for one of the two children killed, 8-year-old Fletcher Merkel, is planned for Sunday.
Together, Children’s Minnesota and Hennepin Healthcare — both Level 1 Pediatric Trauma Centers — treated 17 patients immediately after the shooting. When a mass casualty or crisis happens, there’s a careful choreography that starts even before ambulances reach the emergency room.
To get a glimpse into what it took to turn shooting victims into survivors, MPR News host Cathy Wurzer spoke with two surgeons at Hennepin Healthcare: Trauma Medical Director Dr. Chad Richardson and Vice Chair of Trauma Research Dr. Derek Lumbard.
The following has been lightly edited for clarity. Listen to the conversation by clicking the player button above.
What happens in the first few minutes after you’re notified of a mass casualty?
Richardson: They typically will give us the information on what the event was and the number of patients that they would expect, and then we mobilize all the resources that we have at the hospital. It starts in the emergency department, where many providers are responding, particularly trauma surgery, where we’re going to be making decisions about definitive care for those patients. There’s a lot of resources throughout the hospital that need to be mobilized, and those include other surgeons, trauma, pediatric surgery, pediatric intensivists and then all of the sort of infrastructure within the hospital — so operating rooms, radiology, transfusion medicine, blood bank — all those pieces also need to be mobilized so that we can provide really optimal and definitive care.
Lumbard: Yeah, the key to these situations is organization and clear communication, and it is very choreographed and almost to the point where we can remain calm and address each problem objectively and then decide what needs to happen first, and in what order.
How common is it for gunshot victims to discover injuries from bullet fragments, like Halsne, days after an event?
Richardson: It’s actually not that uncommon. Bullets fragment either before they hit a patient or when they hit bones. And so we do a very extensive examination of patients to make sure that we don’t miss these very small injuries. But just generally speaking, those small fragments often don’t need to be removed. Our body does a really good job of scarring and walling them off so that they don’t cause long-term problems. But there are times, like if it were close to a major blood vessel or the spinal cord or something like that, that we would have to strongly consider removing that fragment.
What are some of the complexities and challenges of pediatric trauma care compared with adults?
Richardson: Pediatric patients do have some anatomic and physiologic differences from adults. Their head size is larger in proportion to their body, so they are susceptible to more head injuries. They have less body fat. So things like blunt trauma, or in a case like this, penetrating trauma, can really have much more devastating effects. The trajectory of and damage caused by bullets are very hard to predict. And with their organs occupying a small amount of space, one bullet can do a lot of damage to a pediatric patient.
Lumbard: Without going into details, I would say that [the injuries that day] were varying and quite complex in nature. And I think not only knowing what was coming in, but what might be coming in next, really kept us alert to manage these individuals the best that we could.
How do you help victims and families move forward with new physical and emotional scars?
Lumbard: We have an inpatient trauma psychology team that’s available every single day. And not only can they help with the initial reaction to the stressful event, but they can also provide meaningful exercises if people experience flashbacks, or even referrals to outpatient resources like therapy. Because I say this often — survival is just the beginning for a lot of these individuals.
Practicing medicine is physically and emotionally challenging, even on the best of days. How are you and your colleagues doing?
Lumbard: I think, in the more recent years, we as a department and as an institution, we’ve had more resources available to us on our shifts, before our shifts, after our shifts and even outside of the hospital, to be able to talk through events and process.
Richardson: There are resources that we will be using, and those are psychologists who really help us work through it. But I think, like most people, we rely on each other, which we do every day, but also on our family and friends.
What’s your biggest takeaway from what you experienced?
Lumbard: This event really showed the institution’s commitment to the community. We had people at home who received a mass casualty notification through our paging system and came in. People offered support outside of our department and throughout the hospital. And I think a lot of other hospitals that I’ve talked to were very impressed with how many resources we were able to gather and utilize in that short period of time.
Richardson: I think one of the things is trauma is the leading cause of death for all people, all Americans aged 1 to 44, and even up to 54; and gunshot wounds are the leading cause of death in children up to 18. That just speaks to the importance of a well-defined trauma system and Level 1 trauma centers for optimal care for all patients. It’s really critical to support your local trauma centers.
