Building resilience in the wake of Sutherland Springs – How will we survive another mass casualty event?

17 Dec 2017
By Lillian Liao, MD, MPH

For years now, our regional trauma system has performed scheduled drills of potential mass casualty events: an airplane crash, a stadium event, a nightclub shooting, etc. Our team is prepared to care for the injured patients “if” it ever hit us. Then came the dreaded text message on a beautiful Sunday morning: “Mass casualty incident – Sutherland Springs. Not a drill. More to come.” By Divine intervention or organized chaos, our trauma program had a meeting there that morning. In additional to the usual team of two trauma surgeons and the complement of residents, we had an additional five trauma surgeons in the building. Our most senior surgeon took the role of the triage officer. The teams of people required to care for the injured patients gathered like sections of a symphony orchestra. By the time the first patient came, everyone [the ER to the OR to the Adult and Pediatric Intensive Care Unit] was ready for what was to come.

Trauma clinical staff anticipating the arrival of patients.

A strong regional trauma system and a dedicated trauma program had prepared us to care for the injured patients. What it had not prepared us for is the sadness; the anger; and the helplessness felt when people die or become injured senselessly. These emotions are difficult to overcome. The nationwide outpouring of support from other healthcare providers certainly helped. Miami, Las Vegas, and Aurora all sent words of encouragement. How sad is it that we now belong to this sacred league of health care providers? However, surgeons are doers; we do not sit around and feel sorry for our plight. We find solutions! Moreover, we can recover from this tragedy by leaning on the resilience we have built up through years of surgical training to overcome all things difficult and seemingly impossible.

There are three major lessons I took away from the horrible tragedy. First, a strong trauma system is key to saving lives. Triage and transport of critically injured patients to the highest level of care is paramount, as there is really “no time to bleed!” Second, tourniquets save lives. When I look at the survivors and focus on the adults and children who came in with tourniquets in place, tourniquets saved their lives and limb! This should re-energize our commitment for regional STOP THE BLEED efforts. We must work to convert every bystander into a first responder. We must get our community leaders involved and help them to see that tourniquets and bleeding control supplies must be available in all public spaces because if this could happen in a church, it really can happen in just about anywhere. Lastly, we must also not shy away from dialogue about firearm availability and firearm safety. Our nation must build a consensus on how the need for freedom and liberty can coexist with the imminent need to reduce firearm related injuries. A good starting point is the ACS bulletin put forth by Dr. Deborah Kuhls and the Committee on Trauma Injury Prevention Team.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email


Dr. Liao completed her undergraduate training in Economics with Honors from the University of Texas Austin where she was a member of the Dean’s Scholars Program. Dr. Liao completed her medical training at the University of Texas Health Sciences Center in San Antonio in 2004 and her surgical residency in 2010. She pursued additional fellowship training in Trauma and Critical care and joined the Trauma Faculty at the Health Sciences Center in 2011. Dr. Liao is board certified in General Surgery and Surgical Critical Care. Her primary clinical and research interests are in vascular trauma, pediatric trauma and burn, and injury prevention/patient education. She is currently the Pediatric Trauma and Burn Director at University Hospital’s Level I Pediatric Trauma center. Follow Dr. Liao on Twitter.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.


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