ORLANDO, Fla. — The Pulse shooting left 49 people dead, but dozens of people critically-wounded survived thanks to the quick actions of first responders.

The trauma surgeon on-call at Orlando Regional Medical Center recalls the quick decisions they had to make to treat so many critically-injured gunshot wound victims at once, and the mental toll that took on him and other members of his medical team.

Because ORMC is just down the street from Pulse, many of the patients were literally carried from Pulse to the hospital, some even in pickup trucks before more ambulances were available. 

“The Orlando Police Department has notified us we’re going to be getting 20-plus gunshot-wound patients that night, and I thought, 'OK, maybe there will be three or four,'” Chadwick Smith said.

But Smith soon realized they would have to treat dozens of critically-injured patients with gunshot wounds.

“I remember thinking that night I had two options – I could sit in the corner and cry or I could just start doing stuff,” said Smith.

It was his job to lead the entire emergency medical team as they had to make some quick and difficult decisions as patients continued to come in.

“When 35-40 people come in the door within about 35-40 minutes, even with all of the resources we have, we have to triage and treat the most life-threatening things first,” said Smith.

Smith says 35 out of the 44 patients they treated survived.  It would take months for their physical wounds to heal.  The mental scars would have to take longer. Smith also had a lot to process.

“There’s two avenues when you go through an event – the post-traumatic stress and post-traumatic growth,” said Smith.  “I hope – and I feel like – I’m on the post-traumatic growth end of things.  But it’s hard for everybody – it was hard for the entire team.”

He says after taking a few days off, it was hard to even return to the hospital.

“Walking back in the building – I did not want to be at work – but you know, you work through that, and you get stronger,” said Smith.

Smith says he and others who treated Pulse patients had group and individual counseling sessions with mental health counselors.  As their mental wounds began to heal, so did physical ones.  He kept in touch with the people he had a hand in saving.

“They would follow up with me in my office and with my partners for a while, and then when you don’t see them anymore that means they’re doing better, they’re going on with their lives, they don’t have any ongoing medical issues,” said Smith.

“They go on about their lives and they recover as well.”

And now five years later and after a lot of healing, Smith - who has seen a lot in the hospital – says those critical minutes after the Pulse shooting left him with a life-lesson he’ll never forget.

“They were just out to have a good time, and an act of terrorism brought upon this community affected their lives forever,” said Smith.

“And when you think about that, it just emphasizes the fragility and sanctity of human life.”

Smith says training was key when responding to the Pulse shooting.  He says Orlando Health takes part in regular community mass-casualty drills – one just three months before the Pulse shooting – and that really helped everyone as they had to react quickly to the unthinkable.