Records reveal medical response further delayed care for Uvalde shooting victims

Eva Mireles, a fourth-grade teacher at Robb Elementary in Uvalde, Texas, was still conscious when police carried her out of a crowded hallway and 112 classroom, where victims were dying and dead. She had tried to shield students from the semiautomatic rifle bullets that pierced her chest.

The video above is from a connected narrative.

This story contains explicit depictions of injuries suffered in a shooting incident at an elementary school, along with the use of explicit language. Please note that the videos examined by journalists have not been included.

She had been losing more blood for over an hour. Mireles looked at him but couldn’t speak. Officer Ruiz, who had been frantically trying to rescue her, started attacking since her husband, a Uvalde school district police officer, said, “You’re fine. You’re fine.”

To view body camera recordings and illustrations illustrating the medical reaction, please visit the website of the Texas Tribune.

Approximately 100 feet in the distance, video footage displayed two emergency vehicles stationed just beyond the edge of the structure. However, despite not witnessing any emergency vehicles, a medical professional informed investigators. Law enforcement officials positioned Mireles on the pavement just past one of the school’s entrances and commenced attending to her injuries.

Experts have stated that the chances of survival for some of the victims of the May 24th massacre were undermined by the deaths of 19 students and two teachers. This was exemplified by the flawed medical response and the chaotic scene, which was captured in traffic radio interviews, investigative documents, and video footage.

The timely care of the victims was the most serious problem among the medical responders due to muddled lines of authority and communication lapses, as shown by previously unreleased records obtained by The Washington Post and The Texas Tribune through ProPublica. However, experts said the well-documented failure of law enforcement to confront the shooter, who terrorized the school for 77 minutes, hindered further treatment.

According to records, Mireles, who was 44 years old, and Xavier Lopez, a 10-year-old student, tragically lost their lives after encountering a delay in receiving necessary medical care at the hospital. This unfortunate incident occurred right after they left the school, still showing signs of life.

Another student, Jacklyn Cazares, also known as “Jackie,” gained access to transportation in the classroom after finally being placed in an ambulance by medics. She promptly survived for more than an hour after being shot.

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

Based on Texas EMS records, six students, including one who was severely injured, were transported to a hospital in a school bus without any trained medical personnel on board. Additional emergency vehicles started arriving 10 minutes later, although it was insufficient for the 10 or more individuals who had sustained gunshot wounds and were still alive at that time. When the perpetrator was neutralized, footage from multiple body cameras worn by officers and one from the police car’s dashboard revealed that only two ambulances were stationed outside the school.

Access to Street Grove South via the school was difficult for the ambulance, as the gunman had killed police officers after crisscrossing through the yards of residents for thirty-three minutes. The medics were unable to quickly reach the school, as some law enforcement cars were locked and they had to frantically try various routes. There were no trained medics on board a school bus, which seriously wounded one student, including six others who were injured. Street Grove was blocked off by law enforcement, and at Street Grove, traffic radio reported that EMS responders in Uvalde struggled to get there, even with additional EMS responders. Two ambulances were at the scene when the police killed the gunman. The street leading to the school was filled with parked school buses, as well as dozens of officers from local, state, and federal agencies.

Following initial transportation via ambulance to a nearby hospital or airport, a minimum of four survivors were subsequently airlifted by helicopter to a more extensively equipped trauma center in San Antonio. Despite the presence of helicopters, none were utilized for direct transportation of the victims from the school.

The inquiry, collaborated on by news outlets, did not obtain comprehensive responses from the federal, state, and local authorities that reacted to the incident. The healthcare reaction was not specifically tackled by these authorities, and law enforcement officials have justified their officers’ conduct as justifiable given the challenging conditions in public declarations issued since May.

Medics faced difficulties, such as a defective communication system, according to Eric Epley, the executive director of the Southwest Texas Regional Advisory Council, a non-profit organization that aids in organizing trauma care in Southwest Texas during instances of multiple casualties.

Epley stated in an email, “These scenes are naturally perplexing, demanding, and disorderly.” He subsequently included, “We firmly believe that the choices made by the medical leaders present at the scene were sensible and fitting.”

The local district attorney, along with law enforcement officers, has stated that she will utilize the investigation to assess whether any individuals will be charged with a criminal offense. The Texas Rangers, a division of the state Department of Public Safety in Uvalde, are currently examining the circumstances to uncover any potential instances where prompt medical attention could have potentially saved the lives of the victims involved.

