Survival measured in minutes
Victims' chances improved with rapid medical response to life-threatening wounds
By Bartholomew Sullivan
Trauma surgeon Dr. Phillip Mallory and a team from Swedish Medical Center opened a victim's chest in the emergency room, clamped off her aorta to stop massive bleeding from a torn vena cava, a vein that feeds the heart, then searched for the wound that had lacerated her liver.
"Anne Marie was the most unstable," Mallory said, sitting on the trauma-room gurney where the miracle work was performed last week. "She was white as a ghost and barely conscious."
While other doctors, nurses and technicians worked to stabilize Anne Marie Hochhalter, Mallory and three other surgeons prepared for the four hours of surgery that would keep the 17-year-old clinging to life.
Police heroics at Columbine High School were quickly followed up by the medical task of lifesaving that doctors last week described nonchalantly as almost routine.
Trauma physician Dr. Christina Katlett of Johns Hopkins University Hospital in Baltimore says seriously injured patients have a "golden hour" to begin receiving treatment for massive trauma. The shootings started at 11:26 a.m. Three of the patients at Swedish, including Anne Marie, arrived with six minutes inside that golden window of opportunity.
Doctors remain circumspect about the chances of complete recovery for some victims. Dr. J. Adair Prall at St. Anthony Hospital Central, who treated Patrick Ireland after he was shot in the forehead and pushed himself out of the library window to safety, said the youth was not bleeding to death when he reached the facility. But Patrick can't understand simple requests, and his language and motor skills have been at least temporarily compromised.
But for doctors who count on seconds, "Time was not quite of the essence in the way it possibly was for the other victims," Prall said of Patrick's case. He had been asked to speculate on whether Patrick could have survived had he not jumped into the waiting arms of SWAT-team members.
In interviews and press briefings, doctors and nurses said they were prepared for the crisis that engulfed them. Dana Pepper, vice president for clinical operations at Swedish, said the center expected to receive more patients and could have handled them. Because it was closest to the high school, Swedish Medical Center received the first wave.
Two things worked in favor of all hospitals and patients: It was midday on a Tuesday, when the facilities were in full swing and fully staffed, and the mainly healthy victims had youth on their side.
"These kids are resilient. The same injuries to adults could have been fatal," said Dr. John Schwappach, member of a spine-surgery team at Swedish.
Eleven students remained hospitalized Saturday. Most continued to improve, responding to high-tech medical care and the love of family and friends.
Schwappach said the survivors owe their lives to quick response by police and paramedics, although others have criticized law enforcement personnel for slow response.
"It was the front-line people who made all the difference," the surgeon at Swedish said. "The four who came here all had potentially lethal injuries. It was remarkable there weren't more fatalities, and I think it was cool heads by law enforcement that prevented more fatalities."
Mallory says Anne Marie is alert and thanks the heroics of two friends -- Kim and Jason, their last names so far unknown -- who pulled her to safety after she was shot and paramedics came under fire. She recognized the paramedics when they came to visit her last week, he said.
Clamping off the aorta before surgery was a "setup for a multisystem organ failure," Mallory acknowledged, but it was necessary, and she has responded well. The nick to the vena cava, the huge vein that returns blood from the lower extremities to the heart, was like an open drain before the blood was cut off. The hole had to be sewn closed.
A second wound to Anne Marie's back is evident in X-ray images. The gently rounded bullet rests alarmingly close to one vertebra and may explain what Mallory hopes is only temporary loss of feeling in her legs.
Valeen Schnurr, who took some of the most serious-sounding injuries with multiple shrapnel fragments to the chest, abdomen and left arm, is recovering and may be released this weekend, Mallory said.
The medical teams' fast work began paying off by week's end.
Dr. Thomas L. Wachtel of St. Anthony was evidently pleased to release Makai Hall on Friday afternoon after arthroscopic knee surgery and treatment for shrapnel to the left cheek.
Hall's prognosis is "excellent," although he'll be on crutches for some time, Wachtel said.
April 25, 1999