After Tucson Shooting, a Race to Save Lives

TUCSON — The moment Tony Compagno stepped off his fire engine, frantic people spattered with blood began running up to direct him to gunshot victims.

Among the wounded was Representative Gabrielle Giffords, who had been shot in the head. Mr. Compagno was one of the first paramedics to reach the scene of the shooting rampage at a shopping center in Tucson last Saturday.

“Lots of people were laying on the ground,” said Mr. Compagno, from Fire Station 30 the in Northwest Fire/Rescue District of Tucson.

“The congresswoman, I could tell that she was still alive. People were giving a little girl CPR. My mind went away. I started counting, and then I thought, ‘What am I counting, injured or dead?’ ”

There were 19 victims. Mr. Compagno’s job was triage: to assess the severity of injuries and label victims so that ambulance crews would know whom to tend to first.

He realized instantly that there was no time to write labels. Ambulances and fire engines were roaring up.

The victims dropped where they stood, forming a row 20 or 30 feet long.

Mr. Compagno could see quickly that five were dead, seven were “immediates,” needing help right away, and the rest could wait.

The child receiving CPR was not responding, but Mr. Compagno was not about to write her off.

“The little girl, I counted her as an immediate,” he said.

Instead of using labels, he simply directed each rescue team to a victim.

The goal was to stabilize them and get them to the hospital as quickly as possible, because people with severe gunshot wounds need trauma surgeons.

The first two patients were ready to go even before the helicopters landed: Nine-year-old Christina-Taylor Green, who had been receiving CPR, and Ms. Giffords were loaded into ambulances.

Ten patients were sent to the trauma center at the University of Arizona medical center. The first to arrive was Christina — still getting CPR, still not responding.

By normal standards, a gunshot victim who is unresponsive after 15 minutes of CPR has almost no hope of surviving and can be declared dead. Christina had already received 20 or 25 minutes, according to a report radioed in.

“This was a 9-year-old girl,” said Dr. Randall S. Friese, 46, a trauma surgeon. “Even though she had CPR beyond our guidelines, I decided to be aggressive.”

Dr. Friese said he could not be certain the radio report was correct. But he could not afford the minutes it would take to verify it.

“You decide, and you do,” he said. “It’s a personal decision, and I decided to be aggressive, just because she was 9.”

He tried a desperate last-ditch maneuver. Within about two minutes, he had cut open her chest, inserted a tube to fill her heart with blood and massaged the heart with his hand to try to start it beating again.

“I had her heart in my hand,” Dr. Friese said. “We filled it with blood. It still didn’t want to beat. So, it was over. We’re finished.”

At that moment, a resident stepped in to tell him a second patient had arrived, assigned to Trauma Room 5: Ms. Giffords. It was the first time Dr. Friese had heard that she was among the victims.

He told the resident assisting him to fill Christina’s heart and try once more to make it start beating again.

By the time he reached Room 5, the resident had tried, and failed. Christina was gone.

The team in Room 5 had already begun assessing Ms. Giffords when Dr. Friese arrived.

“I walked in and held her left hand, held it in both of my hands, and I thought to myself, ‘I need to communicate with her,’ ” he said. “I was uncertain if she would hear me, that she would process my words. It turned out later that she probably did. That was my reward. I leaned in close to her, and I said, ‘Ms. Giffords, you are in a hospital. We are going to take care of you.’ ”

He expected no response. Next, he asked her to squeeze his hand. She did. A few moments later he asked her again, and again she complied. It was cause for hope. But when he tried the same thing with her right hand, there was no response.

Because a brain injury can suddenly impair a person’s ability to breathe, Dr. Friese had a breathing tube inserted into her throat. Then he ordered a chest X-ray and a CT scan of her brain.

Dr. Martin E. Weinand, a neurosurgeon, was ready to operate, but Dr. Friese thought that the chief of neurosurgery, Dr. G. Michael Lemole Jr., who was supposed to have the day off, should also be involved.