Riding the carousel at the Columbia Mall is one of our special “Dad things” that my kids like to do when my wife, who's also an Emergency Medicine physician, is at work. Saturday January 25^th was to be no different. The plan seemed simple: as we've done countless times before, we would head over to the mall, let the kids ride the carousel and have some lunch in the food court. We were getting ready to head to the mall when I received a message on my phone. It was an emergency alert sent to the tactical team: “ACTIVE SHOOTER ACTIVE SHOOTER COLUMBIA MALL.” I must have read this message at least 10 times. My initial thought was “that's odd, I don't recall hearing about a training exercise today; this can't be real.” Suddenly, another message… “ACTIVE SHOOTER CONFIRMED ACTIVE SHOOTER COLUMBIA MALL.” I quietly told my wife what was going on, kissed her and the kids, told them I loved them and was on my way.

While responding to the mall, I monitored radio traffic from both the police and fire/rescue, received phone calls from neighboring jurisdiction's tactical medics who were ready to help, and reviewed in my mind what my first actions would be once I was on scene. The situation was very much still evolving. A County Police rapid entry team had made its way into the mall and located the victims as well as an individual matching the description of the suspect. All were determined to be already deceased. Reports were coming in of large numbers of people evacuating, some with injuries. The mall was in lockdown. People were sheltering-in-place inside stores and restaurants.

Upon arriving on scene, before I could even get out of my vehicle, I was met by a gentleman who was doing his best to maintain composure. He wanted me to know that his wife and kids had locked themselves in a bathroom near the food court. With a look of desperation he asked what I was going to do about it. I hadn't prepared myself for this situation or how to handle it. As a husband and father, I couldn't imagine what he must have been experiencing. I wanted to tell him that they'll be fine, but I simply didn't know that. I asked if they were injured, he said no. I told him not to call them to their cell phone but to communicate via text if needed. I instructed him to wait in his vehicle and that we'd be getting people out as soon as possible. I never saw him again.

I made my way to one of the Emergency Medical Services (EMS) supervisors who was coordinating a casualty collection point outside the mall. He and his team were ready to receive patients. We agreed that we should notify the county's only hospital of a possible surge of patients. I then made my way to the main command post where I found the tactical team commander. He advised me that the first SWAT elements were already inside with one of our team's tactical medics and I'd be going in with the second group. I quickly donned my tactical gear and our team headed in.

Entering the mall was one of the eeriest experiences of my life. Even though we had recently trained at the mall for nearly this very scenario, when we did it was the middle of the night in a previously-vacated mall. This time was different. We entered a ghost town. Everything was on, music was playing. The aromatic smell of freshly-prepared fast food emanated from the food court. Personal belongings were scattered throughout: abandoned strollers, baby bottles and shopping bags.

We quickly met up with the other half of our tactical team inside. My fellow tactical medic and I confirmed our medical plan for inside the structure and got to work. We realized we were the first medical personnel inside the mall, and I confirmed the status of those who were initially triaged as deceased. I want the families of those who died to know that if there was anything I could have done medically, I was prepared to, but their injuries were too severe.

Medical efforts then shifted to supporting members of the tactical teams and being ready to initiate care for any additional victims. The tactical units began the meticulous process of securing the structure by checking each store for additional threats and evacuating those who sheltering in place. Along the way I treated anyone I encountered as needed, from a SWAT officer who cut his hand on broken glass, to an evacuating civilian female with syncope.

By now, there were more than 85 tactical personnel, including several tactical medics, working inside the over one million square foot facility. I transitioned my role and began to set up resources for incident rehabilitation of the tactical personnel. An already secured area of the mall was selected and food, water and medical treatment were set up. All the while, operational and medical readiness was maintained to receive seriously-ill or injured victims so they could be handed off to EMS. Upon completion of the tactical team's sweeps of the mall, efforts then turned to supporting the on-scene investigation.

Nearly 12 hours later, I returned home with a sense of exhaustion that I'd felt only once or twice in my life. It was one of the hardest days that any of us have experienced. Our training, planning and readiness had proven invaluable. Moving forward, we know there's more work to be done—lessons learned to be identified, after action reports to be written, debriefings to be had and committees to meet. We accept this challenge and promise the victim's families that we will continue to prepare, to exercise our response, to educate our community and to be ready…that's my promise to them. They will not be forgotten.