Code silver alert
At around 3: 25 am, as victims were actively evaluated
and resuscitated, a report was issued indicating that
gunfire had been heard in the ED lobby. The hospital’s
“code silver” active shooter plan was implemented.
Heavily armed police officers and sheriff’s deputies
immediately began clearing the ED of any possible
threats. Staff closed doors and remained in place while
continuing to provide patient care. Portable X-ray
machines were used to barricade the trauma resuscitation room doors and prevent entry. Initial reports
were that one of the victims had been a second shooter
at the club. This allegation was subsequently determined to be false. After 45 minutes, the code silver
alert was lifted. Of note, many of the physicians and
nurses continued to move from room to room of the
ED during this time, caring for patients despite the risk
of personal injury.
As additional surgical residents and fellows arrived,
patients requiring hospitalization were transferred
from the various intensive care units (ICUs) and step-
down units to inpatient units as appropriate to increase
critical care bed capacity. To accommodate arriving
victims, patients requiring nonoperative interven-
tion were rapidly moved from the ED to the ICUs and
hospital floors where their evaluation and resuscita-
tion continued. Two attending medical intensivists,
Charles Hunley, MD, and Jeffrey Sadowsky, MD, and
a surgical critical care fellow, Anthony Gielow, DO,
supervised the ongoing management of patients in the
ICUs while the trauma surgeons/surgical intensivists
were in the OR.
All victims not held hostage in the nightclub had
been evacuated to the trauma center by 4:00 am. The
frenetic activity of the preceding 1. 5 hours gave way
to a period of relative calm. After the rapid influx of
38 victims, this lull allowed the ORMC trauma team
to evaluate the initial wave of victims and systematically review their injuries and disposition. Patients
were reevaluated and triaged to determine who would
go to the OR next. This break in activity also allowed
the hospital staff to restock the ED with supplies from
prepared disaster supply carts, as the large number of
chest gunshot wounds had exhausted the ED’s supply
of chest tubes and water seal chambers.
Second wave of victims
A loud explosion was heard in the distance at approximately 5:02 am as SWAT teams breached the wall of
the nightclub to rescue the remaining hostages. Soon
after, a second wave of 10 victims arrived, including a
SWAT team member who had been shot in the head.
His Kevlar helmet was fractured on impact, but he
Aerial view demonstrating the location of the Pulse night club (lower left) in
relation to the Orlando Health campus (upper right). The proximity of the club
facilitated rapid transport of victims to the Level I trauma center at ORMC.
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