First off, just a quick background about me.
I started in EMS back in 2001, I’ve worked in Arizona and Oregon, and finally back to Las Vegas where I was born and raised. I’ve been with AMR for 12 years, as a paramedic and paramedic preceptor , and got my Critical Care paramedic back in 2010 and have been a CCT medic ever since. In 2011, I applied, tested, and got accepted to work for Careflight as a flight paramedic/paramedic preceptor ( now known as Air Methods), and I also have worked at So. Hills hospital here in Las Vegas as their only staff paramedic in the hospital, and eventually got recruited by Nellis Air Force Base to work as one of their Critical Care medics for the base where I work in the ER alongside nurses and doctors as a medic ,as well as 911 response for the military base and surrounding areas. So as far as “air, ground and hospital” go, I’ve got it covered. I am also a NAEMT certified TCCC and PHTLS instructor and teach with PFC (Progressive Force Concepts) here in Las Vegas.
I travelled from Las Vegas to take the TCCC course back in November of 2016 at Covered 6. I needed to take the course in order to teach where I was being hired to teach. Not going to lie, when I was prepping to take the class, I had this “idea”, that I would be just fine and that the class would be a “cake walk.”
Once in the class, (my class had 10-11 people), it became obvious very quickly that people from ” all walks of life” were taking this class. We had everything from a photographer, a Navy rescue diver, a firefighter, another medic from King County, and everything else in between, and all age ranges. I was the only female, and I found that to be interesting. The staff (Val and Patrick) were very “up-front” that the class was all book work and tons of info the first day, and the second day would be a lot more hands on with scenarios.
The book material was nothing I hadn’t heard before, so it was a good refresher. The only difference was when to apply different skills whether it be in care under fire, safe zone, etc. That was a “curve ball” that I would have to remember and be very aware of come scenario time. I also struggled with being told “you will only have A/B/C to work with.” THAT, and THAT alone was a HUGE “WTF” moment for me. In about less then 2 seconds, I had already done an eye roll, and had this “WTF” moment paired with “what do you mean that’s all I get? I’m used to working out of a rig (ambulance), or a jump bag, where I have multiple choices of drugs, bandages, airways, IVs of multiple sizes, and other supplies at my disposal, and I can work on multiple patients at any given time out of my rig and jump bag if needs be.” All of this went through my mind in less then 2 seconds, and the “news” that Val and Patrick delivered kept getting better. (add sarcasm here)
Val and Patrick went on to talk about IFAK bags, and how that’s all we would have to work with, plus anything we had on our person. That’s it. Once again, not going to lie, I had never worked out of JUST an IFAK kit and I wasn’t 100% sure HOW that was going to even happen. (Once again, coming from someone that is a long time street medic, I would like to think I have had my fair share of “shit show,” and “wtf moments,” followed with “well that didn’t work” opportunities, as well as successes and “high 5s” in the back of the rig.)
Practicing with different tourniquets, bandaging techniques, hands on with the different things found in IFAKs, and figuring out what to do in place of things NOT found in an IFAK kit.. all new stuff to me, and MORE importantly, a NEW WAY of thinking. I quickly adopted the motto “Doing the most with the LEAST.” It did not matter that I was veteran medic coming into this class, the way of thinking and utilizing what I had available was BRAND NEW to me. I thoroughly enjoyed the wound packing, patient drags, and the scenarios. I appreciated going out to the range and being put into a situation with guns being fired, because that’s something the general public in most cases, does not get exposed to, and it does add a different stress level to things. Being thrown multiple patients with varying degrees of injury didn’t stress me out, even having a partner that I didn’t know, or being yelled at wasn’t the big stresser. The fear of “not having equipment available to treat” was MY stressor. (remember, I’m used to working on a big ol’ band aid box.) Needless to say, I passed the class, learned a lot, added to my collection of “tricks of the trade,” and I feel became a better medic for it.
Oct 1st, 2017, Las Vegas.
Big weekend in Las Vegas because of the Route 91 festival. It’s an annual event that brings close to 30,000 people into Vegas for a 3 day country music festival. All walks of life come with the intent of “living it up” Vegas style. The concert goes well into the night, and the whole venue transforms the south end of the strip as barricades and road closures are created to keep concert goers safe.
