EL PASO, Texas - Dr. Stephen Flaherty, Del Sol Medical Center's trauma medical director, says last Saturday morning started like any other even on the quieter side.
That began to quickly change shortly after he received the first text alert sent to medical staff.
"The first notification that we got said there's an active shooter," Dr. Flaherty said.
But that didn't prompt immediate action. Dr. Flaherty said details were so limited and the hospital gets numerous alerts.
"Our alerting system lets us know about lots of things around the city. If SWAT responds to a site somewhere we get a notification, a bomb threat. We get a lot of notifications that don't translate into any activity."
About 20 minutes later a second alert was issued saying there are casualties. But beyond that details remained limited.
"We sort of took an internal inventory of what was going on," Dr. Flaherty said. "First thing we did was stop more cases going into the operating room, so if we need the operating room it would be available."
Dr. Flaherty says 'pretty shortly' after that alert a third one was issued.
"Five patients with gunshot wounds to the abdomen were coming to Del Sol Medical Center."
Dr. Flaherty says that was the moment it became very real. He sent a text to Del Sol's CEO David Shimp that read, 'This is the real deal.'
From that moment Dr. Flaherty could sense a change in the vibe at the hospital.
"Stressful nervousness," Dr. Flaherty recalled. "Because you don't know anymore. We don't really know what it's going to be like. Many of these people, many of the other staff here at the hospital, have not experienced an event like this before."
Sensing those nerves Dr. Flaherty called for a team huddle in the emergency room. He shared a very direct message with the staff.
"[I told them] you're well-trained. You know what to do. We've trained for this before. We've exercised for this."
But even Dr. Flaherty, who admits it takes a lot to surprise him given his 22 years serving in the U.S. Army and in two wars, was surprised by something when he saw the first patient arrive.
"It wasn't a gunshot wound to the abdomen. It was an extremity injury. When I looked at the magnitude of the injury that had happened to that person's extremity, I thought to myself this is much more reminiscent of something I saw in Iraq and Afghanistan than the typical gunshot wound I see in the cities of the United States."
Some of those injuries ended up being so severe, two of the 11 patients transported to Del Sol Medical Center later died.
As of Thursday evening, six patients remain hospitalized in the wake of Saturday's mass shooting. Three are now considered to be in 'good condition,' two patients are stable and one remains in critical condition.