As the nation struggles to comprehend the horrors that unfolded Tuesday inside Robb Elementary School in Uvalde, Texas, one of the biggest unanswered questions is whether anyone could have been saved.
Authorities have left the public with more questions than answers about the mass shooting that left 21 dead, and their timeline has shifted multiple times. At least 17 children were hospitalized with injuries, though it’s unclear how many of those survived.
According to the latest update provided Friday by the Texas Department of Public Safety, more than an hour elapsed between the time the shooter entered the school at 11:33 a.m. and the time law enforcement officers breached a locked classroom and killed him at 12:50 p.m.
While officials have maintained that the vast majority of the shots were fired within the first few minutes, there is some evidence to indicate that some victims could have been alive and in need of medical aid while authorities waited outside for backup.
“In retrospect from where I’m sitting right now, clearly there was kids in the room. Clearly they were at risk,” Department of Public Safety Director Steven McCraw said during a news conference, adding: “There may be kids that are injured, that may have been shot but injured, and it’s important for lifesaving purposes to immediately get there and render aid.”
McCraw said the commander at the scene, Uvalde Consolidated Independent School District Police Chief Pete Arredondo, believed — wrongly — in the moment that officers had more time because the incident had transitioned from an active-shooter situation to one with a barricaded subject with “no kids at risk.”
“I’m not defending anything, but if you go back to the timeline, there was a barrage: Hundreds of rounds were pumped in in four minutes into those two classrooms,” he said. “Then any firing afterward was sporadic, and it was at the door. The belief is that there may not be anybody living anymore, and that the subject is now trying to keep law enforcement at bay, or entice them to come in.”
Yet according to the timeline provided by McCraw, a person called 911 from inside Room 112, one of the classrooms where the shooting occurred, at 12:16 p.m. and said there were “eight to nine students alive.”
Though it is not yet known whether those students were ultimately among the victims, the injured or the survivors, police and medical experts said that in most instances, the sooner a patient can get some form of medical attention, the better the chances at pulling through.
“You’ve got to stop the bleed of those children, and you’ve got to stop others from being shot,” former Houston Police Chief Art Acevedo told The Times after the news conference. “You have to go in immediately. The kids were calling 911 for help.”
Critically injured patients typically need to receive care within an hour or the risk of mortality significantly increases, Acevedo said, adding: “We used to call it the golden hour.”
Though it is a generalization, experts say time can make a critical difference in whether a person survives after a gunshot. Police believe this so much that after officers are shot, colleagues often don’t wait for an ambulance and use a patrol car to barrel to the emergency room.
According to Dr. Demetrios Demetriades, a professor of surgery and director of trauma at Los Angeles County-USC Medical Center, the mortality rate of a patient increases by about 10% for every 10 minutes of delayed bleeding control.
L.A. County-USC’s chief of trauma, Dr. Kenji Inaba, said similarly that “bleeding remains the No. 1 preventable cause of death after ballistic injury,” though he said he could not comment on the law enforcement tactics used in Uvalde or the medical care provided at the scene.
“After sustaining a ballistic injury, every second counts, and as soon as it is feasible to do so, victims should be triaged, have any obvious bleeding stopped, and then be transported to the nearest trauma center for definitive care,” he said.
Travis Norton, a leader of the California Assn. of Tactical Officers’ after-action review team who has studied numerous mass shootings, said it is a common mistake in these situations to think “when the shooting stops, we stop.”
“That is the problem with the term ‘active shooter.’ The shooter is still active if there are people in harm’s way,” Norton said.
He said similar patterns occurred during the 2018 Borderline shooting in Thousand Oaks and the supermarket shooting last year in Boulder, Colo., when on-scene commanders mistook a lack of shots to indicate it was a “barricade” situation. He said that by contrast, in the Pittsburgh synagogue shooting, officers did not stop when the gunman stopped firing.
Norton said those with gunshot wounds need immediate treatment “because they can bleed out quickly depending on the severity of their wounds. That’s why we have pushed tourniquets, chest seals and combat gauze to first-responder officers.”
“If you think back to Columbine, we did not have that equipment,” he said, referring to the 1999 school massacre in Colorado. “Now it is even being pushed to the citizen level. … Gunshot trauma kits are now being seen right next to [defibrillators] in some places.”
Some survivors have relayed harrowing stories from the scene. One fourth-grader who was inside the classroom told San Antonio TV station KENS that he, his best friend and three other students hid beneath a table with a tablecloth and were able to survive as his teachers and many of his classmates were killed.
Another student, 11-year-old Miah Cerillo, survived by smearing her friend’s blood on herself and playing dead, her aunt, Blanca Rivera, told NBC News. She was hospitalized with bullet fragments in her back, but has since been released, Rivera said.
Nine-year-old Kendall Olivarez was shot in her left shoulder and hit by bullet fragments in her right leg and tailbone, according to a GoFundMe page created on behalf of her family. “She will be needing several surgeries until she is completely healed,” the page says.
Dr. Marc Eckstein, professor of emergency medicine and chief of the EMS Division at USC, said, “The longer it takes to evacuate patients from the hot zone, the worse their outcome is going to be.”
“When you have a place like [Uvalde] where your nearest Level 1 trauma center, San Antonio, is 80 miles away, the responsibility of law enforcement is to simultaneously try to neutralize the shooter and evacuate the workers and the kids and teachers as quickly as possible,” Eckstein said. “That was a lesson learned in Columbine, and a lesson that wasn’t learned in the Pulse nightclub shooting [in Orlando, Fla.], where patients who were potentially viable bled to death.”
Still, Eckstein said, he didn’t want to give grieving families the sense that their loved ones might have survived had authorities responded differently, particularly since so much depends on the location and type of injury.
The AR-15-type of rifle used in the shooting causes “devastating injuries to the body,” Eckstein said, not because of the size of the rounds but because their high velocity generates immense kinetic energy.
“And then on top of that, you have children,” he said. “The fatality rate of a child getting hit by a round like this is going to be much higher than an adult, and it’s going to be higher than a typical round from a handgun.”
The mother of 8-year-old survivor Adam Pennington said Friday she was troubled by the new timeline released by law enforcement.
“When you’re on scene, you should listen to your gut,” said Laura Pennington, 33. “I think everybody was very afraid and confused, and that causes problems. But there should be a set protocol for all of these situations.”
Pennington, who is also a substitute teacher in the district, said her brother-in-law was among those who rushed to the school to help but were kept outside by law enforcement even as officers refused to enter.
“I understand that they’re afraid for their own lives, but these guys are in tactical gear. They could have swarmed the building from all angles,” she said. “He was terrorizing these children. They needed to do more.”
Pennington also said there were parents who ran in “and actually saved their kids,” and that one off-duty Border Patrol agent sped to the school with a friend armed with a shotgun to search rooms.
“If he could do that, why did they stand down?” she said of local police. “Imagine how many people he saved just by taking things into his own hands.”
Pennington said she was in touch with a woman whose niece was wounded in the attack and was still hospitalized Friday.
“There’s several more that are critical and I don’t know if they’ll live,” Pennington said, and began to cry. “I want to cry because they deserve better than that.”
Times staff writer Hennessy-Fisk reported from Texas, Winton and Smith from Los Angeles.