That evening, my husband and I had taken our kids to another concert at the Hard Rock Hotel. The concert had gotten out at 10ish, and I was stuck in traffic in the parking garage trying to leave with the rest of the traffic from that concert. Hard Rock was only 3/4 mile from the Route 91 concert grounds, so I wasn’t surprised to see people flooding the street and screaming, and acting erratic because after all, this is Vegas, and it was the final night of a 3 day music/drunk fest. While waiting in traffic, one of my colleagues text me “active shooter at the concert, multiple cops down, be careful.” I immediately called my colleague that had text me that to get more info. At the same time , I received a mass text from AMR stating “any and all available medics/EMTs report to station immediately”, followed with a “all hands on deck” text message from AMR. I was able to get pieces of info. from my colleague regarding the events occurring, as I was trying to take back roads to get home safely from the strip with my kids in the car. While driving home, and after having received the text from AMR, one of the supervisors from AMR called me personally, asking me to come in, and that “we need your patch Leslie, people are going to be hurt and hurt bad.” Driving home, seeing freeway entrances and exits blocked off with local buses, and how completely empty and deserted the I-15 was, is something I’ve never seen before (and I was born and raised in Vegas, and will probably never see again.) It was eerie, and I pointed it out to my older 2 kids and said “This will be the darkest and emptiest you will ever see this freeway, so take a look.” I made it home, got the kids out of the car, was half changing half hopping up the stairs as I was trying to get changed into my work uniform, kissed my kids goodbye telling my youngest “mommy is needed because a lot of people are hurt,” and left. I arrived at AMR station to others doing the same thing I was , parking spaces not available, so we were parking in the desert across the way. I grabbed 3 tourniquets out of my personal stash, stuffed them into my bag, and I walked in. I was given an EMT-B partner that was a recent graduate from EMT-B school, and was “chomping at the bit” to get out there. I was given an ambulance, I grabbed narcotics, and we took off. First rendezvous point was near the Luxor, outside of the barricades, we were there only briefly, due to a suspicious van with wires hanging out being found, and the area was being evacuated. We were then moved to Hooters. The radio traffic was going crazy, and eventually an “all message” went out from our dispatch center that all radio traffic needed to be restricted to “pertinent, need to know” only. I had taken a picture of my partner and I while at Luxor, and looking at it now, the background is red from the glare of emergency lights, kind of symbolic of “getting ready to enter Hell.” At Hooters, a line of ambulances was out in front, and reports of “multiple shooters” was coming across. The back doors of my rig were opened as 2 GSWs were pushed in. One was bleeding from a “bullet graze”, the other shot in the leg, with a t-shirt being held against it. Pressure dressing on the graze, and tourniquet with pressure dressing on the other. Off to Sunrise hospital we went. CHAOS at Sunrise. I was met outside the ER by a nurse, who met me outside my rig, and directed me where to put my patients. Only thing she asked was “stable or not stable?” “Bleeding controlled?” “Injury?” My patients were left there and back to the strip we went. Never made it back to the rendezvous point. Lights and sirens everywhere we went were our instructions, and we did just that. I was stopped by metro next, and they opened my back doors as I got out of the passenger seat up front, and 3 patients were put in. Metro saying to me “one is pretty bad”, in which I responded ” Give her to me, I got her.” Open tib-fib actively bleeding, GSW to the belly, and a ricochet wound. Tourniquet to the tib-fib, trauma pad and dressing to ABD wound and pressure dressing to the ricochet. IVs for both Tib-fib and ABD wound. Back to Sunrise. I had no time to write charts, and I didn’t try. Triage tags were attempted, but it was quickly figured out that the triage tags I had on the ambulance were too complex and time consuming. My solution, all my patients got a strip of trauma tape either on their chest or on the front of their leg with their age, injury, very basic set of vitals that included a palped BP, resp. rate, pulse and treatment given. For those with tourniquets, I wrote in sharpie the time tourniquet applied. The later and later it got, the pts. that had been “initially triage tagged” by the event stand by medics, started to have changes in status. The “once greens”, were now well into yellows, and a few of the yellows becoming red. It was a moment when a “paramedic’s ego” is put aside, as you realize your pts. need a surgeon, and NOT JUST a medic. It was me vs. the clock.
