Inside a Massacre: What Can We Learn from this Tragedy?

22196355_1322562194540103_5611392929592137338_nI had already finished my weekly post on Trump, the GOP and their possible attempt at sabotaging the Affordable Care Bill. But the tragedy in Las Vegas got me thinking- what can we learn from this and other tragedies.

Consider that police have named Stephen Paddock, a 64-year-old from Mesquite, Nevada, as the suspect who opened fire from a high-rise hotel on a country music concert in Las Vegas and killed at least 59 people in the worst mass shooting in recent US history.

Las Vegas sheriff Joe Lombardo said Swat officers found Paddock dead, apparently having killed himself, on the 32nd floor of the Mandalay Bay Resort and Casino. Officers found him with at least 10 rifles.

On the street below, the Vegas strip was the scene of the deadliest mass shooting in modern American history. More than 500 people were taken to nearby hospitals, authorities said.

“I don’t know how he could stoop to this low point, hurting someone else,” Bruce Paddock, who identified himself as the suspect’s brother, told NBC News.

Stephen Paddock was a resident of Mesquite, Nevada, a retirement, and golf community of about 20,000 people about 80 miles north of Las Vegas near the Arizona state line, a police spokesman confirmed. He also had a home in Reno, in the east of the state, according to reports.

“We don’t have a lot on Mr. Paddock,” said Mesquite police spokesman, Quinn Averett. Local police records showed no reports of any contact with the suspect, Averett said: no calls for service, no arrests, not even a record of traffic stops.

In Las Vegas, police there said, the suspect’s only run-in with law enforcement was a traffic violation.

Authorities were struggling to understand the motives behind the mass killing. An FBI agent, Aaron Rouse, told reporters the agency has “determined at this point no connection to an international terrorist organization”.

“We have no idea what his belief system was,” said Lombardo. “Right now, we believe he was the sole aggressor, and the scene is static.”

Eric Paddock, a man identified by several news outlets as another brother of the suspect, told reporters the family was “dumbstruck” and compared hearing the news to being “crushed by an asteroid”.

Eric Paddock, who lives in Orlando, learned of his brother’s involvement when police called him early on Monday. He gave a statement to authorities, according to an interview he gave to a Florida affiliate of ABC and said he didn’t know of any “affiliations” that would explain his brother’s actions.

“We are completely dumbfounded. We can’t understand what happened,” he told the Orlando Sentinel. Speaking to a CBS reporter, he described his brother as “not an avid gun guy at all”, although he added that Stephen may have owned several handguns.

“The fact that he had those kinds of weapons is just, where the hell did he get automatic weapons?” Eric Paddock continued. “He has no military background or anything like that. He’s a guy who lived in a house in Mesquite, drove down and gambled in Las Vegas.”

He added the family, including the suspect’s elderly mother, was “freaked out” by the news. “They’re fucked up,” he said. “I’ve got a 90-year-old mother whose son just killed 50-plus people and now he’s dead.”

The suspect’s father was at one time on the FBI’s most wanted list for his role in several bank robberies, both brothers have told reporters.

Eric Paddock said the brothers didn’t know their father, Benjamin Paddock, who was in and out of jail during the 1960s and escaped custody in 1968.

An FBI poster from then warned the elder Paddock was an “armed and dangerous” suspect convicted of bank robbery, automobile larceny and “confidence game”. He was captured in 1978.

Bruce Paddock, who said he has not spoken to his brother Stephen in many years, said the family grew up in Sun Valley, California.

In interviews with the Washington Post, neighbors in Reno described the suspect as extremely standoffish. “It was like living next to nothing,” said one. Paddock and his girlfriend would go often to Vegas on gambling trips or for concerts, neighbors said, but he was aggressively unsocial toward other members of the retirement community.

Heavily armed police were seen searching the suspect’s home in Mesquite early on Monday morning. Police chief Troy Tanner said officers surrounded and entered the one-story, three-bedroom home where he lived with 62-year-old Marilou Danley.

Police saw “no movement” inside before serving a search warrant at the ranch-style home in the Sun City Mesquite retirement community. Photos of the residence showed a metal garage door crumpled in the driveway. Mesquite police said they ripped the door off while executing the warrant and that detectives from Las Vegas and North Las Vegas were at the scene.

Las Vegas police said Danley was out of the country at the time of the shooting and they had cleared her of any involvement. “Marilou Danley is no longer being sought out as a person of interest,” the Las Vegas metropolitan police department said in a statement to CNN.