Investigators and media outlets acquired a DPS evaluation of gunshots and interviews students provided, based on the initial moments of the incident, Mireles, a passionate hiker and CrossFit devotee who took great pride in her daughter’s college education, was wounded by a bullet.

As per medical professionals, Mireles most likely sustained wounds that were not fatal, suggesting that she was aware and responsive when rescued from the classroom. However, authorities at the local level have declined to disclose the autopsy findings, which hinders determining whether Mireles or any other individuals who perished on that day could have potentially survived their injuries.

Babak Sarani, the critical care director at George Washington University Hospital, expressed that if the medics had arrived promptly, there was a high likelihood of her survival.

In several cases, delays in medical care for victims resulted in communication problems. Despite the development of recommended practices after the 1999 Columbine High School massacre, the flawed coordination among medical and police crews echoes missteps during other mass shootings.

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

In an interview conducted by the Texas Rangers, Julie Lewis, the regional manager for AirLIFE, an air medical transport service that dispatched three helicopters from the larger San Antonio region, stated that they were instructed to proceed to the airport and remain there. She mentioned their confusion regarding the chain of command.

Pleading for help.Output: Desperately seeking assistance.

It was one of the festive and planned celebratory days for the teachers and class, which happened to be the last day. The morning of May 24th was sunny and warm in Uvalde, the seat of a rural county near the Texas-Mexico border, with approximately 25,000 residents.

Mireles left her residence donning a floral top and a set of dark trousers, feeling joyful, as per her daughter.

“My father had just informed her about her stunning appearance,” Adalynn Ruiz, 23, reminisced in a text message to a journalist.

On that particular day, approximately twenty-four fourth graders were present in Rooms 111 and 112, which were adjacent to each other. Jackie, who thoroughly enjoyed cherry limeades with additional cherries, and Xavier, who had a great passion for art class and was eagerly anticipating the beginning of middle school, were among those included.

The teenage gunman, dressed in black, scaled the school’s fence and fired shots at 11:32 a.M. They had just finished a student awards ceremony and settled into watching Disney’s “Lilo & Stitch” movie.

Upon hearing the sound of gunshots, Mireles promptly contacted her spouse.

“There’s someone firing at the educational institution,” she mentioned, Ruben Ruiz recollected in an interview with investigators.

“There, we will go. The police officer later stated that he drove her to the school, and we will hear comments from the investigators about it when they come.”

After the gunman fired at the door, two of them retreated. However, they later approached her classroom and a few minutes later, officers rushed into the school. The gunman entered Mireles’ classroom first, firing his AR-15-style rifle.

Based on the video recording, Ruiz, who chose not to provide a statement for this report but conversed with state investigators, dashed into the corridor at 11:36 a.M. However, none of the law enforcement officials attempted to access the classrooms, where the assailant persisted in discharging rounds intermittently.

Eager to get in touch with his spouse, Ruiz informed the remaining officers of the information he possessed.

Based on the video evidence, he stated, “He is present in my spouse’s educational space.” Subsequently, during the interrogation, he recollected, “It felt as though my essence had departed from my physical being.”

Approximately twenty minutes later, his spouse called once more.

At 11:56 a.M., He exclaimed, “She claims she’s been injured!”.

The law enforcement officers who responded to the attack incorrectly assumed that Arredondo, the chief of police for the school district, did not comment on the shooting in the legislative report. However, it was a key piece of information that indicated officers were not dealing with an active shooter but rather a subject who had barricaded themselves.

In August, amidst sharp public criticism of the police response, the Uvalde school board fired Arredondo for the shooting. Arredondo has repeatedly defended his role in the Texas massacre, telling lawmakers that he did not consider himself to be responsible for the delay in investigating the incident. The school district’s active shooter protocol designated Arredondo as the chief commander.

Investigators were informed that Mireles, one of her students, wrapped a plastic bag around her arm in an attempt to reduce the bleeding while she was stuck in her classroom. Another child in Room 112 informed investigators that Mireles made an effort to shield him. Although the boy endured, he was struck in the rear part of his shoulder.

At least two students utilized Mireles’ mobile device to dial 911, earnestly imploring law enforcement to dispatch assistance.

The investigators later told him that they had seized his gun for his own safety. He tried to get it back from his fellow officers, but they stopped him. In the law enforcement interview, he explained that his wife was in danger and he was told that “someone would get next to me.” As a result, he was forced to wait outside the school, and Ruiz’s gun was confiscated by the officers.

