Next came a child shot in the shoulder and buttocks. Then a teacher with gunshot wounds in the arm, chest, and back. Then another young girl who had been shot in her chest, arm, and hand. A boy arrived, already covered in a white sheet. He was taken to the only space available for the deceased—the hospital chapel.

Dr. Arbelaez evaluated a young girl who had taken a ricocheting bullet to the face. It entered her right nostril and lodged in the upper left portion of her nose. She wasn’t bleeding, wasn’t even crying, and had only minimal associated fractures. For Dr. Arbelaez, viewing her scan was one of the few moments of relief during a day of horror. He shook his head and thought back to viewing her scan: “Millimeters in another direction and it could have killed her.”

Dr. Arbelaez, the only emergency physician on staff that day, and his small emergency care team of one physician assistant and a few nurses were joined by family physicians and a pediatrician, who took the lower acuity patients, and a radiologist with a portable X-ray machine who helped read scans as quickly as possible. Off-shift staff who heard the news dropped everything to come help at the hospital.

The Southwest Texas Regional Advisory Council (STRAC), designated by the Texas Department of State Health Services (DSHS) to develop, implement, and maintain the regional trauma and emergency health care system for more than 26,000 square miles in southwest Texas, helped Uvalde Memorial coordinate transfers of patients to associated hospitals in San Antonio, including University Hospital, San Antonio Military Medical Center, and Methodist Children’s Hospital.

As they worked, the members of the medical team—some of whom had children and grandchildren at the school—were hearing bits and pieces of information: The shooting has ceased. No, shots are still being fired. Kids are calling for help on cell phones. They’re pulling them out of windows. Kids are running away barefoot because they were making paper maché shoes … The uncertainty was excruciating. Dr. Arbelaez could see his colleagues had tears in their eyes, but they stayed focused. “They never lost their cool,” he said. “They never complained. Everyone just kept going.” 

Dr. Arbelaez has a five-year old daughter, and he kept imagining himself in the same situation as the Robb Elementary parents. He clicked into an “emotionless” state to cope with the horror of the situation and to continue providing his best care to the victims. “I’m not sure if that’s the best way to put it, but I felt if I put any kind of emotion into it, I’d just be frozen and not be able to do what I’m supposed to do.”