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As regular readers know, the definitive, official state of Texas report on the Uvalde attack—more specifically, the incompetent law enforcement response to that attack—has yet to be released. The attack occurred on 05-24-22, more than seven months ago. The SMM Uvalde archive is here.  A committee of the Texas Legislature released an interim report in July of 2022, which I covered in four articles, beginning here.  While that report exposed at least some of the inexplicable law enforcement incompetence, it omitted a comprehensive timeline, which is absolutely necessary to understand what happened, what didn’t and why.

The Texas Tribune, which has been the best source of information to date, released a report that indicates the law enforcement response wasn’t the only deadly failure that day. So too was the response of emergency medical personnel. From that late December, 2022 article:

Bullets had pierced Eva Mireles’ chest as she tried to shield students from a gunman’s semiautomatic rifle. But the fourth grade teacher at Robb Elementary was still conscious when police carried her out of classroom 112 and through a hallway crowded with dead and dying victims.

‘You’re fine. You’re fine,’ said her husband, Uvalde school district police officer Ruben Ruiz, who had been frantically trying to rescue her since the attack began. Mireles looked at him but could not speak. She’d been losing blood for more than an hour.

Other officers disarmed and removed Ruiz from the school, preventing him from doing anything to save his wife.

Officers placed Mireles on the sidewalk just beyond one of the school’s exits and started treating her wounds. A medic later told investigators he did not see any ambulances, though video footage showed two parked just past the corner of the building, about 100 feet away.

The chaotic scene exemplified the flawed medical response — captured in video footage, investigative documents, interviews and radio traffic — that experts said undermined the chances of survival for some victims of the May 24 massacre. Two teachers and 19 students died.

To be absolutely fair, keep in mind medical personnel responding to such situations “stage.” They park a safe distance from the location of the incident and do not approach until directed by law enforcement. At Uvalde, no one was ever in charge, so no one knew what was happening. As a result, medical personnel never got timely or correct information, and children and teachers died.

Three victims who emerged from the school with a pulse later died. In the case of two of those victims, critical resources were not available when medics expected they would be, delaying hospital treatment for Mireles, 44, and student Xavier Lopez, 10, records show.

Another student, Jacklyn ‘Jackie’ Cazares, 9, likely survived for more than an hour after being shot and was promptly placed in an ambulance after medics finally gained access to her classroom. She died in transport.

The disjointed medical response frustrated medics while delaying efforts to get ambulances, air transport and other emergency services to victims. Medical helicopters with critical supplies of blood tried to land at the school, but an unidentified fire department official told them to wait at an airport 3 miles away. Dozens of parked police vehicles blocked the paths of ambulances trying to reach victims.

There were so many police agencies present that day, none of them could talk to each other on their radios–different frequencies And the Uvalde School District Police Chief actually abandoned his two radios by the school fence. He has since been fired.

‘Two ambulances were at the scene when police killed the gunman. But additional EMS responders struggled to get there.

Uvalde EMS radio traffic (12:58 p.m.) ‘10-4 we are [inaudible] at Grove Street and Grove Street is blocked off by law enforcement.’

One minute later, six students, including one who was seriously wounded, were taken to a hospital in a school bus with no trained medics on board.

Some law enforcement cars were left locked and could not quickly be moved, forcing medics to frantically try various routes to the school, crisscrossing through residents’ yards.

Thirty-three minutes after police killed the gunman, an ambulance struggled to access the school via South Grove Street.’

Although helicopters were available, none were used to carry victims directly from the school. At least four patients who survived were flown by helicopter to a more fully equipped trauma center in San Antonio after first being driven by ambulance to a nearby hospital or airport.

There was more than adequate space for helicopter operations near the school, but no one to coordinate. There is absolutely no excuse for keeping medical personnel away from the school after the attacker was killed.

Eric Epley, executive director of the Southwest Texas Regional Advisory Council, a nonprofit that helps coordinate trauma care in Southwest Texas during mass-casualty events, said medics encountered challenges, including a faulty radio system.

‘These scenes are inherently confusing, challenging, and chaotic,’ Epley said in an email. He later added, ‘We remain steadfast that the decisions by the on-scene medical leadership were sound and appropriate.’

Perhaps. We don’t know the details, other than that people who might have lived given a normal, appropriate medical response, died.

Mireles, an avid hiker and CrossFit enthusiast who was fiercely proud of her college-graduate daughter, was shot within the first minutes of the attack, according to interviews students gave to investigators and a DPS analysis of gunfire obtained by the news organizations.

It’s difficult to know whether Mireles or anyone else who died that day might have survived their wounds, in part because local officials have refused to release autopsy reports. But footage shows that Mireles was conscious and responsive when she was pulled from the classroom, an indicator that she probably had survivable wounds, according to medical experts.

