Sunrise Hospital’s emergency room was already full at about 10pm on 1 October when a police officer dropping off an accident victim received a call on his radio announcing: “Shots fired.”

Doctor Kevin Menes and nurse Rhonda Davis looked up from their charts. “Is this for real?” Menes asked. A series of gunshots crackled through the officer’s radio in automatic bursts. It sounded like a combat zone. As he ran out, the officer said, “That’s the Route 91 concert.”

Immediately, Menes realized there would be hundreds if not thousands of victims, and Sunrise – Las Vegas’s largest trauma center and the hospital nearest to the site of the country music festival – would probably receive the most.

He and Davis started to prepare. Menes contacted house supervisor Kat Comanescu, who then summoned all available nurses to the ER to help move or discharge patients. Davis requested crash carts and gurneys.

With only four ER doctors and one trauma surgeon on shift at the time, a mass casualty incident alert went out to bring in day-shift doctors, nurses and support staff.

On a typical day, Sunrise receives 20 trauma patients, but in the coming hours they would see approximately 200, including 124 people with gunshot wounds, the first of which would arrive within 15 minutes.

The staff waited with a line of stretchers and wheelchairs in Sunrise’s ambulance bay as the sirens grew closer and louder. The plan was to separate patients into triage zones based on whether each person had seconds, minutes or hours to live, then stabilize or resuscitate them in preparation for surgery.

Everyone who was there that night described the blood and chaos, but also shared oddly uplifting stories of teamwork, humanity and grit. The Guardian interviewed 10 Sunrise staff members – here are their experiences.

Facebook Twitter Pinterest Kevin Menes. Photograph: Hector Torres/The Guardian

‘The first cars were police cruisers. They had filled up with as many patients as they could.’

Kevin Menes, ER doctor

The first thing Menes did was get a police radio from his car. As well as being an ER physician, he is a medic for the Swat team, and listening to the Las Vegas Metropolitan police channel he began to grasp the scope of the tragedy. Menes gathered the four other ER doctors on shift, and they agreed that Menes would handle lead triage. That meant organizing patients for nurses and physicians who would focus on blood, intubation, chest tubes and everything else needed before surgery.

Menes told secretaries to prep all 24 operating rooms and call every surgeon and anesthesiologist. “The surgery department is really what’s going to save people’s lives,” he told the Guardian. “As ER doctors we bring people back to life and keep them alive for a short time, but surgeons are the ones who work the miracles. They’re the ones who get the bleeding to stop and continue to get them better over next days and weeks, and eventually get them home.”



All available gurneys and wheelchairs were taken out to the ambulance bay, where non-ER staff would wheel patients in. They set up and waited. “At about that time I was out on the driveway,” Menes recalled. “You could hear it in the distance. You could hear the sirens coming soft initially, then getting louder and louder. The first cars that came were police cruisers. They can run red lights and had filled up with as many patients as they could.”

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There is a textbook way to handle a mass casualty surge. Patients are given colored tags based on whether they have seconds or minutes to live (red), an hour or so (yellow), are unlikely to die (green), or have died (black). But to save time, Menes designated the four trauma bays as red, orange, yellow and green, inventing an extra severity level and skipping black – those he believed to be dead would go to the red tag area so a second doctor could assess them in case Menes was wrong. Those who had died went to a temporary morgue in the endoscopy room.

It was a plan he had developed through studying the hospital’s layout and the city’s vulnerability. “It’s an open secret that we have a lot of crowds here in Las Vegas and there is always the potential for something like this to happen. For years I’d been thinking about what I’d do. I never said anything to anyone though because I didn’t want them thinking I was crazy.”

After 150 people had been brought in, a nurse came out to the ambulance bay to say, “Menes, they need you inside; they’re getting behind.” He went to help stabilize or resuscitate people who were near death, while a trauma surgeon decided who would go into the operating room next. At one point Menes told nurses to take every unit of O-negative from the blood bank and fill their pockets with the intubation drugs to save the precious time it normally takes to fill out paperwork and use digital devices that track supplies. “These are complete no-nos in nursing – carrying drugs in pockets that aren’t accounted for,” Menes admitted. “But we had to do it to save patients’ lives, and it worked.”

