The mass stabbing at Union Gospel Mission on Sunday night was the first time in at least eight years that Salem Hospital activated its mass casualty protocol. 

A dozen people were injured and 11 were sent to Salem hospital, according to the Salem Police Department.

In such circumstances, emergency department doctors brace to receive more patients than their resources can handle. Under Salem Hospital’s plan, the team has 20 minutes to clear treatment bays and prepare equipment.

The hospital, located south of downtown two miles from the stabbing scene, didn’t have 20 minutes to prepare.

“We didn’t have 10 minutes. We barely had five minutes,” said Dr. Libby Windell, the medical director of trauma services.

In the emergency department, the charge nurse has the duty to keep an eye on emergencies in the community that may come through their doors. She saw Sunday night that responders were on their way to a stabbing. Then the notice became three stabbings, then ten.

The charge nurse immediately activated the Mass Casualty Incident protocol for the first time in Windell’s memory, since at least 2017 when she joined the team.

Under that protocol, doctors prepare for more patients than their resources and usual procedures can accommodate. They’re trained to act fast, skip steps they’d follow on a slower day and to only spend resources on those who can be saved. 

Windell got the call while at home, and dropped everything to rush straight into the “organized chaos.” By the time she arrived, staff were working to triage the victims, which ranks patients by the severity of their injuries.

Four patients were triaged under “red,” meaning they were at risk of death within the hour. One was “yellow” – their injuries urgent but able to wait a little longer than the other four. 

The rest were “walking wounded,” Windell said, triaged as “green” and able to wait for internal imaging and closer inspection.

A car crash around the same time brought in three more patients, she said, adding to the caseload.

The first step for doctors was to check their “ABCs.” First is seeing whether a patient’s airway is clear, then if their breathing is impacted, then check their circulation. The next steps are checking mental status, and determining if anything major was missed during the quick assessment. 

“One of the things that you worry about with a stabbing is, let’s say you have a big giant cut on your arm and you’re getting distracted with the pain there, and we’re missing the stab wound in the right flank that’s going to be the one that kills you,” Windell said.

Among their tools are mobile ultrasounds to detect internal bleeding.

“If you had a stab wound in the chest, if I see blood around your heart, I know that your heart’s been poked and I need to take you super emergently up to the operating room. We collect a lot of information in a very short period of time,” she said. 

Last night’s responders included 10 surgeons, eight emergency room doctors and six anesthesiologists, she said. That was eight more surgeons than is typically needed on a given night.

Windell said the emergency department responded like a well-oiled machine. Some of the staff had never seen that many patients come in at once, and each rose to the challenge, she said.  Lab results were expedited, the blood bank was rushing bags in and medical scans were flying.

“It’s all hands on deck. There’s really no ego. Everybody’s there to do the best care, and it’s really remarkable to see when people just unite together to save people. It’s actually a beautiful thing to witness,” she said. “When you have a really good team, it’s almost like a beautiful symphony that you’re watching.”

They called off the protocol at 8:53 p.m., no longer needing to triage. The chaos of triaging lasted a little over an hour.

“It was kind of another day in the ER. It was, again, organized chaos. Really, at no point, did it feel overwhelming,” she said. “It was really great to witness.”

Contact reporter Abbey McDonald: [email protected] or 503-575-1251.

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