Dr. Babak Sarani’s morning rounds at GW Hospital last Monday were interrupted at about 8:45 a.m. The hospital’s horn blared and a voice over the intercom called in the highest level of alert: Trauma Yellow.
Sarani, the chief trauma surgeon at GW Hospital, rushed out of the surgical ward and down to the emergency room. Within minutes, Sarani was mobilizing dozens of doctors, nurses and anesthesiologists in what was shaping up to be one of the most intense days of their careers.
Multiple people had been shot at the Washington Navy Yard about four miles away, and one patient was already en route to the hospital with a bullet wound to the head. But after scanning the news on his iPhone and speaking with other doctors on call, Sarani prepared for many more.
“You have to maintain an aura of calm, otherwise, when you get down there, you’ll lose control,” Sarani said. “I think you have to be calm on the outside, if not on the inside.”
The shooting was high profile and brought media attention to Foggy Bottom, but GW Hospital’s surgeons have seen an increasing number of trauma patients each day. The hospital counted nearly 2,000 patients so far this year, up from 1,300 patients in all of 2011.
Nearly 200 of this year’s patients headed to the hospital’s emergency room with gunshot wounds.
Last Monday, Sarani huddled with the head nurses and chief ER physician. Anesthesiologists blocked off four operating rooms, the top nurses sent others to the trauma bay and mobilize teams to the operating rooms, and Sarani notified the blood bank that they might need “massive amounts of blood.”
The team was prepared to receive up to five people with life-threatening injuries and 20 non-critical patients simultaneously. But with over 15 years of experience and nearly 10 years in trauma care, Sarani said he tried to stay mentally prepared.
When the 61-year-old shooting victim, Vishnu Pandit, arrived at the hospital at about 9 a.m. with a wound to the left temple, the man’s chances of survival had dropped to less than 1 percent, Sarani said.
As the ambulance raced to the hospital, Pandit had no pulse. Sarani and his team hooked him up to an EKG machine. Nothing. He was pronounced dead less than a minute after arriving.
Pandit was one of 12 people killed by a gunman Monday during the Navy Yard massacre.
He was the only critically wounded patient treated at GW Hospital. Many of the victims were airlifted to MedStar Washington Hospital Center to receive urgent care because that facility that has a helipad, unlike GW Hospital.
GW Hospital’s trauma surgeons are prepared to handle the most extreme situations, from a terrorist attack to a presidential assassination attempt, because of the hospital’s proximity to the White House and other government buildings.
“That’s definitely something that crosses my mind on a daily basis,” Sarani said.
Those crisis situations are rare, but the last time a gunman made an attempt on a U.S. president’s life –more than three decades ago – GW trauma surgeons operated on President Ronald Reagan and other victims.
Sarani and his colleagues meet every month to ensure the hospital has enough doctors and nurses on backup in case of a crisis. But the hospital doesn’t organize drills, because as Sarani said, “If you plan for that, then I think you’re destined for failure. Those events are just chaotic.”
Dr. James Dunne, who was also on call at GW Hospital on Monday morning, agreed that trauma surgeons are always prepared for the unexpected.
“You have to be, because trauma is not a scheduled event,” said Dunne, who spent more than 20 years as a top Navy surgeon. “We’re prepared for the single gunshot wound, but we’re also prepared for the bus accident that happens that has multiple patients.”
GW Hospital’s trauma surgeons save 90 percent of gunshot victims, though in Pandit’s case, doctors said the wound was fatal.
Seconds after the shooting, Pandit’s colleagues said his heartbeat was still strong and rushed him to an ambulance. They carried him down four flights of stairs in a desk chair as the gunman continued to fire off rounds in the same side of the building, according to an Associated Press report.
But as two of Pandit’s colleagues reached a nearby street corner, they could no longer feel a pulse.
Sarani was then left with the grim task of speaking with Pandit’s wife and two sons.
The leader of the team can take credit for the save when there’s one to celebrate, but he must also handle the burden of telling families the last thing they want to hear.