After 30 minutes, more staff showed up, additional operating rooms were opened, and after an hour more surgeons and doctors arrived. “We were getting more and more patients out of the ER and into life-saving surgeries. This dance continued on for hours, and when everything was said and done, at 5am, it was like a ghost town. Almost everybody had been taken care of.”

Sixteen people of at least 200 patients seen that night died in their care, but during the first six hours the trauma team performed 28 surgeries to stop internal bleeding, and 67 operations in the first 24 hours.

More than 100 physicians and 200 nurses had come in.

“As a medical community we came together. But it wasn’t just us. This happened all over the [Las Vegas] Valley, and in a smaller way this happens every night all over the world, 365 days a year.”

Facebook Twitter Pinterest An ambulance by the scene of the mass shooting at a country music festival in Las Vegas, Nevada on 1 October 2017. Photograph: Ethan Miller/Getty Images

‘Quickly it turned into a sea of blood and patients.’

Rhonda Davis, trauma nurse

“We actually got a few minutes’ heads-up quicker than anyone else because that officer just happened to be standing in our ER,” recalled Davis. “It kind of took a while to process what was really going on. Hearing a barrage of bullets was shocking – I was stunned.” After worrying about friends at the show her “nurse brain” kicked in. “I thought: oh my goodness, this is going to be huge.”

She helped notify doctors and surgeons. They started getting the trauma bays ready, which required moving non-critical patients to other areas of the hospital. Emergency dispatchers for Clark County, which contains Las Vegas, usually estimate how many people each hospital will receive, but this time all they could do was stress: “You will get a lot of patients.”

“Even then I didn’t quite get the grand scale of what it would be,” Davis recalled. “It’s hard to imagine that you’re going to get hundreds of patients in minutes.”

This first wave arrived in police cars and private vehicles. She saw a young man with a gunshot wound to his leg, and seconds later the most critical patients started coming in, covered in blood. The most critical cases were gunshot wounds to the head, chest and stomach. Some of the patients did not have a pulse.

“We were trying to do CPR, putting chest tubes in, all of the life-saving measures that you would do,” she said. “We get patients like this all the time, but maybe two at a time at most. You do all these steps to try to save their life. At this moment we had several who needed all these life-saving critical interventions at the same time. We went patient to patient as quickly as possible, trying to help save them. I wasn’t thinking. You just kind of do. Quickly it turned into a sea of blood and patients.”

Nurses usually get assigned patients to care for through their shifts, but in this case “you literally did whatever you could to whatever patient”, she recalled. The four trauma bay rooms typically hold six patients in total, yet each one was being used for four or five people, and there were more in the halls.

She recalled receiving a young female who had been shot in the chest. With every square inch of the trauma bay taken, Davis and an anesthesiologist worked on her in the hall. He was trying to put a chest tube in, because she wasn’t breathing, and when they could not detect a pulse Davis started doing CPR immediately. “I was leaning up on top of the gurney doing chest compressions, trying to save this poor girl’s life, and there’s just blood coming out of her chest from the wound.”

At one point Davis looked up and saw three more patients being moved into the hallway. Doctors and nurses were doing the exact same things for them. There was blood all over the floor.

Unfortunately, the patient she was working on could not be saved. Davis had to move on very quickly to the next patient: another young female in the same situation.

Not a day goes by without Davis thinking about that night. “Some moments during the day I’m completely fine, then I’ll hear something or see something and the memory of that scene in the ER will pop in my mind. It’s very vivid still.”

Facebook Twitter Pinterest Dorita Sondereker. Photograph: Hector Torres/The Guardian

‘The devastation those bullets caused in the human body was catastrophic.’

Dorita Sondereker, emergency department director

When she received the first Mass Casualty Incident alert, Sondereker turned on the news and saw nothing. She called her unit and was told: “There’s blood everywhere. Get in here now.”

