Dr. Ronald Stewart is a trauma surgeon at University Hospital in San Antonio, Texas, the region’s Level I trauma center for adults and children. Three kids and one adult were transported to the hospital from Uvalde after last week’s school shooting, in which an 18-year-old used an AR-15-style weapon and fatally shot 19 children and two teachers. This was the second time Stewart and his colleagues treated victims from a mass casualty event. The first was the 2017 shooting at a church in Sutherland Springs, Texas, Stewart, 63, shared his experiences with TODAY.
I was in business clothes here at work when I got a page at about 11:50 am that there may be an active shooter at an elementary school. We started activating our teams to respond to a mass casualty event — gathering surgeons, anesthesiologists, nurses and emergency medicine physicians; preparing operating rooms, intensive care unit beds, the blood bank. I don’t really like saying it, but we’re experienced in dealing with this.
We had 30 to 45 minutes to prepare until patients arrived. I changed into scrubs.
We weren’t sure how many patients we were going to get, but we knew we needed to be prepared for a very large number. We received four — two 10-year olds, one 9-year-old and a 66-year-old patient. We wished we would have received more. The reason we didn’t is so many died at the scene.
Two of our initial patients who both came by air were in critical condition. We received the other two patients a little bit later and they were seriously injured, too, but in more stable condition. They all had gunshot wounds.
On a normal everyday basis, we see children who may be injured from firearms or guns, anything from a BB gun and air rifle to a high-velocity rifle.
A high-velocity rifle, which is what we’re talking about with the AR-15, causes really destructive tissue wounds. The tissue damage is severe and extreme, particularly at close range, whether you’re an adult or a child. But obviously the smaller your body, the more likely that larger sections of your body are involved, and so it is horribly lethal at close range with a high-velocity rifle.
Physical and psychological recovery
All of our patients are improving, which brings joy to us. We’re optimistic that they are on a path where they will continue to improve and get better.
One patient is still in the intensive care unit — in serious but stable condition. Two patients are in stable condition, and one of the children has been discharged. But there are still a lot of things to be done. A lot of the physical care is supporting patients and working on getting the injuries reconstructed. We’re in that phase with a great team of reconstructive surgeons.
But there’s the emotional injury, too, so we’re working with all of our patients to offer psychological support.
We learned important lessons after the Sutherland Springs church shooting. First, an organized trauma system across the region really makes a difference and is critically important. In our profession, communication and cooperation save lives.
Second, we’ve been active in “Stop The Bleed” education training, which is a way to turn bystanders into first responders — to teach everyone the basics of bleeding control.
Third, we worked to get cold-stored whole blood for trauma patients — a lesson learned by the US military in Iraq and Afghanistan. Usually, if I give a unit of blood, it’s divided up into components: red blood cells, plasma and platelets. For many patients, that’s exactly what they need. But if I’m bleeding, then I’m losing whole blood — red blood cells, plasma and the platelets. The simplest, fastest, most direct way is to replace that is with whole blood.
This incident has been difficult for health care professionals — it’s difficult for me. But any distress that I have pales in comparison to what our patients and their families have experienced. I want the focus to be on them because they are the heroes here.
I have the best job in the world. It is an honor and privilege to help somebody on what is oftentimes the very worst day of their life. To see them get better over time is incredibly rewarding and meaningful.
But I also have the worst job in the world. To see these things and be the person to have to explain to a mother of a child who was normal at breakfast that he or she is now dead is the worst.
Intentional injury and violence is itself a pandemic and a public health crisis. I want to reduce unnecessary death and suffering of my patients and the people in our community. These events can be prevented. We can significantly reduce death and disability by committing to do two things: work to understand and address the underlying root causes of violence, while simultaneously making firearm ownership as safe as possible — for those who own a firearm and for those who don’t.
I want to express my personal gratitude to the amazing team of health care professionals in Uvalde, from emergency medical services to the hospital — a very capable small rural hospital. My thanks and admiration to them for everything they’ve done.
This interview was edited and condensed for clarity.