On Monday, April 16, Virginia Tech Rescue Squad (VTRS) members Matt Lewis and Matt Green were engaged in typical morning routines. At the same time, events were unfolding on their campus that would shatter the lives of fellow students, faculty and family members and send shock waves throughout the world.
Lewis was brushing his teeth when he received the call for a person with an injury after falling from a bunk. When the volunteer EMT walked into the room in West Ambler Johnston dorm, he found the situation far different than what he learned from dispatch.
There were two patients suffering multiple gunshot wounds. Lewis called for an additional ambulance and advanced life support crews. The victims were taken to Montgomery Regional Hospital in Blacksburg.
Those patients-Emily Hilscher and Ryan Clark-were the first victims in what would be the deadliest shooting in modern U.S. history.
Green, another volunteer EMT, was headed to a gym when he heard about the call for multiple patients with traumatic injuries in Norris Hall.
The student-operated Virginia Tech Rescue Squad soon found themselves smack in the middle of a mass-casualty incident. Although it could be challenging for the most seasoned EMS providers, Lewis says they initiated the plan they'd practiced so many times.
"We were ready," Green says. "The training paid off today."
Additional personnel and ambulances from neighboring companies were dispatched. Lt. Matt Johnson, another student, assumed incident command and requested Montgomery County respond with its trailer of extra medical supplies such as backboards, straps and collars. Since the scene was not secure, the ambulances staged away from the location. Personnel were assigned triage, treatment and transportation duties. They also had to warn other students about the incident.
"People would say they had a class in Norris," says Lt. Sarah Walker of Blacksburg Volunteer Rescue Squad. "They hadn't heard what was going on. There was no panic. Some just didn't get it when we told them to go home."
Police officers carried some injured patients to the ambulances, while others walked to the treatment areas.
The majority of the victims had been shot multiple times. Medevac helicopters were grounded by high winds. The most serious patients were taken to the trauma center in Roanoke.
A Blacksburg EMT was injured when the ambulance door slammed shut on his fingers. Despite his pain, he drove the ambulance to the hospital. D.J. Robinson eventually sought treatment, and suffered no fractures.
The Tuesday afternoon following the shooting, more than 40 crew members gathered at their campus EMS station before heading out to a memorial service. Their badges were covered with black bands. They were joined by other EMTs and paramedics who helped in the effort Monday.
"It hasn't sunk in yet. We all know it," Lewis said. "We'll have to lean on each other."
Teamwork Key at Virginia Tech
It wasn't the first time the responders worked together as a team. During football season, they are responsible for the safety of 65,000 fans, as well as others who may be on campus for other events.
Lewis says it would be ludicrous to think VTRS could handle it alone. "We always ask nearby companies to send units out to help. We pool our resources and work together."
The VTRS has 43 members who are trained as EMTs, enhanced EMTs and paramedics. They provide EMS coverage 365 days a year. In addition to running two ALS-equipped ambulances, they have an SUV stocked with ALS supplies. They also have a bike team that handles various campus events. They run an average of 900 calls annually, not counting responses to incidents at football games.
The squad is the second oldest collegiate rescue squad in the country, and was organized in 1969.
The majority of the first responders to the Norris Hall shootings were volunteers, the norm in that area of Virginia. Crews left jobs, homes, errands and families to answer the call.
Lewis says 38 of the 43 members of the VTRS responded, while Blacksburg Volunteer Rescue sent 58 personnel. Other companies sent multiple providers and ambulances as well.
A paramedic from Christiansburg Volunteer Rescue said he was impressed with the way the students handled the scene. He said crews worked well because they were familiar with one another.
The Columbine Experience
At the scene of a major incident is not the time for agency commanders to meet for the first time. But, that's just what happened on April 20, 1999, after the shooting at Columbine High School.
There was no incident commander early on at Columbine. Multiple police agencies responded, and were operating off different radio frequencies. Fire and ambulance crews also were working independently.