While driving in she heard that 75 ambulances had been dispatched to the Strip, which was “beyond comprehension”, she said. “That’s never happened before.”

Ambulances flew past as she drove in, and while turning into Sunrise, pickup trucks cut her off; she heard injured people crying in their flatbeds. “In 35 years in medicine I’ve worked in ambulance, EMS, trauma and helicopter crews. I’ve seen burn ward devastation, but nothing like this.”

The victims arrived in cars, trucks, rideshares, police SUVs and of course ambulances, which instead of the usual one patient would transport six to eight at a time.

She too mentioned a “sea of blood”: “I’ve never seen this amount of trauma in a few hours come through the door. The bullet wounds were the size of your nail bed, but the devastation those bullets caused in the human body was catastrophic. People could be talking with a small wound in their chest then be gone within seconds.

“The night flew so fast,” she said. “You directed it, but it was surreal how things just happened; the flow was amazing. We’d call for more stretchers and recliners and they’d appear. The ER was full, so we moved people up and discharged from the top floors. In all the chaos was a calmness I can’t describe because everyone was working their hearts out. That’s one reason it was successful – a camaraderie and teamwork like I’ve never experienced in my life.”

She added: “Hospitals have an option to divert [patients]. EMS kept asking me, ‘how many more can you take?’ I kept saying 10 more. It was an eyeball thing – like where are we at? How many have I moved to cardio, to ICU, to surgery?”

Within an hour, 100 physicians and 100 nurses had arrived to help. “I’m from small-town Iowa; I’ve seen camaraderie, but nothing like Las Vegas has put out in the past few weeks. The way they came together was heroic – concierges helping people in, nurses’ assistants holding hands, even the patients who said “take care of those who are hurt worse. I’m good.” It wasn’t an ER of screaming. There was a calmness, because people were being taken care of.”

Facebook Twitter Pinterest Jennifer Sanguinet. Photograph: Hector Torres/The Guardian

‘I tried to set aside my own emotions, but obviously I’m human.’

Jennifer Sanguinet, director of infection prevention

Sanguinet had to wait for her mother to come to watch her kids before she could get to Sunrise at 4am. The hospital was on lockdown and the halls were quiet. “The fear and anguish was palpable,” she said. “Everyone had the same look of shock.”

At that hour victims’ families were also trickling in, some from out of state. Sanguinet went to the family resource center to help provide food, blankets and emotional support. Victims who had already been discharged from the ER were interspersed with families, holding each other’s hands. “People swirled around us,” she recalled, “because they saw a badge and saw us taking names. It definitely put my skills to a test. I tried to set aside my own emotions as a parent, but obviously I’m still human, so as I’m walking and doing my job, I’m also crying.”

She and two colleagues took it upon themselves to search for people. They photographed images from the families’ cellphones and walked floor to floor, in some cases scrutinizing victims’ tattoos or piercings. “A lot of people unfortunately had issues where they weren’t recognizable. You also look different in a hospital than when you’re on the street smiling and happy.”

If a victim was alive and could be touched, staff immediately ran to the family to bring them to their side. But if the person was in the morgue, it was more complicated. Sanguinet personally matched eight or nine fatally wounded victims to their family members, a bittersweet experience. She delivered the news with a team that included clergy, medical staff and a case manager. “I was there for the comforting part.”



A couple of days later, one of those parents called to see if her late daughter’s boots had been found – the family wanted to bury their daughter in her favorite outfit. Very few patients’ belongings were at Sunrise – a lot of loose items fell off or were torn away at the site. But at the bottom of the ER’s storage box were the young woman’s boots in a bag.

“I went to package them,” Sanguinet said. “I took them out of the bag and saw they were covered in blood, dirt, and filth from the event. I’m a mom. I have kids, and God forbid this would ever happen to me, I wouldn’t want that to come back. I wouldn’t want that reminder. I closed my door, I put something on the floor, and I sat there for two hours scrubbing those boots. A co-worker brought me a tool to help clean the soles.

