“It was around noontime when all of our pages went off and we were notified that a mass shooting had occurred in Sutherland Springs, Texas,” recalls Dr. Lillian Liao, a pediatric trauma surgeon and medical director at University Hospital in San Antonio.
Moments earlier, 26-year-old gunman Devin Patrick Kelly opened fire on a packed Sunday church service using a semi-automatic rifle. Twenty-six people were killed, and 20 others were injured. “Usually in these types of situations, most people don’t survive the shooting. They’re dead on scene,” says Dr. Liao. “We had no idea how many victims would come through.”
In this third episode of “Unfiltered,” a new weekly Yahoo News interview series documenting the real, unflinching and unapologetic voices of America, we learn what it’s like for trauma surgeons to treat victims of assault rifle mass shootings.
That day, a total of nine victims, four of whom were children, were admitted to the University Hospital from Sutherland Springs where Dr. Liao and Dr. Ronald M. Stewart, the chair of the department of surgery at UT Health San Antonio, treated victims. The trauma team discerned that most of the injuries were located in or near the pelvis because the patients were sitting when the shooting occurred. “People who actually were hit any higher up were the ones that didn’t survive,” notes Dr. Liao, “because of the potential for hitting organs that bled more quickly.”
RELATED: The deadliest mass shootings in the US since 1990
The deadliest mass shootings in the US since 1900
The deadliest mass shootings in the US since 1900
On October 1, 2017 in Las Vegas, Nevada, gunman Stephen Paddock opened fire on concertgoers below from the windows of his suite at the Mandalay Bay Resort and Casino.
As of October 3, at least 59 people are dead and over 500 injured in what became the deadliest mass shooting in United States history.
(Photo by David Becker/Getty Images)
Five Dallas police officers were shot and killed by Micah Xavier Johnson, 25, as they guarded a group of protesters on July 7, 2016.
(Photo via REUTERS/Carlo Allegri)
On June 12, 2016, Omar Mateen opened fire inside Pulse Nightclub, a well-known LGBT club in Orlando, Florida, killing 49 people and injuring 58.
REUTERS/Carlo Allegri/File Photo
Chris Harper-Mercer, 26, opened fire on the Umpqua Community College campus in Roseburg, Oregon, killing nine people and wounding nine others before he was shot dead by police on October 1, 2015.
(Photo by Scott Olson/Getty Images)
White supremacist Dylann Roof, 21, opened fire at Emanuel African Methodist Episcopal Church in Charleston, South Carolina, during a bible study, leaving nine churchgoers dead on June 18, 2015.
Rival motorcycle gangs killed nine at a restaurant in Waco, Texas, on May 18, 2015. More than 190 people are arrested.
(REUTERS/Waco Police Department/Handout)
Fourteen people were killed and 22 were wounded when married couple Syed Rizwan Farook and Tashfeen Malik attacked a service center for people with developmental disabilities during its holiday party in San Bernadino, California, on Dec. 2, 2015.
(Photo by Barbara Davidson/The Los Angeles Times via Getty Images)
A college student killed six people, three in his apartment and others on the streets of Isla Vista, California, on May 23, 2014. The mentally ill gunman committed suicide.
(Photo by Irfan Khan/Los Angeles Times via Getty Images)
A former Navy reservist working as a government contractor killed 12 people at the Washington Navy Yard on Sept. 16, 2013. He was shot dead by police.
(Photo by Mark Wilson/Getty Images)
On December 14, 2012, Adam Lanza attacked Sandy Hook Elementary School in Newtown, Connecticut, killing 20 children and six school staff members.
(Photo by James Keivom/NY Daily News via Getty Images)
A masked gunman killed 12 people and wounded 70 when he opened fire on July 20, 2012, at a midnight premiere of the Batman film "The Dark Knight Rises" in Aurora, Denver.
A white supremacist opened fire in the Sikh Temple of Wisconsin in Oak Creek, Wisconsin, on August 6, 2012, killing six people.
Then-U.S. Rep. Gabrielle Giffords (D-AZ) was the target of an assassination attempt by a gunman in Tucson, Arizona, on Jan. 8, 2011. More than a dozen other people were injured and six people were killed at a public event entitled 'Congress on Your Corner' when a gunman opened fire.
(Photo by James Palka/Getty Images)
U.S. Army Major Nidal Malik Hasan, an army psychiatrist, killed 13 people and wounded 30 in a shooting at Fort Hood military base on November 5, 2009.