Mireles had very little spare time, as they were aware of that. The students anxiously tried to get the attention of officers inside rooms 112 and 111.

One girl later recounted to investigators that Mireles “was informing us that she was going to perish.”

“As a country, we are not prepared.”

Over twenty years after the shocking Columbine school shooting that shook the entire country, significant failures persistently recur.

“They must instruct first responders and trainers to halt the loss of life and neutralize the assailant. It has been reported that after a mass shooting incident, officers across the country should receive training on what actions to take in order to subdue and apprehend the shooter.”

According to experts, the overall incident commander is supposed to coordinate with the fire department supervisor or the head paramedic to organize the medical response. The idea that all first responders, including EMS and fire police, should work under a joint command that coordinates and oversees the response became an established mantra, insisting on effective and prompt medical care.

“According to Bob Harrison, a former chief of police and a researcher in homeland security at the Rand Corp., A California-based think tank, “the entire reaction goes wrong if there is no system in place.”

A review conducted by the Department of Justice analyzed the response to the 2016 shooting at the Pulse nightclub in Orlando, Florida, which resulted in the deaths of 49 individuals. The review discovered that the lack of coordination led to separate operations and decision-making among the fire and police departments.

A review conducted by local authorities discovered that the establishment of a unified command led to delayed communication problems between fire and police responders, slowing medical care for the victims of the shooting that killed 12 people in the movie theater in Aurora, Colorado in 2012.

Sarani, the head of the critical care department at George Washington University Hospital, expressed, “As a country, we are unprepared. The fire department and the police force lack effective communication with one another.” The aerial resources and the terrestrial resources also struggle with effective communication.

According to experts, it seems that the Uvalde shooting response did not have a designated incident commander or a person clearly responsible for coordinating the emergency medical response.

Investigators later informed Stephen Stephens, the director of Uvalde EMS, that he was responsible for coordinating helicopters and ambulances dispatched to Robb Elementary on that specific day in May. Private corporations are hired by the rural community’s emergency medical services.

“I was responsible for overseeing assets,” he mentioned, highlighting that Juan Martinez, his assistant, directed medical personnel who arrived at the location.

The fire chief of Medina chose not to provide a statement to the news agencies. Following the entry of the police into the classrooms where the shooter had barricaded himself, Stephens mentioned that he transferred control to the fire chief of the adjacent county of Medina.

It is unclear how many victims had information about Stephens. There was confusion expressed by multiple medics over who was in charge of the medical response and where to find first responders.

Julio Perez, a medic for AirLIFE, expressed to investigators that he was desperately seeking assistance, stating, “There was a lack of coordination and communication within the EMS system. I was left without any guidance or information.”

“They believe that the resources were not utilized in the manner they were supposed to,” stated Lewis, the manager for the air transportation service, corroborating his statement. A number of her medical personnel were distressed.

The state has been struggling with the release of the active shooter response and plans. The decision on whether government information should be made public is determined by the office of Attorney General Ken Paxton, with the backing of Texas. The state has fought to require school districts to submit their active shooter plans for release. In addition, news organizations have sued city and state officials for some records related to the shooting response. The school district declined to answer questions posed by The Post and Tribune and did not release its active shooter response protocols or plans.

The city of Uvalde did not provide a response to specific inquiries regarding the interaction between law enforcement and medical personnel, as well as their preparedness for incidents of mass violence, due to ongoing legal proceedings. However, a representative stated via email that the police department of Uvalde has not engaged in any official instruction with Uvalde EMS, a non-profit organization responsible for delivering urgent medical assistance to the city and county.

The document, published later by the San Antonio school district, provides general guidance on how EMS and police should work together, only broadcasted on KSAT television station. The training for active shooter conducted in March.

Law enforcement and fire EMS need to know the types and number of injuries, as well as the exact location of the injured, upon their arrival. The states’ plan does not provide detailed information for the process of communicating that.

Five other private ambulance companies, besides EMS Uvalde, did not respond to requests for comment or answer written questions. Martinez and Stephens, representatives for EMS Uvalde, also did not respond to the certified letter sent, including queries and comment requests.

Uncertainty and setbacks.

Martinez told investigators that he directed other medics to park their nearby ambulances until they knew whether it was safe to move closer. Experts said it’s not unusual to keep ambulances at a short distance from active crime scenes with shooters.