“It was really a cathartic time for me to sit and reflect on everything that had happened. It brings home the fact that Las Vegas is my home now, and Sunrise hospital is my home now. I know that that mom is grateful that I took the time; for me it was a bit of closure to know that even out of tragedy you could do something to make a difference in an outcome that was so horrible.”

Facebook Twitter Pinterest Kat Comanescu. Photograph: Hector Torres/The Guardian

‘People were just coming to help, bringing all these supplies.’

Ecaterina ‘Kat’ Comanescu, house supervisor

As a former trauma nurse, Comanescu knew exactly what was needed when Menes called saying: “Something has happened at the Mandalay Bay,” the hotel from which the killer shot into the crowd. Her ER experience also allowed her to stay calm. “I was thinking we needed manpower, space and supplies if a lot of people are coming. Our hospital was almost full.”

She broadcast to intensive care and telemetry units: “Send all your available nurses to the ER.” Less critical patients needed to be moved out of trauma bays. Each department was also instructed to keep one “crash cart”, or mobile cabinet, and these were rolled to the ER, their trays full of chest tubes, drugs and other life-saving supplies. They were in high demand when the ER became overrun with gunshot wound victims as patient after patient needed to be stabilized and intubated for emergency surgery.

“They were amazing,” Comanescu says of her staff. “People were just coming to help, bringing all these supplies. The fact that people came from home and opened spaces that weren’t open … That night will stay with me for the rest of my life.”

Facebook Twitter Pinterest Heather Brown, Thea Parish and Tatiana Banassevitch. Photograph: SergioFlores/The Guardian

‘There was a lot of trauma – at the same moment humanity was happening. It was amazing.’

Thea Parish, pharmacy technician

Parish ran full speed pushing crash carts to the ER. They are heavy machines, and to keep supplies flowing she would sprint back and forth between the pharmacy and the ER throughout the night. A nursing student, once the ER was stocked with drugs, she told the charge nurse: “There are limited things I can do, but I can help.” So many patients were in danger of bleeding out that she helped assess wounds, apply tourniquets, place IVs and monitor vital signs to notify doctors when patients crashed, until on-call staff nurses arrived.

“Some of the nurses from upstairs were traumatized,” she recalled. “They’ve seen patients pass before, but on a scale this size it’s overwhelming.”

She helped colleagues focus on a checklist: assess and if necessary pack the wounds – stopping the bleeding came first. And she helped victims call their families. “There were people who couldn’t operate their phones because they had blood in their eyes, were in shock, or had lost their phones. I let them use mine, and it’s been a little hard now. I have families contacting me to say thank you even though their people didn’t make it.”

By that time the staff was operating with mechanical efficiency, she said.

“Everybody was doing exactly what they needed to do to help as many people as they could. At that point I was in awe … Ever since I started nursing school, the human race has been declining and hating on each other. I was debating whether I wanted to be a nurse. But when I looked around, I was like, this is what it’s about: saving people. We were the helpers. That was the most memorable moment. Yeah, there was a lot of trauma happening, but at the same moment humanity was happening and it was amazing.”

Facebook Twitter Pinterest Chris Fisher. Photograph: Hector Torres/The Guardian

‘I got a pit in my stomach walking up because I knew something huge happened.’

Chris Fisher, trauma surgeon

“A lot of mass casualty alerts end up not significant, or false alarms,” said Fisher. “But when I first pulled in it was an unbelievable sight. I got a pit in my stomach walking up because I knew something huge happened. There were multiple Metro vehicles, ambulances pulling in, nurses bringing out multiple gurneys to take people in stretchers from private vehicles.”

Two other surgeons were already in and three more were en route. Fisher went to the operating room where the first patient was on the table, prepped and draped. The anesthesiologist came in while Fisher located the wounds. He started operating. The key difference from a normal night, apart from the sheer volume of patients, was that the wounds were from a rifle, which is more serious because the rounds have a higher velocity than handgun bullets.

Their assembly-line approach worked “fantastically well”, he said. “Patients didn’t have to wait to be operated on. We used all 24 operating rooms. All the staff came in right away, and that made a huge difference.”

