On Oct. 1 2017, American gunman Stephen Paddock fired over 1,100 rounds from a 32nd floor suite of a nearby hotel on a crowd of concert-goers at the Route 91 Harvest music festival on the Las Vegas Strip in Nevada.

Considered the deadliest mass shooting in recent U.S. history, the horrible tragedy left 58 people dead and 546 injured.

That night, Filipino American Dr. Kevin Menes was the ER doctor in charge at the Sunrise Hospital, some 8 kilometers (5 miles) away from the site of the shooting. It became a very busy shift for him and his team, treating about 200 patients, and managing to save all but 16 people.

It certainly helped that Menes, who had prior experience supporting a local SWAT team, had thought out in advance how he’d respond to a “mass casualty incident,” or MCI.

“For years I had been planning how I would handle an MCI, but I rarely shared it because people might think I was crazy,” he said in his account of the incident published in Emergency Physicians Monthly.

Since the hospital wasn’t actually designed to accommodate such influx of gunshot victims, Menes came up with a system that enabled them to cope with the wave of patients.

He said he and his colleagues utilized a strategy that would give everyone a chance to live. That meant normal hospital protocols such as “tagging” patients according to the severity of injury had to be modified.

In normal cases, hospital staff would place green tags for minor wounds, red for severe but can still be saved, grey for those patients found to be hopeless, and black tags for the dead. Menes used only red, yellow, green and orange, an intermediate zone corresponding to victims who were critically injured and likely to turn into a red tag any moment.

“That night we did save a huge majority of grey tags,” he said, adding that he and his team “were all going to try until we dropped dead ourselves.”

He dedicated specific ER stations to specific tags, which he used in lieu of the actual tags themselves.

“Instead of wasting valuable resuscitation time actually tagging the patients, they were sent to their respective tagged areas. I would look at these patients as they came in, and I would grade them red to green,” he was quoted as saying.

Instead of simply tagging dead victims with “black tags,” he flagged them with red tags so another doctor can verify his initial assessment.

“I pulled at least 10 people from cars that I knew were dead—and sent them straight back to Station 1 so that another doc could see them,” he noted. “If the two of us ended up thinking that this person was dead, then I knew that it was a legitimate black tag.”

He also minded subtle procedural “choke points” in his system and made immediate adjustments to correct them.

Menes noticed that certain protocols, such as nurses having to press the scanner of a machine called a Pyxis to dispense each dose of medication took way too long. He told the staff pharmacist to automatically just fill he nurses’ pockets and stations with whatever they deemed necessary.

Menes also observed that when patients needed CT scans, the technician would wheel the patients to the machine himself and then perform the scan, causing a bottleneck.

“You’re just going to press buttons for the rest of the night,” he told the attendant, ordering him to park in his chair and not move.

He assigned some of the extra nurses who had just arrived at the hospital to move patients through the CT scanning queue. Such decisions saved precious seconds and minutes on every patient, allowing the team to treat 215 gunshot wounds during the seven-hour frantic hospital activity.

Menes, who has made international headlines for the way he handled the critical situation, is reluctant to take credit for the lives saved that night.

“We had about a 100 doctors, nurse practitioners, physician assistants… and 200 nurses come in. This is a Sunday night at 10 o’clock… for these staff members to first take the phone call, then decide they are going to come in and help, to this day, still amazes me,” he later said in an interview with White Coat, Black Art, stressing that it was a team effort that made the difference.

Feature Image via Facebook / Sunrise Hospital and Medical Center