Eric Paddock told a CBS news reporter Danley was his brother’s girlfriend and the family was relieved to hear she was unhurt.

Public records listed previous addresses for Stephen Paddock in Texas and California, as well as a 2010 license to hunt and fish in Alaska. Paddock lived in central Florida as recently as 2015, according to media outlets there.

Florida Today spoke to residents of Heritage Isle retirement community in Viera, where records show the suspect owned a two-bedroom house from 2013 until 2015. Mick Anderson, who bought the house from Paddock, said he never met or spoke with him.

“It was all done through my realtor and his realtor,” Anderson told the newspaper. “The only thing I can tell you is that the documents were regularly late.”

Next-door neighbors Don and Sharon Judy said they saw Paddock and his girlfriend only rarely in the two years he owned the property.

Roger Segel, Senior Editor, and Greg Laub wrote about the lessons learned after interviewing three physicians, who shared the ways in which gunmen forever changed their lives.

They questioned at what point does the professional in scrubs become just a person overwhelmed by human tragedy — and does that tipping point forever change that professional? Imagine going from the euphoria of a job well done, to the crushing reality of lives lost.

The witnesses are Comilla Sasson, an emergency physician who treated victims of the 2012 movie theater massacre in Aurora, Colorado; Justin L. Regner, who cared for victims of the 2014 Fort Hood shooting; and Corey Slovis, who treated victims of the Nashville church shooting that occurred just 2 weeks ago.

Following is a transcript of their remarks:

Comilla Sasson, MD: “I worked through the Aurora shooting as one of the emergency medicine docs on that night, and I think … you know, I trained in a level 1 trauma center in Atlanta. I had kind of thought I had seen and done everything during residency and I was ready to go, and I think on the night of the Aurora shooting I was not expecting to see all those patients come in so quickly and to be so sick. It was a really, I think, one of those life-changing moments that you have as a healthcare provider because you feel like, ‘Gosh, I’m emergency medicine-trained, I can see and do anything that I want to do.’ But on that night, I think everything kind of changed for me.”

Justin L. Regner, MD: “I was in charge with triaging the patients, assign the surgeons and the ED teams to treat each individual casualty. The last patient that came in suffered a gunshot wound to the neck and chest, and he was the one that I personally took back to the OR to treat as well. We were fortunate that we had enough lead time for each transport patient, that we were able to mobilize teams and have an entire team ready for each individual patient. Not all mass casualty situations are always that fortunate. Because of the lead time and the number of people that we were able to have for each patient, we suffered no casualties or fatalities for any of the patients that arrived to us.”

Corey Slovis, MD: “During and right after the trauma, I had a sense of euphoria. We had done great. Every patient had been treated well. People had gone to the operating room quickly. All of our surgeons and emergency responders had just done their jobs and had done them with essentially no errors, no mistakes, nothing where we said, ‘Oh, geez. I wish we had done that differently.’ And so, as I was driving home, I had this sense of euphoria that what a great medical center, what great doctors, nurses, and paramedics I have the privilege of working with.

“Then I got home and learned that what I had initially been told was the other shooter was, in fact, this poor, innocent victim and heard about the people that were in the operating room, and learned about them as people and not just as patients that I don’t have an emotional attachment to. As you begin to appreciate the horror of what their family members and they are experiencing, it’s the exact opposite of euphoria. It’s this sense of just doom, impending doom, lost of control, the fact that things are unraveling. And you go from being this objective clinician physician or nurse, or paramedic — or, for me, physician — to just being human and feeling horrible for what’s happened and what’s going to be happening as people suffer and experience the pain of either a loss or catastrophic injury.”

Regner: “Once you’re done operating on those patients, you know however many it is — 12, 20 — that are still in your care. Say for the second Fort Hood shooting, I didn’t finish taking care of all the patients until about 4:30 in the morning. 4:30 in the morning I finally go home, I basically eat breakfast, talk to my wife, take a shower and then I turn around and come back to work at 6:30.

“For me, I never really had a chance to really think about the Fort Hood shooting or my activity in it for probably days to weeks after the event, mainly because I never got a break. I was in right to the next set of patients that need to be taken care of.