In order to reach the school, the ambulances required the roads to be cleared by officers who had parked their vehicles in a way that obstructed them, as numerous officers arrived at the scene, he quickly identified a significant hindrance.

Martinez directed the two dispatchers of the county to request law enforcement to establish a distinct route.

“We were expecting basically just seizing whatever patients we had and fleeing,” he later informed investigators.

The shooter fired at the classroom entrance, barely hitting a Uvalde police lieutenant in the head, while Martinez and another paramedic attended to him outside. Unaware of the terrifying situation happening within the school, they patiently waited.

Interviews with investigators, Martinez recalled, “We didn’t know the numbers of patients, number of injuries, number of fatalities.” “Nobody was relaying that.”

Other emergency teams were also facing difficulties in obtaining vital information and determining their route.

The emergency responders, whose names were not provided, repeatedly had their assistance rejected. Later, investigators told the crew that they had talked to the responders who offered help and heard the chaos unfolding on the radio. The crew of an AirLIFE helicopter in Uvalde, which was grounded for maintenance, heard the unfolding chaos.

Perez, one of the helicopter medics, expressed, “No one had any idea about the actual situation.” According to him, the officials instructed his team to “wait, remain in that location – do not approach.”

According to a report in July by a committee tasked with investigating, the elite Border Patrol tactical team began arriving at the school at 12:10 p.M., Assuming both roles without clearly taking charge of medical or police responses.

The team, known for managing perilous circumstances related to migrants at the border, developed a strategy to infiltrate the adjacent classrooms while their medical personnel established a triage center.

In response, they retaliated by shooting him. The shooter emerged suddenly from a closet and discharged his weapon. At 12:50 p.M., A joint team consisting of Border Patrol and local law enforcement forcefully entered the classrooms.

The team gave the green light.

Most of them deceased, numerous in close proximity to or atop one another, children were lying on the floor. In search of his wife, Ruiz hurriedly returned to the school. The classrooms were now occupied by officers who had crowded the hallway.

“I can still sense the heartbeat.”

Within the educational institution, authorities promptly initiated the process of transporting casualties to a designated area for prioritized medical attention, transporting a few individuals by their extremities. The presence of numerous law enforcement officers and initial responders at the location limited the available space for movement. Along both sides of the corridor, a group of children were arranged in a linear formation.

A nearby healthcare provider subsequently conveyed their discontent to investigators, affirming that the reaction was sufficiently chaotic that emergency teams were unintentionally inflicting harm upon the victims.

A number of medical professionals expressed their frustration to investigators that law enforcement officials brought them students who could not be rescued.

Upon receiving a child with a substantial cranial trauma, Martinez, the deputy supervisor of Uvalde EMS, recollected shouting at the police, “You’re executing this incorrectly.” “There is no action I can take for this particular individual.”

Skilled medical professionals at a hospital could offer specialized treatment to promptly attend to multiple severely injured individuals with strong heartbeats, as determined by healthcare providers in a matter of minutes.

The 9-year-old girl, described by her family as a “firecracker” for being full of life, died on the way to the hospital. She was placed in one of the two ambulances at the school, wearing the same black shorts and red shirt that she had worn earlier in the day – a description that matched Jackie, the girl.

Andrew Aviles, the regional trainer for the Border Medic team, began treating a young boy, helping him revive and do everything he could.

Aviles shouted, “I can still sense the heartbeat,” as he later described to investigators in an emotional interview. “I require a damn airplane. I require a helicopter to descend. I need to have a child brought in!”

The boy needed to be transported to San Antonio’s University Hospital, which is the closest Level 1 trauma center capable of handling the most severe cases. It would take approximately 90 minutes by ambulance or 45 minutes by helicopter.

According to a law enforcement document that listed the attire of students, Xavier was wearing a black shirt, blue jeans, and black-and-white shoes. The police body-camera footage reveals that the boy Aviles was attending to was dressed in similar clothing, which matched Xavier’s description.

At 12:56 p.M., Aviles and other medical professionals commenced hurrying him out to the sandy area after placing the young boy on a gurney. They had received information that the injured individuals were being transported by air from an expanse of land situated on the western side of the educational institution.

There was no chopper.

Based on an analysis of flight data, satellite images, and photographs, as well as interviews conducted by Texas Rangers with air crew members, no individuals were observed being rescued from Rooms 111 and 112 at the school, despite the fact that a minimum of five medical helicopters were dispatched in response to the shooting.