‘Had medics gotten to her quickly, there’s a good chance she would’ve survived,’ said Babak Sarani, director of critical care at George Washington University Hospital. [skip]

Medics on helicopters and in ambulances who responded to the Uvalde shooting told investigators they were confused about who was in charge, where they should be stationed and how many victims to expect. Some of them pleaded to be allowed closer to the scene. In the absence of clear guidance, experts said medics did the best they could while trying to save lives.

‘They were told, essentially, to go to the airport and wait,’ according to an interview the Texas Rangers conducted with Julie Lewis, the regional manager for AirLIFE, an air medical transport service that sent three helicopters from the greater San Antonio area. ‘They couldn’t figure out who was in command.

That’s because no one ever was. This is as horrifying as it is pathetic:

Trapped inside her classroom, Mireles tied a plastic bag around her arm to help slow the blood loss, one of her students told investigators. Another child in Room 112 told investigators that Mireles tried to protect him. The boy was hit in the back of his shoulder but survived.

At least two students used Mireles’ phone to call 911, begging officers to send help. [skip]

Inside Rooms 111 and 112, students anxiously tried to get officers’ attention. They knew that for Mireles, there was little time to spare.

One girl later recalled to investigators that Mireles ‘was telling us she was going to die.’

She had no idea how right she was.

‘There was no EMS command and control,’ said Julio Perez, a medic for AirLIFE, who told investigators he was pleading to help. ‘Nobody could tell me anything.’

His account was backed up by Lewis, the manager for the air transport service, who said several of her medics were upset. ‘They feel like the resources weren’t used as they should have been.’

Everyone there was clueless.

Other emergency crews were also struggling to get crucial information and figure out where to go.

The crew of an AirLIFE helicopter grounded in Uvalde for maintenance heard the unfolding chaos on the radio and offered to help. The crew later told investigators that the emergency responders they talked to had rejected their assistance repeatedly. They did not provide the names of those responders.

When the attacker was killed, the Border Patrol team that killed him gave an “all clear,” though there is no way to know how many, if any, of the other police agencies present knew that, and when.  The utter lack of information available to medical personnel suggests few, if any, knew.

Officers who had packed the hallway now filled the classrooms. Ruiz ran back into the school, looking for his wife. Children lay on the floor, many near or on top of each other, most of them dead.

Officers quickly began taking victims to a triage area inside the school, carrying some by their limbs. With so many law enforcement officers and first responders at the scene, there was little space to move. Some children were placed in a line on each side of the hallway.

One local medic later complained to investigators that the response was so chaotic that emergency crews were stepping on victims.

Several medics expressed frustration to investigators that law enforcement officers brought them students who could not be saved.

‘You’re doing this wrong,’ Martinez, the Uvalde EMS deputy supervisor, recalled yelling to police after being handed a child with a significant head injury. ‘There’s nothing I can do for this patient.’

Within minutes, medics determined that several critically wounded patients with pulses needed to be urgently taken to a hospital where surgeons could provide advanced care.

A girl matching the description of Jackie — wearing the same red shirt and black shorts she’d had on earlier in the day — was placed in one of the two ambulances at the school. The 9-year-old, described by her family as a ‘firecracker’ for being so full of life, died on the way to the hospital.

Andrew Aviles, a regional trainer for the Border Patrol’s medic team, began treating a young boy, doing everything he could to revive him.

‘I can still feel the heart,’ Aviles yelled, as he later recounted to investigators in an interview punctuated with sobs. ‘I need a fucking plane. I need a helicopter down. I need to get a kid inside there!’

The boy needed to be taken to San Antonio’s University Hospital, the nearest Level 1 trauma center, which is equipped to handle the most serious cases. It was about 45 minutes away by helicopter, 90 minutes in an ambulance.

The child seen in the police body-camera footage fits the description of Xavier. A law enforcement document listing what students were wearing indicates that Xavier had on a black shirt, blue jeans and black-and-white shoes. That is similar to the clothing worn by the boy Aviles was treating, the officer video shows.

Aviles had heard that the wounded were being airlifted from a field on the west side of the school, so he and other medics put the boy on a stretcher and began rushing him out to the dusty patch of grass at 12:56 p.m.

There was no helicopter.

Although at least five medical helicopters responded to the shooting, not one picked up anyone from Rooms 111 and 112 at the school, according to a review of flight data, satellite imagery and photographs, as well as interviews with air crew members by Texas Rangers.

Again, not a single helicopter was able to transport a critically injured patient.

Dread set in when Aviles felt softness on the back of the child’s head, indicating a significant injury. The wounds were consistent with those detailed in the autopsy report shared with Xavier’s family, which revealed that the boy had been shot five times.

