Platteville native Deborah Kuhls, M.D., has spent her entire career in trauma medicine, including disaster training overseas.
But the first real mass casualty incident in Kuhls’ career came Oct. 1, while she was completing a full day at University Medical Center of Southern Nevada in Las Vegas, Nevada’s only Level 1 trauma center.
Kuhls’ hospital took more than 100 of the more than 500 people shot, out of a crowd of 22,000, by a sniper firing automatic rifles into a crowd estimated at 22,000 from a perch 32 stories above the Route 91 Harvest Festival at Las Vegas’ Mandalay Bay Resort and Casino. The sniper, Stephen C. Paddock, killed 58 people before killing himself.
Kuhls is a trauma surgeon who manages UMC’s Trauma Intensive Care Unit. She is also a professor of surgery and director of the critical care fellowship at the University of Nevada, Las Vegas School of Medicine.
Kuhls’ trauma unit gets about 12,000 patients a year, about 20 percent victims of penetrating wounds — gun shot wounds and stabbings — and the rest “blunt” injuries, including vehicle crashes, car–pedestrian crashes, and falls.
“We were very busy; I actually worked all weekend,” said Kuhls. “When all of this started a little after 10 o’clock, I was still in the hospital taking care of things from earlier in the day.”
Kuhls got the first word of the shootings from a Clark County security officer at the hospital.
“Within a minute or two, we got word that first we’d getting maybe 10 casualties,” she said. “And then it was 50 to 100. Literally a couple of minutes after we heard people would be coming in, they came.”
Within four minutes UMC got 10 patients, “including some people who had active CPR going on,” plus patients who needed airways, chest tubes or central IV lines, said Kuhls. “People came in in the back of pickup trucks and the back of cars.
“We do disaster drills often, both within the hospital and in the entire Las Vegas area, at least quarterly,” she said. “As soon as we knew it was really a disaster, we set up people outside who had training in disaster” to identify the most critically wounded patients.
More than 50 of the patients were in critical conduction. Patients were assessed at the shooting site, with UMC getting patients based on Centers for Disease Control and Prevention and State of Nevada protocols that assign patients to trauma centers based on injury patterns — gun shot wounds to the head, neck, chest, abdomen and pelvis, and above the elbow or the knee.
Patients were assessed in the field as well for “mentating, but yo never know who’s bleeding a lot inside,” she said. Many people were given tourniquets at the shooting scene.
“A lot of hospitals got injured patients,” she said. “Patients were sent all over the valley.
“I ended up seeing all of it and kind of kept track of everybody to make sure who needed to go to the OR, who needed blood.”
Kuhls’ hospital has trauma emergency rooms, operating rooms, a 14-bed ICU separate from the hospital and its own blood bank with more than 40 units of blood. “We call it a hospital within a hospital,” she said. “We basically only deal with trauma, so we can handle volume. We have really busy nights, but not like this.”
The hospital already had two trauma teams there, and Kuhls said, “I think that saved a lot of lives. … All that we have set up, trauma systems, save lives. There’s no doubt about it.”
She then called in trauma surgery fellows and surgical residents, and staffing “increased dramatically pretty quickly.” Medical professionals from Nellis Air Force Base, which has an integrated program with UMC, came to assist, as well as other emergency-room doctors and doctors with no surgery experience.
Some of the Nellis personnel had been in Iraq and Afghanistan. “They were well used to working in a mass casualty situation, and they were quite helpful,” said Kuhls. “Everybody did a remarkable job.”
A UMC recovery area was quickly converted to a third emergency room. At the peak of the night, six operating rooms were full of patients, most with what Kuhls called “damage-control surgery” to stabilize the patient for later surgeries.
Making matters worse was that some of the victims were unconscious and without IDs, making them impossible to identify.
“They had no idea where their loved ones were, and we had no idea of their names,” said Kuhls. “That’s really agonizing not to be able to find your loved one.”
Additionally, she said, “There were rumors that there were active shooters in two of the casinos,” followed by a report of an active shooter in her own hospital.
While the hospital was caring for its victims, Las Vegas residents and businesses came to help. The hospital received more than 1,000 cases of water dropped off on the sidewalk. One of the casinos sent in 50 pizzas for nurses. The hospital received donations of clothing and blankets for patients, and toiletries for the victims’ families.
The best news of the night: “There was no one who died who had a survivable injury at our hospital,” said Kuhls. “We trained for this, and our training paid off. … To be honest with you we had enough doctors and enough operating rooms that we really could have taken more patients.”
Within the next few days, the hospital was visited by Las Vegas Mayor Carolyn Goodman, whose appearance coincided with a security alert. Many politicians, including Nevada Gov. Brian Sandoval, visited.
Then came Donald and Melania Trump. “Both he and Melania were warm and compassionate to our patients, and they spent a lot of time with our patients,” said Kuhls.
A few days after the shootings, Kuhls said, “I think our patients are doing well, but we’re worried about our doctors and our nurses. Even our housekeepers — everyone, what they’ve seen in a few hours … most of our trauma is kind of one person/one trauma; they’ve been in some kind of altercation or something. [This] is intentional toward people with whom the shooter should not have had any experience with. These people, none of them did anything wrong … people who wanted to get away and enjoy great music.”
Kuhls has undergone disaster training created in the wake of the Sept. 11, 2001 terrorist attacks. She has also helped in training at a military hospital in Thailand, leaving just before the 2004 tsunami. She had also taken Disaster Management and Emergency Preparedness courses from the American College of Surgeons.
“I had this training, but until now I had never actually been in a disaster,” she said.
A few days after her first disaster, Kuhls called it “really bad. It’s one of the worst problems in our country, and I think we need to do something about it. What to do about it — I have some pretty strong ideas. I think it’s awful.”
Kuhls has been active against gun violence in her profession. The American College of Surgeons’ Committee on Trauma has a position paper on firearms injury prevention (see page 4A) that advocates for bans on “assault weapons” and high-capacity ammunition clips, mandatory background checks for purchases, improved care for those with “behavioral medical conditions,” and teaching “non-violent conflict resolution for a culture that often glorifies guns and violence in media and gaming.”
“I grew up with guns and don’t have a problem with guns, but I do have a problem with what people do with guns,” she said. “The top killer of people up until age 44 is injury. Firearm injuries take the lives of as many people as people killed in motor vehicle crashes. This is a public health crisis.”