It took 15 additional minutes for the first responders to reach the school. Although police in Uvalde could be heard on radio transmissions asking for medical helicopters after the gunman was killed, it was said that the scene was not safe to have medical helicopters for trauma care. The executive director of the regional agency coordinating medical care, Epley, mentioned this.

The spokespersons for both Lifeteam Evac Air and AirLIFE, which includes Air Methods, the helicopter ambulance companies, said they should rely on local medics to decide who should be airlifted in response to the shooting, and they declined to respond to detailed questions.

With every passing moment, the chances for the boy who seemed to be Xavier dwindled.

The autopsy report, which was shared with Xavier’s family, revealed that the boy had been shot five times. The wounds described in the report were consistent with the detailed information provided. Aviles felt a sense of dread when he touched the softness on the back of the child’s head, indicating a significant injury.

Aviles expressed, briefly stopping to inhale before conversing with investigators, “I was similar to, ‘Gentlemen, he’s…’ That deflated my enthusiasm.”

Matthew Neese, a state trooper, decided to drive to San Antonio to help with CPR after the medics were overwhelmed with the cardiac arrest that the boy had already gone into, but when the helicopter arrived, the first responders had to wait for 11 minutes.

According to experts, the chances of survival decrease significantly when a gunshot victim’s heart ceases to beat. A surgeon in an operating room may try to control internal bleeding, so it is crucial to promptly bring a patient in that state.

As per his family, medical professionals pronounced the child deceased shortly after 2 p.M. When the ambulance redirected to Medina Regional Hospital in Hondo, which is approximately 40 miles away from Uvalde. While a medical professional attempted to address the injuries of the boy, Neese administered CPR to Xavier for over 30 minutes. However, it is evident from state records that he did not possess an EMT or paramedic license in Texas.

A chopper arrived close to Robb Elementary at 1:15 p.M., Eight minutes after the ambulance left.

Hospital officials did not respond to the request for comment. Neese neither responded, and, as per the boy’s family, the trooper attended Xavier’s funeral later.

The CBP spokesperson said that the agency is currently investigating the role of its officers in the response, and that Aviles, a supervisor at U.S. Customs and Border Protection, declined to comment when reached on his cellphone.

Gazing through the buses obstructing the sight of the school, Abel Lopez, his father, looked intently for any indication of his son. Felicha Martinez, Xavier’s mother, stood outside the school anxiously awaiting updates, and she expressed a dreadful sense of foreboding. Suddenly, she lost consciousness and her body became completely relaxed.

What happened to Xavier and why he wasn’t transported to a hospital by helicopter are questions that they have learned about since then, but there are still some pieces and bits left to uncover.

“If the police had performed their duty, the medical professionals might have had an opportunity,” Lopez stated.

Martinez expressed, “I am overwhelmed with rage. I am unable to articulate the extent of my pain.”

“Never surrender.”

First responders began administering CPR to her and stopped within minutes. She was rapidly deteriorating. On the day of the shooting, emergency responders outside Robb Elementary frantically tried to keep Mireles alive on the sidewalk.

More emergency vehicles arrived at the educational establishment, but it wasn’t until 16 minutes after the breach in security that healthcare experts placed her inside an ambulance.

Ultimately, it is unclear why Mireles was not immediately put into one of these ambulances and moved off the ground. During the 10 minutes that elapsed while six ambulances arrived, Mireles was left on the ground. Chest compressions were performed on her and she was laid on the ground. There were two ambulances parked about 100 feet away. However, we need to look to the right and left. But we had to work on her here, as there were no ambulances available. In an interview with investigators, Patrol Border Medic said, “Hey guys, there are no ambulances.” Eva Mireles was carried out of her classroom in Room 112 by four police officers following her husband, who was being followed by a Border Patrol medic.

“Come on, madam, don’t surrender,” a voice can be heard uttering in a state trooper’s body-camera video.

By that time, the teacher’s likelihood of survival had decreased.

They administered fluids and intubated her. In an attempt to revive the teacher’s heart, they provided her with an automatic compression device and initiated a blood transfusion while en route in the ambulance. The medics utilized this technique.

Mireles never thought that medics could indicate the survival of chance, as some experts described it as a mistake. They decided not to take her to a hospital.

The initial medical responders continued performing cardiopulmonary resuscitation (CPR) inside the ambulance for around 40 minutes before the head healthcare expert from Uvalde EMS declared her deceased.

The ambulance that Mireles was in never departed from the school curb.

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