The Columbine Tragedy: Two Years Later
By NurseZone Staff Writer
At 11:30 am, a reporter called the Swedish Medical Center ED to find out more about the shooting at Columbine High School. What shooting? A second call notified the ED staff that a victim from the shooting was headed to Swedish; it seemed fairly minor - a student with an ankle injury. But what the nurses originally thought to be a minor incident would turn out to be the ultimate test of their training and skills.
"When they first reported that there was a shooting at Columbine and we heard about the injured ankle, I think we just assumed that it was an argument between two people in the parking lot," Sandi O'Connor, RN, the ED charge nurse, remembered. "But when the police called a few minutes later and said that they had set up a perimeter around the high school, we knew it was pretty serious."
At that time, the only source for information about the shooting was the television. News reports broadcast that there were up to 300 hostages at the school, in addition to an unknown number of students already killed. The main question appeared to be whether the hospital - and more importantly, the hospital staff - could handle hundreds of shooting victims.
"We didn't know what to expect. We were worried about being able to handle this," O'Connor said.
As the closest trauma center to Columbine High School, Swedish Medical Center received the first wounded students transported from the scene. The nurses in the ED were ready.
O'Connor was responsible for coordinating the patient flow, placing nurses and physicians in trauma rooms and managing all activity in the department. She faced a new responsibility on this day: clearing the halls for only the necessary medical staff.
"Within 30 minutes of the shooting, nurses, administrators and other hospital staff were all calling the ED nurses' station to see what they could do to help," O'Connor said. "By 11:40, 14 additional staff came in. My biggest job after we prepped the rooms was determining who needed to be there and where they should be. It was already very busy with lots of phone calls coming in and crowds.
"The most amazing thing was that there was a meeting upstairs for ED docs and surgeons. It ended about the same time we received the first call. Many came downstairs so we had plenty of physicians; at least two in each room. It was one of those grace-of-God coincidences."
Dispatchers called O'Connor to ask how many trauma cases they could accept.
"There was never a time I told them we couldn't accept any," she said. "The surgeons' meeting, the extra staff and the availability of the trauma and operating rooms - somebody was looking out for us that day."
Four Victims Arrive
Valeen Schnurr, 18, and Sean Graves, 15, arrived in the same ambulance, at 12:20 p.m., pulled out of the line of fire near the school's entrance by two paramedics. Anne Marie Hochalter, 17, arrived at the same time in a separate ambulance.
"They were all awake and conscious when they came in," said Anna Marie Hamel, the Acting Director of the ED that day. "But [Hochalter] was going down the tubes quickly." O'Connor had pulled Hamel out of her office and assigned her to a trauma room, where she helped the physicians working on Hochalter.
The staff intubated Hochalter immediately, but her pulse was rising and her blood pressure was dropping -- fast. She had a gunshot wound to the chest but doctors could not find where the blood loss was coming from. A trauma surgeon, assisted by a neurosurgeon and a cardiovascular surgeon, opened Hochalter's chest and found that her vena cava had been punctured. The surgeon placed his fingers in the hole, stopping the flow of blood. Hochalter was wheeled into the OR with the surgeon riding on the gurney, his fingers literally plugging the hole in her heart.
"No one who has ever had their chest cracked in the ED has ever survived," Hamel explained. "It's usually a last-ditch effort if it happens at that point. We didn't think she would make it."
Graves and Schnurr were treated in the ED at the same time as Hochalter, each with multiple gunshot wounds. Graves was wheeled in on his stomach - shot four times in the back - and reported limited sensation in his legs. Schnurr looked like she was shot several times or stabbed repeatedly with a knife. Her body was covered with gunshot wounds and dozens of lacerations, inflicted by the flying screws, metal and glass that resulted from the pipe bombs that went off inside the school. Both Graves and Schnurr were taken to the OR approximately 30 minutes after arriving in the ED.
At 1:05, Richard Castaldo, 17, presented to the ED with gunshot wounds to his chest, arms and back. He was treated on a backboard because - like Graves - the staff didn't have time to scan for spinal cord injuries. He was wheeled into the OR 25 minutes later.
While the nurses were prepared to perform their duties as assigned, they were not prepared for the emotional trauma that would accompany these young victims.
"They wheeled them in and each of them had a 'deer-in-the-headlights' look on them," O'Connor said.
Goerke remembered that she had tried to keep Hochalter calm in the ED, talking to her about graduation and prom in an attempt to distract her from the pain and confusion. When the nurses removed Hochalter's clothes, Goerke held the girl's wristwatch in her pocket. After Hochalter was wheeled into the OR, Goerke almost broke down when she realized that she was still carrying the girl's wristwatch - the same wristwatch that would later be used to identify Hochalter as one of the shooting victims.
Because of the good communication set up between the ED and the OR, the four ORs were ready for the specific cases coming their way.
Hochalter arrived in the OR at 12:47. Surgeons performed an exploratory laparotomy and liver hemostasis and repaired her diaphragm and vena cava. A bullet lodged right behind her liver forced doctors to temporarily remove the organ in order to treat the gunshot wound, according to Dr. Burt Katubig, the trauma surgeon who treated Hochalter.
Graves was wheeled into the OR at 12:50. Doctors performed an exploratory laparotomy, resection of the colon and debridement of four bullet wounds. Schnurr was taken to the OR at 12:55. Doctors performed an exploratory laparotomy and pericardial window and repaired shrapnel wounds to her left arm.
Castaldo arrived in the OR at 1:30. Doctors performed a thoracotomy, laparotomy and splenectomy, placed a chest tube and repaired his left diaphragm. Peripheral vascular surgeons performed a fasciotomy of the left arm and a graft from the right lower leg to the left brachial artery.
The parents of the young victims had begun to arrive at the hospital while the four teenagers were in surgery. The victims' parents and families were escorted to separate waiting rooms, anxiously awaiting any news on the condition of their loved ones.
Later, Goerke received a call from a staff member in the ED.
"We heard you lost one up there," Goerke remembered the caller saying, referring to Hochalter.
"I told that person that she had made it," Goerke said. Her eyes welled up with tears and a slight smile crossed her face as she recalled the exchange.
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