I ran out of linen in my rig as medics and FD that were staying at the scene treating pts. the best they could, asked for whatever I had. They were using it to move pts.. cover up pts. and cover the dead (which initially the dead pts. only had hats covering their faces). They tore up sheets and blankets making tourniquets or secondary tourniquets, and using it as bandages as well. We were starting to run out of supplies. First aid supplies were dwindling, and commercially manufactured chest seals were long gone, to be replaced with pieces of plastic and wrappers from IV bags, nasal cannulas, and IV tape. People with belts on as tourniquets, I tightened the best I could and managed bleeding as well. Others were put in my ambulance with less severe injuries, but were shirtless or beltless. Women, I came to realize, had even given up their bras to start making tourniquets out of. I started transporting my less severe patients to other hospitals. Arriving at those other hospitals, I came to discover that even they were taking GSW, and other trauma that would normally be “trauma facility required” type of pts., but they were handling it. One dr. gave me instructions to “bring whatever you have, we have ER docs and surgeons ready to work.” Hours went by, with the same steps of “get stopped or flagged down, back doors were opened, I got out of passenger seat, wounds were looked at and treated, those that needed IVs and other interventions were attended to, pieces of trauma tape to the chest or leg, with basic info., pts. unloaded at hospital, blood wiped/knocked off gurney best we could (no linen available anywhere ), cavi wipes down my arms and tops of boots to knock off what I could off of me , and back out we went. Gloves were not changed between patients when I had 3-4 pts. in the back of the rig. Hands were too sweaty, the process was too time consuming, and besides, pts. would be getting an updated Tetanus and more then likely an antibiotic too. The most pts. I had had in the back of the rig at one time was 5. Strangers helping strangers, and “new friends” (because that’s what the injured were becoming) leaning on each other. More then once, I had other pts. offering to hold up an IV bag for an other pt. there with them, while in the back of my rig. I declined saying “we have hooks for that right there on the wall,” none the less, the offer to help was appreciated, and I made sure to thank them. Never before in my career, have I had so much “random blood” on me and my clothes from who knows who, and who knows where. Never before did I have to tell someone ” no, I’m not taking you right now because ‘this person’ is more critical. Wait here and someone else will take you.” Never before had I been directed by a doc to “go get whatever airway you have from your truck and secure this airway”, as my partner was left there to bag a pt. in a hallway, while I ran to the truck to grab an airway, just to come back and realize it’s just me and my partner with a pt. needing an airway, and a CNA that would take over bagging the pt. as soon as the airway was in, so that my partner and I could get back out on the streets. Drs. were relying on each other, ortho, OB, GI, neuro, all docs were down in the ER, and I’m pretty sure for a lot of them, the last time they did any kind of “ER WORK” was back in medical school rotations.
Eventually the amount of pts. started to dwindle down. We were called back to station, my ambulance in shambles, cabinets depleted of any kind of first aid equipment, all tourniquets and linen long gone, my jump bag depleted of any and all tourniquets and first aid supplies as well. Bloody hand prints on my cabinet doors from when I was grabbing supplies, blood splattered on the back of my door as one pt. with a GSW started coughing up blood, and I had given him a suction yankeur with instructions how to use it so he could suction blood out of his mouth as it came up. Blood down the ambulance walls from pts. leaning against it, and it had gotten missed during the “quick clean” between hospital trips. The supply techs at station were ready to go, and I appreciated them that much more as they took over “my mess”, without complaining. Finally!! A sink with running water as I washed from elbow down, with soap and water.
A few things I took from that night, NONE of my patients required “higher level of skills”, with the exception of intubating in the hospital hallway, and that was because doctors were using us medics as another source of help where they could. I needed WAY more bandages, and WAY more tourniquets. Majority of the men in my ambulance were not wearing shirts. First thought was because “it’s Vegas, and its a concert, paired with alcohol, and clothes start coming off. Clothing came off, but it was because it was being used for tourniquets and bandages. You don’t have to have “commercial products ” to fix someone. Using what you have available and thinking outside the box works fine too. (and I had no doctors chew my ass for a chest seal being made out of a nasal cannula wrapper and tape. It did its job and served the purpose it needed to). Doing the most with the least was key, because I did start to run out of supplies. And the one thing we are all taught in medic school, is your ALS is only as strong as your BLS. Basic skills save lives.