Mass shootings: Doctors share lessons from the front lines

On Nov. 3, at Learn Serve Lead 2025: The AAMC Annual Meeting, emergency physicians Christopher Colwell, MD, and Peter Antevy, MD, and trauma surgeon Lillian Liao, MD, shared insights into responding to mass shooting events.

Credit: Kaveh Sardari

Peter Antevy, MD, told an audience of medical educators, students, and doctors yesterday that treating victims of the mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida, in 2018, "turned me completely upside down."

"I've been doing pediatric ER for 25 years, and nothing bothered me - until that day. That totally screwed me up," Antevy, chief medical officer at the Coral Springs-Parkland Fire Department, said in a session at Learn Serve Lead 2025: The AAMC Annual Meeting, on Monday, Nov 3.

"Even now, just knowing that I'm going to be talking about the topic - it's hard for me."

That long-lasting impact is why Antevy and two other physicians who treated mass shooting victims engaged in a fireside chat-style discussion entitled, "Never the Same: How Mass Shootings Forever Change the Doctors Who Respond." Building on an AAMC award-winning documentary and narrative of the same name, the doctors focused on constructive lessons: how health systems and hospital leaders can best prepare staff to deal with the crisis in the moment and build emotional resilience after a mass casualty incident (MCI).

Below are some excerpts from their observations:

Strained resources force heart-rendering choices

In an MCI with many critically injured victims, doctors might not be able to do all they can to save each life, as they have been trained. They have to devote scarce resources of time, staff, and supplies to victims who are most likely to live.

"We have to assume that we will not have enough resources," said Christopher Colwell, MD, chief of emergency medicine at Zuckerberg San Francisco General Hospital and Trauma Center. "What's the emotional impact of having made those decisions?"

Colwell - who treated victims of the Columbine High School shooting in 1999 and the Aurora movie theater shooting in 2012, while he was an emergency physician in Colorado - recalled such a decision:

"We had a teacher at Columbine who had been shot, and [responders] requested medical help multiple times. When we were finally able to access him, he did not have vital signs, and there were only reflex attempts to breathe. Normally we would have applied all our resources" to try to save his life.

"We decided to move on, knowing that the chances of survival were very low, and there may be other [victims] who we should apply the resources to. Around the corner we ran into a young lady who had been shot in the chest. She was transported, brought to the operating room, and did survive."

The teacher did not.

"Twenty-six years later, I still wonder about that decision, although I believe it may have been the right one."

One way to offset the shortage of emergency and trauma staff at the hospital is to make sure that "everyone involved in health care participates" in the response, "down to the environmental service provider," said Lillian Liao, MD, professor of surgery at University of Texas - San Antonio, Long School of Medicine. Liao treated victims of shootings at the First Baptist Church in Sutherland Springs in 2017, and at Robb Elementary School in Uvalde in 2022, both in Texas.

Colwell gave an example, from the Columbine shooting, of involving as many as possible: While medical staff frantically worked on gunshot wounds in the emergency room, a dermatologist offered to help. "The initial thought was, this is a shooting, I don't know what you're going to do with the dermatologist," Colwell recalled.

Then he realized that the emergency room was filled to capacity not just with shooting victims, but with the routine array of people who had arrived with other afflictions - including four with severe skin rashes and another in the waiting room. The dermatologist took those patients to her clinic about 100 feet away, freeing up five beds for shooting victims who had been waiting to be treated.

Tap students and residents as appropriate

The advice to use all available hands extends to some students and residents as they are willing and able, the doctors said - which differs from common practice.

"When I was a medical student and over the next five or 10 years, the first thought, as soon as a major event happened, was to send the students home, send the junior residents home, get them out of the way," Colwell recalled. "Protect them.

"That was a mistake."

In Colwell's view, many senior-level medical and paramedic students, as well as early-stage residents, can play supporting roles in the response to an MCI, although staff leaders have to make careful judgments on an individual basis.

Liao said that having medical students observe active patient care right from the start of their training better prepares them - both professionally and emotionally - for roles in supporting emergency care later.

"At our trauma center, we incorporate medical students through the entire process of injured care from the minute they arrive," she said. That includes observational visits to the ICU and the operating room.

Provide emotional support right away - then longer

Medical leaders must develop an array of support processes for all health care workers as well as other staff, starting in the emergency room and continuing beyond for days, weeks, and months. Those supports have to be tailored to how each individual responds differently to the event.

"As an institution, you need to have the spectrum of available resources," Liao said. "Some people need just an immediate debriefing" in a group or individually, to express thoughts and feelings about what they just went through. "Some are not ready to talk at that moment, but they may need to talk a week later or a month later."

At the same time, leaders should recognize that some of their staff respond better to informal support from colleagues. After the Parkland shooting, Antevy did not get much out of the official staff debriefing. What did help, he said, "was peer support: the people who looked at me and said, 'Pete, is something wrong with you, buddy. You need help.' And I said, 'Okay, fine. I will come and sit with you.'"

"We're talking about secondary trauma," Liao said. "The more it builds up, the more we lose our health care workforce."

Facilitate constructive action

After mass shootings, many of the health responders channel their grief toward improving medical preparation and response.

After the Uvalde shooting, hospital staff worked to create Stop the Bleed training throughout Texas, whereby citizens are trained to stop or reduce bleeding in trauma victims so that they stand a better chance of survival when medical help arrives. In Florida, the steps taken by emergency doctors include making sure that all ambulances in several large counties are equipped with whole blood.

"Each of us heals differently," Antevy said. "What is healing for me is working toward large things that we're doing locally and statewide that are going to make a big impact" on saving lives.

Focusing narrowly on improving processes within a health system is another constructive strategy, Liao said. That could include conducting better analyses after trauma care events and training staff to improve their skills.

"Having that hope that you are going to do better the next time is really important," she said.

The foundational mission, the doctors said, is to create an environment where the norm is for staff to express their feelings after traumatic events like MCIs, and for leadership to demonstrate how.

"We at medical schools talk about humanism in medicine, and sometimes that's not existent in some of our practices," Liao said. "These feelings are part of our humanistic characteristics. It should be reaffirming that we are not robots, and should have a positive impact on our trainees.

"It is okay to show emotion, because we're dealing with other humans, and we should all take pride in that."