One evening a local law enforcement officer emerged through the ambulance bay doors frantically asking if he had made it yet. At this point, my ED team and I were unaware of the situation she had brought to our attention. Minutes later, we received a heads-up from EMS dispatch that an injured deputy was headed our way. Both city and county officers were running emergency traffic along the main interstate to deliver him as quickly as possible to our facility. I knew that if EMS and law enforcement were working together to ensure his arrival, the situation would be a difficult one. I quickly inform my trauma core nurse (TCN), a small group of nurses, and technicians and meet with security to get up to date on details. We knew he was wounded when answering a domestic call, and his partners were the first individuals on scene to help pull him from further danger. 

Before we knew it, multiple squad cars came in from the ambulance bay doors with the EMS truck on their tail. The EMS back doors open, and our injured deputy arrives. They lead the stretcher through the doors and into our trauma bay where the team is ready and waiting. Our TCN nurse is the first to contact the patient while the assisting nurses and technicians help initiate care for the deputy. The short report from EMS and initial assessment of the situation made it clear the deputy was in critical condition. 

Rachel, our chaplain, was on call that night and came to provide support. Between myself, the security team, and Rachel it was our job to provide support and order to such an overwhelming situation. Many officers and deputies were standing on the other end of the curtain anxiously awaiting any updates to their fellow deputy. It felt as if there were no words of comfort to provide for such a heartbreaking case. In addition, we knew that the family had been notified and would soon arrive. Rachel took it upon herself and waited for their arrival to anticipate helping meet their needs in any way. 

As more officers and deputies began pouring through the ambulance bay in support, many more began to arrive through all other entrances to the hospital. Due to a smaller security team at night, Sargent Potts and I decided to offer a closed area of the ED for officers and deputies to await updates. This would allow our care team to work diligently and transition smoothly to have the needed scans completed. 

The security team and I helped direct officers and deputies to the closed ED area. In addition, we made the ED technicians in the lobby aware of the waiting area for further incoming officers and deputies. While the security team was helping bring everyone to a central location, I did my best to provide drinks, tissues, and necessities to those waiting in support. However, as more officers and deputies arrived, the ED's initial closed area became quickly full. With Rachel's help, we decided to direct all officers and deputies to the much larger surgical waiting area on a different floor of the hospital. This way they could all convene comfortably, and the ED flow of care could continue for all our other patients. 

At this point, our TCN was nearly finished with the initial scans for the patient. He suggested we move to one of the rooms in the trauma bay with a closed door. This would ensure privacy for the arrival of his family. Simultaneously, Rachel was meeting with family who had just arrived and helped place them in our designated family waiting room just on the outskirts of the lobby. The team leader nurse from the Trauma Surgical Intensive Care Unit (TSICU) came down to assess the situation and determine needs for their floor. That night Ada, the TSICU team leader, informed me her ICU was completely full. At that time, we did not know what his plan of care would be but made a point to stay in touch when a decision was made. The room in the trauma bay was quickly prepared. The nursing team and respiratory therapy smoothly transitioned into this room where care could continue. 

The initial reports returned and provided a poor prognosis. The neurosurgery team was consulted to assess the deputy and provided a similar prognosis. We were all waiting for the trauma team to update the family in the family waiting room and determine a further plan of care. The team took their time to explain the situation and provide all available options so the family could make an informed decision. Rachel made herself readily available when the doctors delivered this news. Ultimately, we knew that the family, fellow officers, and deputies needed more time and space to visit with him. During the interim, the nursing team worked to clean up the trauma bay room and provide space for the family to visit him. 

Seeing the devastation in his family's eyes when they first arrived at the deputy's bedside was gut wrenching. Rachel stepped in to provide any support needed. And for the first time that night, the nursing team was able to step away from the bedside to provide privacy for the family. In these moments, we all took a breath and realized how emotionally difficult this case was for us. In such a fast-paced ED, we rarely have time to process how deeply these moments affect us. We leaned on each other that night and silently provided support for a case that hit much too close to home for many of the nursing team involved. 

Knowing there were no available TSICU beds, I quickly called Ada to see what we could do. She informed me she would make some calls to perform a lateral transition of care for one of her patients to another ICU so space could be provided for the deputy. While we waited for this room to become available, security was diligently working to direct further arriving officers and deputies to the designated waiting area upstairs. Sargent Potts stationed as many of his security team as he could spare at various locations along the way to help ensure this smooth transition. Rachel and I acted as the liaison between the family at bedside and extended family in the lobby to keep them informed and take care of any details involving the deputy. 

Throughout the remainder of the night, I continued to ensure that family and supporting law enforcement had drinks and other necessities in the waiting room upstairs. Many officers and deputies made their way through the hospital that night. Continued control and direction of the situation would not have been possible without the hard work and dedication of the security team. In addition, Rachel continued to make her support available within the TSICU for all these individuals arriving in support of the deputy and his family. 

Ultimately, the family made a decision to withdraw care. Local law enforcement arrived in support during a candlelight vigil that night outside the hospital. They stood by honorably as the healthcare team helped donate his organs and eventually sent the deputy to his final resting place. I found some closure as I stood by law enforcement in silent support, in honor and remembrance of the deputy who had lost his life. And I knew that in my heart, my team and everyone who helped contribute to his care did everything they could to care for him with the dignity he deserved until the very end. 

The memories and impact of this night will remain with my team and I forever. To see the impact he had on so many people in the community was something we could never forget. In the ED we have the privilege to work so closely with local law enforcement and first responders. I felt that the EMS crew who brought in the deputy deserved to be included in the recognition. This was an especially difficult call for them, and their efforts did not go unnoticed. It is a reminder that at the end of the day, we all work together to provide the best possible care for our patients. From the CT technicians to the x-ray techs and ancillary staff. Everyone did their part to provide high-quality, fast and purposeful care. The security team provided so much control and stability to what could have been a very chaotic situation. Their presence allowed us to focus on providing exceptional care for the deputy while they provided space and support for the numerous law enforcement offices and deputies present that night. Finally, our wonderful chaplain Rachel was an irreplaceable asset to the team. Her calming presence, positive attitude and quick thinking made all the difference that night. 

The care for the deputy was an unprecedented event for my ED team. We demonstrated the integrity, values, and mission of UT Medical Center. Our collaboration as one team that night allowed us to provide high quality and compassionate care for the deputy, his family, supporting law enforcement and the greater community.