‘I was like, ‘Guys, he’s …,’ Aviles said, pausing for a moment to take a breath as he spoke with investigators. ‘That took the wind out of my sails.’

First responders waited 11 minutes for a helicopter but decided to drive to San Antonio when it didn’t arrive. At that point, the boy had already gone into cardiac arrest. Overwhelmed medics enlisted state Trooper Matthew Neese to help with CPR in the ambulance.

Once a gunshot victim’s heart stops beating, the likelihood of survival diminishes sharply, experts said. A patient in that condition should immediately be brought to an operating room, where a surgeon can attempt to stop internal bleeding.

State records show that Neese did not have an EMT or paramedic license in Texas, but he performed CPR on Xavier for more than 30 minutes while a medic tried to treat the boy’s wounds. The ambulance diverted to Medina Regional Hospital in Hondo, about 40 miles from Uvalde, where doctors declared the child dead shortly after 2 p.m., according to his family.

A helicopter arrived near Robb Elementary at 1:15 p.m., eight minutes after the ambulance departed.

Take the link and read the entire article. As it began with Eva Mirales, it ended with her:

The ambulance that Mireles was inside never left the school curb.

credit: google maps   Notice all the space around the school available to helicopter operations.

The Texas Tribune also reported on the bus driver who did her best to save lives, because she had to:

When Uvalde school bus driver Sylvia Uriegas got the call on May 24 to report to Robb Elementary, she had no idea about the horror she was approaching.

With nothing but a rudimentary first aid kit filled mostly with Band-Aids, Uriegas had been called to the scene of one of the nation’s worst mass school shootings — with no training for the important role she would play as the chaotic scene unfolded.

When Uriegas and two other drivers, who had been taking kids to a field trip at a nearby park, reached the school, the streets were swarmed with law enforcement officers and parents. The central office dispatcher who asked her to report to the school had warned of an emergency — but said no more.

Her normal path to the building was blocked, so Uriegas backed up her bus and found another route. The two other school buses followed. Another driver opened her door and asked a bystander what was happening. Only then did they learn that there was an active shooter inside Robb.

Ultimately, Uriegas’ bus became a makeshift ambulance that carried kids with gunshot wounds to the hospital.

‘We’re not first responders,’ Uriegas said. ‘But then we were.’

As I’ve written from the beginning, I’m sure there were heroes that day. Uriegas was one:

When the buses reached Robb, no one on the outside knew the situation inside, and parents were frantic during the nightmarish hour they waited for law enforcement to take control.

But for Uriegas, the nightmare began once the shooting was over and children began evacuating.

‘Once I saw the kids, that changed everything,’ she said.

Lines of sobbing children headed for the other buses to be taken to a reunification center, but officers approached Uriegas’ bus with a wounded student and told her more were on the way. The officer asked if she had any medical supplies. Later, Uriegas scoffed at the memory of handing over what she called her ‘Mickey Mouse’ first aid kit with little more than Band-Aids inside.

Consider that, gentle readers. Police officers utterly uninformed about any medical response, relied on a school bus with no medical personnel or supplies to try to save children.

Outside on the sidewalk, another officer was performing CPR on a child, Uriegas recalled. Parents had picked up on the evacuation and began searching for their children. Some were pounding on the windows of Uriegas’ bus, begging to know if their kids were inside.

‘They wanted to see which kids were in there, which is natural,’ she said.

Uriegas said she believed it was only a matter of time before a parent tried to breach the bus’s emergency exit, in the back where the officers were doing their best to administer first aid to a boy who had been shot through the thigh. She said she could see the potential for more damage if panicked, frantic people rushed onto the bus, so she locked the emergency exit, which went against her training. But then she realized nothing in her training seemed to apply to this situation. She only had her instincts.

They served her, and the kids, well.

Uriegas said she knew the names of two boys on her bus but not the name of a little girl, whose face she cannot remember but whose screams she will never forget. She drove the students and officers to the hospital, praying along the way.

After the hospital, Uriegas dropped off the bus at the district depot. It’s usually the drivers’ job to clean their own buses, but when the crew saw the blood all over the inside, they told her to stand down and said they would handle it. She was grateful but not ready to call it a day. She took another bus and returned to Robb, just in case.

She heard later that the students she transported all survived. She’s grateful for that. It gives her some comfort as she struggles to make sense of that day.

Final Thoughts: Again, gentle readers, take the link and read the entire article. The only way a disastrous response like that at Uvalde can be avoided in the future is if a complete and non-political report is eventually issued. Yes, some heads will roll, and they should, but the focus must be on identifying every failure at every step, and how to avoid them in the future.

Law enforcement had the ultimate, primary authority for handling the attack. It appears they failed in every way possible, and that failure apparently prevented medical personnel from saving lives that could have been saved.

More as it becomes available.