Florida

In the midst of madness: the Pulse nightclub paramedics

After all of the chaos, the wounded and their blood, the pleas for help, after the silence — finally — of the unyielding gunfire followed by a sea of sirens, they went home.

Orlando firefighter paramedics Carlos Tavarez and Joshua Granada, randomly thrust onto the front lines of the predawn aftermath, woke Sunday afternoon to news that the popular Saturday night party commandeered by a gunman had born even more carnage, 49 dead and 53 injured.

The crew of Station 5, medically supported that night by Tavarez and Granada, was close enough to hear the horror, the unmistakable gunfire cadence of a mass shooting. In the earliest hours of that Sunday, the 61-year-old sturdy, bricked exterior walls of Orlando’s second oldest fire station, about 300 feet from Pulse nightclub, would become a shelter for the wounded and terrorized — and a makeshift treatment area.

And Granada and Tavarez, swept in by timing and location and duty — they are usually based at Station 7 — would end up treating and transporting nearly one-third of the total 44 patients taken to Orlando Regional Medical Center over four trips. Had it not been for one guy’s early-morning stomach pains and his rescue truck ride to the emergency rooms a half-hour before the first shots, the two firefighter paramedics would not have been so close, blocks from where Omar Mateen, 29, exacted what is now the nation’s deadliest mass shooting by a single gunman.

“Our happy little firehouse will never be the same,” says Lt. Davis Odell Jr., who led the Station 5 crew through the crisis. “We have now become part of a national horror.”

Now, exactly three weeks later, after the surreal settled into real, after the dozens of vigils and memorials and funerals, the first responders are working to reconcile what they witnessed and experienced during their half-mile loop, from Station 5 to the scene to the hospital and back again, over three hours.

It was around 2 a.m. June 12 and Tavarez and Granada had just dropped off the patient with the stomach pains at the hospital’s emergency room. What they didn’t know was that the first Pulse patrons were running from bullets, frantically spilling out of the club blocks away. Granada was outside loading the stretcher back into the paramedic truck. Tavarez was inside filling out paperwork and talking with a police officer when his radio announced shots fired, not uncommon on a Saturday night. Tavarez rushed outside — and could actually hear the gunshots. Granada heard them, too, the pace and intensity reminding him of firecrackers.

They followed the police toward a scene enveloped in darkness, stopping just north of Station 5, a bricked building on Orange Avenue, in the south shadows of downtown. Built in 1955, it boasts large red bay doors next to a sign that reads “Forged In Fire.” As they got close, a parade of police vehicles whizzed by, heading south on Orange Avenue toward the club. They could see Station 5 firefighters dragging a wounded man up under the bay doors. He came to be known as Patient No. 1. And he would survive.

 
Lt. Davis O’Dell Jr. led the Station 5 crew through the crisis. PEDRO PORTAL / pportal@elnuevoherald.com

Running and screaming

It hadn’t been 45 minutes since Odell and the three-man crew had returned from Pulse to treat a patron who had drunk too much. They were on the 24-hour B-shift ending at 8 a.m., not Odell’s typical shift. He had replaced another supervisor, who was off duty for the birth of a grandchild.

“It seemed as if it was going to be a routine night at the club. It was beginning to fill up and the music was playing and the crowd was enjoying themselves on a Saturday night,” Odell said. “Little did we know . . . what was going to happen.”

The three other firefighters were settling in for the rest of the shift when Odell heard a report of a shooting involving multiple people.

He stepped outside. “I immediately see people running and screaming across the street. And as soon as I was able to recognize that these people were running, basically for their lives, I heard the gunfire. Very steady and methodical,” he said. “It was so loud, I didn’t know if he was chasing these people down the street or if he was right here in the intersection.”

Not more than two minutes later, Odell spotted an Orlando police officer guarding the firehouse, armed with an AR-15 — similar to the assault rifle that gunman Omar Mateen was using two doors down to spray bullets inside the packed club.

With police cover, Odell opened the bay door.

The first sight: a group of club patrons huddled behind one of the exterior brick walls. “They were panicked, extremely agitated, and some were hurt.”

The second sight: Patient No. 1 in the station driveway, shot twice in the abdomen. “We drug him into the station right next to the engine. . . . We had two others walk in who were the walking wounded.”

‘Don’t let me die’

Tavarez and Granada rushed into Station 5 to begin treating Patient No. 1. They found him bloodied and lying next to the engine.

“I saw that he was talking, that tells me his breathing and airways are open. I could see he was pale and really sweaty,” Tavarez said. “The first thing I do with any gunshot wound is cut their clothing so I can see where he was injured.”

He reached for the stickiest thing he could find to cover the wound so no air could get in or out. Turns out he’d grabbed defibrillator pads (they cut the wires off), something that would adhere to skin wet with sweat and blood. It wasn’t the first time he had used the pads for wounds.

“He just kept asking for help and saying, ‘Don’t let me die,’ ” Tavarez, 35, recalled.

