PROVIDENCE — At Rhode Island Hospital Thursday night, there was no advance warning about the mass casualty incident that was about to unfold.
Around 6:45 p.m. four or five people in a car drove through the city’s Washington Park neighborhood and opened fire at people on the porch at 87 Carolina Ave. Some of the people on the porch returned fire, said Providence police Major David Lapatin. Investigators found dozens of shell casings from four or five semiautomatic handguns, and seized firearms at the house, he said.
Shortly before 7 p.m., nurses at the hospital heard a car coming up the ramp to the emergency department, blaring its horn to get their attention. Some staff ran outside to get the first gunshot victims out of the car and into the critical care bays.
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Then, an alert: More victims were on the way. Five or six more. An already difficult situation, with multiple Level A trauma patients, was about to become more chaotic.
Most of the nine victims came through the hospital’s walk-in entrance; only one arrived via ambulance. Within about 20 minutes, nine people injured in a shooting were in the emergency department, three of them critically wounded. The hospital went into lockdown and diverted other patients from its emergency room as police responded to the crime scene and hospital.
“All you can do is react,” said Dr. Nadine Himelfarb, who was the critical care attending physician that night.
React they did. Trauma is algorithmic, Himelfarb said. Health care workers go down a checklist. For people shot in the chest, it’s important to check for a collapsed lung or blood collecting around vital organs. Even as some providers worked to undress the victims to find hidden wounds, nurses looked for IV access and techs checked for vitals. They had to quickly determine who might need observation, who might need blood, and who might need to be rushed to the operating room.
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While an outside observer may only notice the chaos — doctors, nurses, and technicians jostling in a cramped area over a critically injured person — each provider knows their role in this process, and they tried to do it dispassionately and professionally. One victim settled. Then onto the next one. Then the next. And the next.
“It really sounds crazy and it looks crazy,” Himelfarb said. But “everything that is happening is pretty intentional.”
There are other difficult tasks to perform: Himelfarb had to call someone’s mom.
“We have to make these phone calls, and you go from someone not knowing who you are to giving them awful news,” Himelfarb said. “That causes trauma as well. There’s a little bit of a ripple effect”
It was only after things had calmed down that they had time to decompress and process what happened. As of late Friday afternoon, none of the nine victims had died, although authorities said seven remained hospitalized. Eight had been shot and the ninth was hit by something else, police said later.
Even as other patients arrived with injuries and illnesses unrelated to gunfire, the staff talked among themselves when they had the chance. Lindsay McKeever, a nurse and the director of emergency services at Rhode Island Hospital, organized a support session with a crisis intervention counselor for a staff that has already faced a difficult year in the COVID-19 pandemic.
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“This was not an easy night,” Himelfarb said later, “but there have been many not easy nights.”
Rhode Island Hospital was lucky in one respect: The victims started coming in right around a change in shift. Some staffers hadn’t yet left, and others had already arrived. That meant they had more doctors and nurses around than usual, said Dr. Saul Weingart, the president of Rhode Island Hospital, who went to the scene when he received an alert and who marveled at the huge police presence there.
“People are exhausted and drained from the year we’ve been through, but this is what we live to do,” he said.
Dr. Jeremiah Schuur, head of emergency medicine at Lifespan and president of Brown Emergency Physicians, was one of the many doctors to get an alert about the mass casualty incident. He was away from the hospital at the time. They can tell, by looking at the data, that gun violence has picked up in Rhode Island this year. That calls for a public health solution, much like COVID-19 did, Schuur said.
“We knew early this year that gun violence was back and more than before,” Schuur said. “In the moment, we’re well trained for it, much like COVID now. But most of us, we wonder what we can do as a society to address gun violence and prevent it. What we can do is use public health approaches.”
Brian Amaral can be reached at brian.amaral@globe.com. Follow him @bamaral44.