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This is Not a Drill

Posted by on Thursday, March 2, 2017 in Features, Winter 2017 .

Photograph by Judy Tracy

At 2:20 a.m. on June 12, 2016, Michael Cheatham, M.D., asleep at home in Orlando, Florida, was awakened by a phone call. A colleague said, “There’s been a mass casualty shooting event, and we need you here.”

Cheatham, VUSM ‘89, board-certified in general surgery, surgical critical care and neurocritical care, was not on call that night, but he quickly began the 10-minute drive to Orlando Regional Medical Center (ORMC).

With no idea what had happened or where, Cheatham attempted his usual route to the hospital but was met by a roadblock, and police stopped him at every turn to inquire where he was going and to reroute him. He unknowingly was driving directly into the firefight at Pulse, an Orlando nightclub that, by the end of the day, would become the location of the deadliest mass shooting in United States history. On that night, a lone gunman would fire more than 250 rounds of ammunition at the club, killing 49 people and injuring an additional 58.

Shooting victims were rushed to ORMC, which is located just three blocks from Pulse and is the city’s only Level-1 trauma center. Many of them were carried in or put in the back of police cars or private vehicles and driven the short distance, arriving at the hospital within minutes of the shooting.

Upon entering the hospital, Cheatham, who served as medical director of the disaster response, saw dozens of gurneys lining the emergency department halls. He spotted a pair of high heel shoes peeping out from beneath a white sheet— on the feet of one of the Pulse victims who died from her injuries. He passed another sheet-covered victim, and another, and another, before making it to the area where the emergency department staff was working to triage and resuscitate the first wave of patients, who were coming into the hospital at a rate of one per minute.

Cheatham has been a member of the Orlando Health surgical team since 1996 and is the Chief Surgical Quality Officer at ORMC and chairman for the Department of Surgical Education. He holds faculty appointments at the University of Florida, Florida State University and University of Central Florida.

As he and his colleagues treated the first wave of 38 victims from the club shooting, there were reports of gunfire in the emergency department waiting room. At this time, it was unknown how many gunmen were responsible for the still-ongoing massacre, and erroneous rumors of an additional shooter at the hospital began to circulate. As SWAT teams surveyed the facility for a potential active shooter, Cheatham and his team barricaded the trauma bay doors with portable X-ray machines and continued caring for patients.

From approximately 3:30 to 5 a.m., a temporary lull allowed the trauma team to evaluate patients and restock supplies in the emergency department. Meanwhile, the gunman and over a dozen hostages were barricaded in a bathroom at Pulse as that situation continued to escalate.

At 5:02 a.m., a loud explosion was heard from the hospital as SWAT teams stormed the bathroom at Pulse to overtake the shooter and rescue surviving hostages.

ORMC received 11 additional victims in a second wave and were prepared for more, but the remaining victims in the club had not survived.

As medical director for this event, Cheatham became one of the primary spokespeople for the hospital. He spent his time going from their incident command center to the operating room to media interviews. At a press conference at 10:30 a.m. the morning of June 12, a reporter asked Cheatham how it felt to have taken care of victims from the worst shooting in U.S. history.

“This question struck me because, until that moment, I hadn’t considered it and didn’t know it was the worst,” Cheatham said. “We see a fair amount of trauma at ORMC, but we never expected such an event in Orlando. Orlando is a happy place, it’s where people come for vacation, so it was a real shock for us all.”

ORMC is the busiest level-1 Trauma Center in Florida and admits approximately 5,000 trauma patients annually. The facility is continuously refining its mass casualty intake plan due to Florida’s propensity for hurricanes and tornadoes, as well as the city’s status as an international tourist destination. Just three months before the Pulse nightclub shooting, ORMC participated in an active shooter scenario mass casualty intake drill with local EMS agencies.

“As trauma surgeons, we drill and prepare to handle the worst that humanity or Mother Nature can produce yet hope that such events never happen,” Cheatham said.

At 10 p.m. on June 12, Cheatham stopped for the first time in almost 24 hours to eat dinner in the parking lot with his wife, Susie, also a physician. They met while they were students at Vanderbilt University School of Medicine (VUSM). Susie is a 1989 graduate of VUSM and was chief resident in pediatrics in 1992-1993. Cheatham completed his general surgery residency and two-year surgical critical care fellowship at Vanderbilt University Medical Center from 1989-1996. The couple has four daughters.

“Susie and the girls have been incredibly supportive and a tremendous help to me through this,” Cheatham said. “We’re used to drawing strength from our Christian faith and each other.”

Due to the volume of patients ORMC received from the Pulse shootings, 417 additional team members responded to the mass casualty event, which gave them the manpower they needed to treat the victims.

“Our team members were many times doing things outside their normal job description; we had people who were giving 120 percent for each of the victims, all for the common good of getting these victims through this tragic circumstance,” Cheatham said.

The biggest challenge to the hospital was not the volume of patients, Cheatham said, but the overwhelming number of people who arrived at the hospital to look for family members and friends. People flooded the hospital to look for loved ones; meanwhile, 40 victims lay dead in the club before they were removed due to the ongoing investigation surrounding the incident.

Ultimately, nine victims arrived at ORMC near death or with no signs of life and succumbed to their injuries. Of the remaining 35 patients received at ORMC, all of them survived and have since gone home.

“As we look at this and we think back over things, we were tremendously blessed by having a wonderful multidisciplinary team,” Cheatham said. “I think if we had not had the team that we do, a team that is willing to do whatever it takes to improve patient care, I don’t think our outcome would have been as good as it was. Every patient who arrived who had vital signs past the first few minutes, survived. I still cannot fathom how that occurred. I have to think there was tremendous grace from God that day.”

In the months since the Pulse night club shooting, Cheatham has remained active in medical missions and international disaster relief through Samaritan’s Purse and World Medical Mission, Inc., and has served on the boards of both organizations. He and his family frequently participate in mission work together and have traveled to Africa for medical missions numerous times.

“Every hospital needs to be prepared for mass casualty events such as Pulse,” Cheatham said. “It is no longer a question of if a hospital will experience such an event, but when.”