“And that’s what usually happens to us as trauma surgeons is after these big events we get no time off. You go straight to the next patient, straight to the next case, straight to the next family. You never really get a break. It’s not until you have some event like this, or like this Vegas shooting, where you basically are reading about it or watching on the news, and you start to think about all the times you’ve taken care of mass casualty events and all the emotions then start flooding back. They almost become too much. They’re almost where you’re basically telling yourself it’s something you really ever want to experience again. It’s your job, you’ll do it, but it’s not something you would necessarily choose to experience again, and I think that’s where the PTSD really comes in is the long-term chronic effects.”

Sasson: “No matter what you have done in terms of training, what you see in a setting like that, where you have a mass casualty situation, it’s like being at war. And that’s something that is not normal and it’s not something that you ever really can train for. I think as we kind of recovered after that night in terms of having to go back to the emergency department, that really the next days when that PTSD really kind of kicks in and all of a sudden you realize you’re part of the club that you never really wanted to be a part of. And you’re not the same person that you used to be even though everything else around you is exactly the same.”

Slovis: “I think different people respond differently. Many heroic men and women who have fought in our wars come back normal and proud of their service, and many other heroic people who have saved lives and done their job come back and watch as their lives and their family relations just collapse around them, and they have this loss of control. PTSD is post-traumatic, and I believe caring for multiply traumatized victims of senseless violence absolutely can induce post-traumatic stress, and certainly, does.”

Sasson: “We’re 5 years out now and I still have visions of what happened that night, especially on days like the Las Vegas shooting where everything just kind of gets triggered and you sort of go back to that place. But I think it’s just so important to be able to talk about it and to recognize that it’s not something that will just go away, and it’s something that you’re really going to be a different person from this point forward.”

As a physician, I have seen many gunshot victims when I trained in Philadelphia and we all learn to keep our emotions out of our minds so that we can take care of the injured. Sometimes that is very difficult to do. I remember the one night that two gang members were brought in, both suffering gunshot wounds. Our hospital had a very large trauma room in which we tried to resuscitate the two patients. I was paired with a first-year resident in training. We worked relentlessly to attempt to save our patient who had a gunshot wound to his chest. We had opened the patient’s chest to explore and find the source of bleeding and to try to control the bleeding.

As both teams were working hard into the Emergency room came the rest of the gang members followed by the police as both gangs were shooting up the emergency room.

I pulled my young resident under the lead-lined operating table to protect him and me as the bullets were flying around the room. My young resident team member asked me what I was doing and that our patient would die if we didn’t continue to care for him.

My comment was that if were died in the fuselage of bullets we wouldn’t be able to save anyone. Finally, the police got control of the situation after eight additional gang members were shot. Seven people died that night and the next morning my first-year resident quit the surgical residency to eventually enroll in a pathology-training program.

I still remember that night, vividly.

It sounds crazy right, but this type of “activity” has been going on for decades. However, it seems that we are seeing more of these catastrophes.

The politicians never let a situation like this to push their cause. The Democrats want to rewrite the gun laws- Remember the Bill of Right and the Right to Bear Arms?

I live in a community, which has a large population of hunter all of whom defend their right to bear arms. They hunt and learn how to handle their guns from an early age. And the murder rate here in this lazy rural are is almost nonexistent.

Also, look at a country like Switzerland, which has no army. But they have a militia made up of their own people who when they turn 18 years old get a rifle and training as to safety and how to use their weapon. Again the murder rate in Switzerland is almost nonexistent.

In many states, we already have some of the restrictive gun laws but still, some of our major cities have murder rates, which only get worse each year. We have drive-by shootings, killing babies and kids as well as gang killings.

Where do they get their guns?

I’m am blown away at the number of semi-automatic and automatic weapons and weapons outfitted to work like automatic weapons.

Another question is how was the shooter able to buy all those weapons as well as all the bullets, etc??

Don’t these many weapons bought by one person raise red flags to the FBI or the ATF organizations?

More gun laws? Not sure that is the answer because we all know that most if not all these guns that kill are bought illegally.

I do take my hat off to the people that in the crowd still tried to help and rescue other and put themselves many times in the line of fire.

I salute the police and first responders who fairly quickly responded and controlled the tragedy in a matter of minutes and then went on to rescue the injured.

And lastly, I salute the physicians and nurses and ancillary assistants who worked many tireless hours to care for the injured.

Have we learned anything from this tragedy? Only how to manage a situation like this efficiently with courage and compassion. But we have not learned how to prevent these tragedies.

Our health care system does work. But is this tragedy a result of our not being able to manage mental health? I’m not sure that we can blame the system for this considering that no one ever his brother and girlfriend saw this coming.

Where do we go from here?

I’m not sure.

Next week more on health care.

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