As they transported Patient No. 1 to the Orlando Regional Medical Center, Tavarez began to think about the number of casualties they might be facing. He stuffed both pockets with supplies. IV needles. Tourniquets. Gloves. Quick-clot bandages. And more defibrillator pads for the worst wounds.

Granada had just made the right turn onto South Orange Avenue from the hospital when they got a call from the incident commander. Head directly to Einstein Bros. Bagels, directly across the street from Pulse. More victims had taken cover in the parking lot behind the building, some on foot, some dragged there by police and friends. Five first-responders from other units were rushing there, too. It would become the largest of the triage areas, with up to 35 patients treated there, more than half of all the wounded.

“I know that I am going to see a bunch of injuries. . . . I am thinking, do the greatest good for the greatest number of people,” Tavarez said. The lessons from disaster training flooded back, “then the thought comes to my mind, the hospital is right down the street, so if we can put as many people as possible in the truck, then we can just get them all there.”

 
49 American flags were placed outside of the City of Orlando Fire Station 5 as a tribute to the victims who died at nearby Pulse nightclub. PEDRO PORTAL / pportal@elnuevoherald.com

The two men had worked together for six years. Tavarez had taught Granada in paramedic school. They pulled into the parking lot and faced a battle zone. About 10 wounded, more coming, urgency clear. “If somebody gives you one patient at a time spread out, there is a lot you can do and take your time,” said Granada, 36. But when it’s mass casualties, “it’s whatever you can do in 30 seconds and get them to a trauma surgeon.”

In such disasters, first-responders and rescuers use a color-coded tagging system to quickly organize and sort victims by severity of injuries: black, red, yellow and green.

“The red tag were given to victims that had a chance of living if we could rush them to the hospital. Those people’s lives were saved. The black tags went to those who were dead,” said Bryan Davis, District Chief for Orlando’s Fire Department, who served as incident commander. “Our firefighters and paramedics had to make those very difficult determinations. It was very tough for them to have to assign that black tag.”

He said the several tagged — on the wrist or ankle — with the cardboard black tags were hidden from public view.

At the bagel shop, Granada pulled the truck into the back parking lot, about eight feet from the wounded. They could still hear the gunshots, but also screaming and crying.

The first two patients were the most critical, one with a head injury who was drifting in and out of consciousness. The other had a gunshot wound in the torso and was not breathing — a combination that forced Tavarez to puncture the patient’s chest simultaneously with two IV needles. Normally, he would have listened to the chest to determine which lung was collapsed. But there was no time. He assumed both were down. Granada explains:

“When you have a penetrating injury to your torso and you are not breathing, we assume whatever hole is leaking air into your chest cavity. If you have air going in there, it crushes your lung and you can’t breathe. So you have to do something to release the air. A trauma surgeon will put a tube in the side of your chest,” he said. “The best thing we can do is stick the biggest IVs we have right in your chest and it releases air.”

They carried those two patients to the hospital, then returned for trip three — but not before helping doctors in the Emergency Room intubate and medicate other Pulse victims. For that third trip, they turned the truck into a mobile clinic of sorts, bandaging and making splints for another five patients before transporting them to the hospital.

All before 3 a.m.

Two hours later, a SWAT team smashed a hole into the club’s exterior wall, followed by a gun battle in which Mateen was finally killed. Tavarez and Granada treated and transported five of the people — three had to be carried to the truck — who had been trapped inside the club.

The pair returned to Station 7, about three miles and a world away from the scene. They spent the next two hours scrubbing the layers and layers of Sunday morning rescues from their truck.

 
Mourners leave flowers, balloons and signs outside Pulse nightclub in Orlando. PEDRO PORTAL / pportal@elnuevoherald.com

Stress management

By the numbers, the Orlando Fire Department deployed a total of 80 Fire/EMS employees; transported 19 patients to Orlando Regional Medical Center; and 34 units were on the scene, including the rescue truck manned by Tavarez and Granada. Odell, proud of his department’s response, points to its top Insurance Services Office national No. 1 ranking, based on training, equipment and preparedness. Only 177 other departments in the nation hold the ranking.

After the shooting, those who responded attended a mandatory critical incident stress management session, a way for them to process the trauma and express their feelings. They also received help from members of other fire departments who had personally experienced similar tragedies, including the Sept. 11 attacks and the Boston Marathon terror attacks.

For the first couple of days, Tavarez and Granada would talk only to each other, the other being the only person who knew what they were feeling. Tavarez is haunted mostly by sounds of gunfire and angry that one man’s choice robbed Pulse victims of their own choices. Granada’s memory of the night are in flashes, like Polaroids.

“It’s the first thing you think of when you wake up and the last thing you think of when you go to sleep,” Granada said. “You think about it all day.”

The day before the shooting, Odell had promised his children, ages 7 and 8, they would go for a bicycle ride when he got off work.

“After it was all over, I had a cup of coffee and then I drove home. I went from what happened there to being daddy again,” he said. “That was the best bike ride ever.”

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