(Photo by Joe Raedle/Getty Images)
On April 3, 2009, 41-year-old Jiverly Antares Wong killed 13 people inside an immigration center in Binghamton, New York.
(Photo by Spencer Platt/Getty Images)
On April 16, 2007, gunman Seung-Hui Cho killed 32 people on the campus of Virginia Tech in Blacksburg, Virginia.
(Photo by Ted Richardson/Raleigh News & Observer/MCT via Getty Images)
A gunman killed five girls in a one-room Amish schoolhouse October 2, 2006, in Nickel Mines, Pennsylvania. The man entered the school, let the boys go free, tied up the girls and shot them execution-style before killing himself.
(Photo by William Thomas Cain/Getty Images)
Two men, John Allen Muhammad, 41, and Lee Boyd Malvo, 17, ambushed 13 people, killing 10 of them, in sniper-style shootings that terrorized the Washington D.C. area for three weeks in October 2002. Muhammad was executed and Malvo was sentenced to life in prison.
(Photo credit should read LUKE FRAZZA/AFP/Getty Images)
The Columbine High School massacre was perpetrated by students Eric Harris and Dylan Klebold who killed 12 fellow students and one teacher on April 20, 1999.
(Photo via REUTERS/Gary Caskey GCC/HB)
George Hennard killed 23 people and injured 27 others when he attacked Luby's Cafeteria in Killeen, Texas, on October 16, 1991.
(Photo by Gaylon Wampler/The LIFE Images Collection/Getty Images)
James Huberty, pictured here, shot and killed 21 people and hurt 19 others at a McDonald's restaurant in San Ysidro, California, on July 18, 1984.
(Photo via Getty Images)
Student Charles Whitman climbed to the top of the clock tower at the University of Texas where he shot and killed 13 people after killing his mother and wife on August 1, 1966.
(Photo via Getty Images)
The Ludlow massacre took place when members of the Colorado National Guard as well as other militiamen shot down 19 striking coal miners in 1914.
(Photo via the Denver Post via Getty Images)
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For Dr. Liao, the bodily damage caused by the high velocity weapon compared to those by a handgun were worlds apart. “Different firearms cause different types of injury when they hit the body. What we see here in this country are really wounds from a handgun, and those create a small hole. An assault rifle type injury, the speed of the bullet creates the ability to penetrate the body and destroy tissue in a way that a handgun cannot.”
According to the Bureau of Alcohol, Tobacco, Firearms and Explosives, the manufacturing of rifles has more than doubled in the past decade, with more than 4.7 million made and distributed in 2016. From the shooting at Marjory Stoneman Douglas High School in Parkland, Fla., to the massacre at Sandy Hook elementary school, AR-15-style rifles have been used in many of the recent mass shootings. The high-speed bullets they project turn sideways upon impact, causing drastic bone and tissue damage very similar to what is seen in military combat zones.
“If it hits a person in their abdomen,” Dr. Liao continues, “it could take out all of their intestines, the blood vessels in your kidney, and bones. And those people who survive these types of injuries have areas of tissue missing that we can’t replace.”
“What you see in video games or television shows don’t really give you the sense of magnitude of tissue destruction. Things are so broken that you don’t recognize the body parts that they’re supposed to look like.”
In the past, Dr. Liao had always wondered if the one thing she’s missing in her trauma training is being deployed to a war zone. Now she finds that is no longer the case: “Sadly, I don’t have to be deployed to see these devastating high-velocity firearm injuries. That’s really tragic because America, it is thought of as the dreamland. The things that we’re seeing, the epidemic of mass shooting, shouldn’t happen in this country.”
Dr. Liao believes one solution lies with bystanders. “After Sandy Hook, the American College of Surgeons and government agencies went back and looked at the children who died and the adults that died and how they died, and found that if a bystander could have slowed down or stopped the bleeding at the scene, some of those lives might have been saved.” This led to the development of the Stop the Bleed initiative, which focuses on training civilians to stem the bleeding of gunshot victims.
When the victims from the Sutherland Springs shooting were brought into the hospital, she observed that many of them had tourniquets fastened on their arms and legs to stop the bleeding. “That saved their lives,” she says.
“It’s important to develop a national trauma system where every region of the country could potentially be prepared for a devastating event such as Sandy Hook, Sutherland Springs, Las Vegas, because it will happen again: It’s just a matter of when.”