Fisher operated on five people during a 24-hour shift. In between, he helped coordinate where patients would go and who would be next while performing triage. Everyone was in the zone, and the gravity of the mass shooting did not hit him until he went home the next night and his dogs smelled and licked the blood on his shoes. He put them in the trash.

Facebook Twitter Pinterest An outdoor venue from across the Mandalay Bay Hotel where the shooting occurred. Photograph: Anadolu Agency/Getty Images

‘Many of the patients were saying, “No I’m not that bad, go to work on them not me.”’

Tracy Szymanski, guest services director

At first, Szymanski experienced the night’s trauma as a concertgoer. She and her husband were about to leave the Route 91 festival when the gunfire started. They believed they were hearing the sound of firecrackers. Security officers screamed that people should turn around and take cover, so they ducked into a bar with a roof overhead. They ran out in between shots, and she called her hospital to tell them what was happening. As they got away, they passed injured people resting against dumpsters, and Szymanski asked them: “Are you OK?”

“Honestly, it felt very debilitating,” she recalled, “because I’m a non-clinical member of our team.” All she could do was help Sunrise prepare.



Showing up in her concert T-shirt and shorts, she turned the auditorium into a waiting room for victims’ families. There, she gave people in blood- or dirt-stained clothes fresh outfits and handed cellphone chargers out, got the cafe open to provide coffee, and began working with case managers to help find missing loved ones. “Going back and forth between the war zone was unlike anything I’ve ever seen, but the patients were so wonderful. Many of them laying on gurneys in the ER were saying, ‘No I’m not that bad, go to work on them not me’.”

The next day she managed a massive influx of food and water donations and brought in therapy dogs. Between five and 12 golden retrievers would visit Sunrise over the next few weeks, interacting with families, patients and staff. “My phone was blowing up with names of people who needed fuzzy love. It made a big difference.”

Facebook Twitter Pinterest Heather Brown with Thea Parish and Tatiana Banassevitch. Photograph: Hector Torres/The Guardian

‘From everything we saw that night to a week later the progress was amazing.’

Heather Brown, intensive care unit nurse

Brown was part of the team that moved people upstairs from the ER, and then came back down to help triage the emergency cases. “It was difficult,” she said. “We’re not used to being the first line, per se. I had to revert back to training and try to think of basic things that needed to be done.”

When she returned to the ICU at 7am, she cared for patients whom she had helped stabilize downstairs who had now gone through life-saving surgeries. In the weeks that followed, she watched them further improve. “Some people we thought might not wake up, or talk or walk again were able to get up and move. From everything we saw that night to a week later the progress was amazing.”

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Her most vivid memory, though, was of a patient who had arrived at the ER before the shooting, an older blind woman who asked to leave. “She couldn’t see what was going on in the ER at all, but she could sense it, and hear it obviously. She had a daughter in town who’d gladly take her home, she said. In the middle of everything that was going on, when she came up to ask me that, it was touching. She was realizing she didn’t need to be in our busy ER for what she had at that exact moment. It kind of stuck. There were other victims who were the same way after that. You start to see all that good from people who’ve gone through something traumatic, and it keeps you going for all the ones who aren’t able to do that.”

Facebook Twitter Pinterest Todd Sklamberg. Photograph: Hector Torres/The Guardian

‘Nothing could have prepared us for this event.’

Todd Sklamberg, hospital CEO

“As a level two trauma center we see all sorts of trauma, from stabbings to gunshots, to car accidents,” said Sklamberg, speaking in front of signed placards from medical staff in Orlando, San Bernardino, Denver, Boston and Newtown. “We drill and we prepare on a very regular basis, but nothing could have prepared us for this event in terms of the quantity of patients that came. Over 120 gunshot victims came into Sunrise over a two-hour period of time – unprecedented numbers in the history of the US. But the preparation, the drilling we do, gave us the foundation upon which to provide that care to all the patients who came in.

“No patient was turned away.”