As in the VT incident, cell phone service was quickly overwhelmed and useless. "I got there within 16 minutes, and could not use my phone," says Dave Walcher, division chief of the Jefferson County (CO) Sheriff's Office, as he was interviewed on the eighth anniversary of the shooting.
Rescue Squad Mourns One of Their Own
The Isle of Wight Rescue Squad lost a member in the deadly massacre at Virginia Tech. Nicole White, 20, a volunteer EMT, was remembered as a friendly girl who enjoyed being part of her community.
"She came in as a junior member during high school, and got her EMT. She was very active while she was here," says Chief Brian Carroll. "Nicole was involved in a lot of things around town."
An international studies student, White would stop by the station for duty when she was home on breaks.
The rescue company, with about 50 members, handles about 2,500 calls annually.
"I realized we needed to get a grip on things. We had extraordinary response from police, fire departments and ambulances," he says.
Walcher was credited with assuming command, which former Littleton Fire Chief Bill Pessemier says was not an easy task. "It was like herding cats. He did a fabulous job."
The deputy, a lieutenant at the time, says he'd never met the fire chief before. "We shook hands, and just started talking about the task at hand and what we needed to do. We had to contain the situation."
Pessemier, who has since retired from the fire department, says he urges agencies to not only write an emergency response plan, but practice it. It's essential that commanders are familiar with one another before an incident occurs.
The Importance of Preplanning
The immediate past president of the National Association of Emergency Medical Technicians (NAEMT) also urges EMS companies to develop a working plan that specifically addresses school shootings.
"Unfortunately, we're seeing it more and more. And, EMTs need to be prepared," says Ken Bouvier, a paramedic in New Orleans.
Bouvier, who lectures on the importance of planning for school shootings, says the event presents special challenges for everyone involved. "It's essential that everyone be on the same sheet of music before it happens. That way, God forbid, if it does, everyone knows what they have to do."
A MCI is taxing for any system, career or volunteer. During the Virginia Tech incident, ambulance personnel transferred to Blacksburg to handle other medical emergencies in the community.
"You can strip an area (of an ambulance) quickly. So, you need to have backup," Bouvier says.
Just getting to the scene of a MCI isn't always easy either. "Word travels fast, especially if the shooting is at a school. So, in addition to police and first responders, you're going to have parents and the media all headed there."
He says it also wouldn't be a bad idea to get tow truck services lined up as well, just in case. "If you find the ED or school area blocked, your dispatch could call the wrecker."
All plans also need to include measures to help people deal with their emotions following a MCI. After Columbine, counselors were available to police, firefighters and EMS.
Eric Smothers, a flight paramedic with the Maryland State Police, said it's important that responders receive psychological support. "It's good for them to hear the various emotions or symptoms they may experience after an incident," he said.
Smothers said crews need an avenue to debrief and defuse. "It's especially difficult when a child is involved. Many of the providers may have children the same age."
During group sessions, he says, responders are encouraged to talk about the incident. But, it's not necessary. "Sometimes people want to share. Others just want to sit and listen."
He says departments should take steps to ensure that their personnel are fit for the next emergency, and that includes the person's mental health as well. CISM team leaders don't take notes, and sessions are open only to those involved in the incident.
Smothers, who helped organize START (Surface to Air Response Team)-a nationwide response team dedicated to providing Critical Incident Stress Management (CISM) interventions-has assisted with counseling following several major incidents across the country, including working with contractors at Ground Zero at the World Trade Center.
"The CISM factor should be included in the plan," he says. "Trained individuals or teams should never just show up. But they do. While their intentions may be good, they also can become part of the problem."
Pessemier says it's unfortunate, but although officials may be reviewing their emergency response plans right now in light of the VT massacre, little will likely change. They will soon be back on the shelf.
For more details of the response, as well as photo slideshows, news video, forum discussions and related training articles, visit EMSResponder.com.
Ken Bouvier will teach a class on how to respond to school shootings at EMS EXPO, October 11-13, in Orlando, FL. For more information, visit www.emsexpo2007.com.