2023 APEX Award winning article

When Gilberto Arbelaez, MD, arrived for his shift at Uvalde Memorial Hospital on May 24, he hit the ground running as usual. Though Uvalde, Texas only has 15,000 residents, Memorial has an emergency department that stays busy. That morning, Dr. Arbelaez had already managed a flash pulmonary edema patient who required intubation and diagnosed a thoracic aortic dissection. He was on the phone with specialists in San Antonio, trying to transfer these patients out for further care, when he heard the security guard’s nearby radio: “Gun shots fired.” 

Then, hospital staffers started getting phone calls and texts as word spread through the small town: The shooting is at the elementary school. Someone who was shot in the face is being flown out to San Antonio. This is real. 

The Response

Dr. Arbelaez and his team kicked into preparation mode. The hospital floors were being refinished that morning, so the emergency department had been temporarily relocated to a different, smaller area of the hospital. The flooring crew was dismissed, and everyone worked urgently to return the emergency department to its optimal setup. Some of the staffers worked to quickly discharge non-emergent patients, as the rest of the team gathered extra beds, intubation trays, chest tubes, and tourniquets. 

And then, they waited. “It seemed like it took forever,” Dr. Arbelaez said. He felt a sinking dread as the minutes of trauma’s golden hour ticked away, the emergency department still empty. Never before had he wished for more patients in his emergency department. Finally, they got the call from EMS that their first patient was en route.

Gilberto “Gil” Arbelaez, MD, was the only emergency physician on shift at Uvalde Memorial Hospital the day of the school shooting.

“Everybody was gowned and gloved. Lines were primed, everything was ready,” Dr. Arbelaez said. “We were waiting for the ambulance to arrive in the emergency entrance when all of the sudden, we heard shouting from the lobby. For some reason the ambulances decided to bring the patients through the main doors.”

They turned in unison and looked down the hallway to see two young girls being pushed toward them on gurneys. Dr. Arbelaez and the general surgeon received the first child who was in dire condition. “[The surgeon] did a cut to try a pericardial window, and there was no bleeding from her skin whatsoever,” Dr. Arbelaez said. “She was completely exsanguinated by the time she got to us.”