ORLANDO, Fla. — A trauma surgeon who treated victims of the Pulse nightclub mass shooting says the memories remain vivid 10 years later — and the lessons in preparedness are as critical as ever.
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Dr. Michael Cheatham, a trauma surgeon and former chief surgical officer at Orlando Regional Medical Center, said the tragedy "seems like yesterday" and described how years of disaster planning were put into action in the early morning hours of the 2016 attack.
"We'll never forget that night," Cheatham said. "It was a night that we had prepared for for many years, and unfortunately that night we had to employ the plans that we had put into place, but in doing so we were able to save a number of people."
Prepared for disaster
As a Level I trauma center and the busiest in the state, Cheatham said the hospital has long maintained a disaster plan that is regularly revised to respond to mass shootings, fires, hurricanes, tornadoes and other large-scale emergencies.
Just three months before the Pulse shooting, the hospital conducted a large-scale mock disaster drill based on an active shooter at a local college campus. The lessons from that drill were incorporated into the disaster plan the week before the shooting.
"So three months before Pulse, we had actually drilled for exactly that scenario," Cheatham said.
When victims began arriving, staff initially did not realize the shooting had occurred at Pulse. For the first 45 to 60 minutes, Cheatham said they believed it was at a nightclub downtown. They only learned it was Pulse when a police officer told them it had happened about 2,100 feet from the hospital's door.
Chaos in the emergency room
Inside the emergency department, the scene quickly became overwhelming. The trauma bay at the time had 6 beds, but there were 10 to 12 patients there at once, with more spread throughout the ER.
Some victims were carried from the club to the hospital, while others arrived in police cars. During the first half-hour, Cheatham said they received a patient every minute.
"We were receiving a patient every minute in the first half hour," he said, describing the ER as "very hectic" as patients filled the trauma bay and surrounding areas.
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The hospital, accustomed to handling 10 to 12 trauma patients at once in prior disasters such as hurricanes and tornadoes, had to rapidly expand its plan to treat far more victims.
Cheatham, who was serving as chief surgical officer, initially helped take patients to the operating room alongside the on-call trauma surgeon, Dr. Chadwick Smith. As additional trauma surgeons arrived, Cheatham shifted into the hospital's incident command center, where administrators and physicians oversaw the overall response.
All hands on deck
Under the hospital's disaster plan, there is always a trauma surgeon in-house and a backup surgeon on call. But as the scope of the shooting became clear, the hospital called every trauma surgeon available.
Within about an hour, six trauma surgeons were in the hospital.
Beyond the surgical staff, more than 400 team members came in that morning, Cheatham said. Many were not on duty but responded after hearing the news or receiving phone calls. Some took on roles outside their usual jobs to support patient care.
"There was nothing that I did alone at that point," Cheatham said. He credited surgeons, nurses, emergency physicians, respiratory therapists and even housekeepers, whom he called "some of the unsung heroes" for cleaning as new patients arrived.
"It was a team effort," he said.
Patient outcomes
Cheatham said the hospital ultimately treated a little more than 40 patients from the shooting. He recalled a total of 49 fatalities and 53 people injured overall.
The victims arrived in two waves: an initial wave of about 35 patients, followed by a second wave that brought in the remainder. Hostages were in the club for hours before they could receive treatment, and the remaining victims were removed after the SWAT team breached the club sometime after 5 a.m. A SWAT officer who was shot was also treated at the hospital.
Cheatham said one outcome still stands out: everyone who arrived at Orlando Regional Medical Center alive survived.
Pulse: The Night that Changed Us airs June 12 at 7:30 P.M.
"Everyone who arrived at ORMC alive survived, which we are incredibly thankful for, and it truly was, I think, a miracle," he said. Some victims, he noted, had already died from their injuries before reaching the hospital.
Because of the sheer volume of patients, the medical teams had to adapt. They relied heavily on standardized trauma protocols used worldwide, but were forced to depend more on physical exams than imaging, knowing they could not send 35 patients through a CT scanner at once.
"You follow the same way that you take care of every trauma victim, and that is what allowed us to get through that morning," Cheatham said.
Lasting impact on staff
Cheatham said the emotional toll on hospital staff varied. Some team members sought therapy; others decided health care was not for them and left the field. Many, he said, relied on each other.
"Most of our team members, we found, they sought solace in each other," he said. "The therapy was decompressing with each other, their team members that they work with every day who had experienced it alongside them."
Cheatham, who does international disaster response work outside the hospital, said he drew on his prior experience with large-scale crises, his faith and his family. His wife brought him dinner that night, and they sat in the car discussing what he had seen and done that day.
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As the immediate crisis eased and it became clear no more victims were coming, Cheatham's role shifted further into leadership and support. From incident command, he worked to ensure staff had the supplies and operating rooms they needed and then turned to making sure they received emotional support.
Counselors were available at the hospital within about five hours for staff going off shift, and team members could speak with chaplains or counselors if they chose.
Cheatham said he remained at the hospital from about 2 a.m. Sunday until Monday night.
Long-term care and relationships
In the years since the shooting, Cheatham and his colleagues have continued to care for many of the survivors.
"Many have required other surgeries for their injuries," he said. Some patients have returned to the office for follow-up care, and staff have reunited with survivors at events held at Pulse over the years.
He acknowledged that some survivors face lifelong consequences.
"They have injuries that will affect them the rest of their life, yes, both physically and mentally," he said.
Cheatham said survivors and their families have expressed gratitude for the care they received.
"That is why we have a trauma center," he said. "It's to be able to be ready to have a plan and be able to take care of trauma victims, if it's one or 50."
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