Amber Egyud was already on duty at Forbes Regional Hospital in Monroeville when she got the call at around 7:15 a.m.
"My [emergency room] manager called and said 'We just heard over the radio there's a possible incident' " at Franklin Regional High School, said Ms. Egyud, the hospital's chief nursing officer.
Just up the road at UPMC East, Laura Gailey Moul, vice president of operations, was in a hallway when she fielded a similar call from the emergency department, which had heard from paramedics that stabbings had occurred at the high school. "We didn't know the extent," she said.
Trauma center officials provide update on stabbing victims
Trauma center officials talk about some of the victims being treated at Forbes Regional Hospital. Some remain in critical condition. (Video by Larry Roberts; 4/9/2014)
At both hospitals, the first word of a possible mass-casualty incident touched off a well-rehearsed response that involved quick notification and mobilization of a wide variety of personnel, including surgeons, nurses and support staff.
Both set up emergency command posts to bring together representatives of the various departments that would have a role in treatment of the victims, and to send out alerts to those who needed to be called in.
Ms. Egyud said each department reported on its capabilities -- how many operating rooms were staffed and ready, how many beds were available in the intensive care unit, and the supplies and medicine that were on hand.
At UPMC East, two surgeons went to the emergency department, joining three doctors already on duty there, and additional nursing staff was called in, said Tamra Minton, chief nursing officer.
Mark Rubino, chief medical officer at Forbes, was preparing to see a patient in an office building on the hospital campus when his pager went off.
"I immediately went to the emergency department. By the time I arrived, the teams were all in place. No [victims] had come yet, but the teams were all in place," he said.
Four trauma surgeons were in the hospital and other doctors hurried to assist them, Dr. Rubino said.
"We had cardiovascular surgeons, thoracic surgeons, urologists -- they were all there ready to assist," he said. "I looked up at one time and I think I saw 20 surgeons in that emergency room ready to respond to these injuries.
"We were ready to handle what came in the door."
Emergency medical officials said 24 people were taken to six area hospitals after the stabbings. Twenty-two people, including an adult security guard, were stabbed. Two students were injured in the aftermath.
When the UPMC command center sent the first notification to staffers, they were told to prepare for as many as 20 patients. "That's good, because you want to prepare for the worst-case scenario," Ms. Minton said.
The time of the incident also proved fortuitous, coming just after the 7 a.m. shift change, enabling the hospital to hold over staffers from the night shift, she said.
At UPMC Presbyterian, staff postponed several scheduled surgeries to make sure it was able to treat victims.
"We have drills to deal with massive casualty incidents like this," said Louis Alarcon, medical director of trauma surgery. "We're lucky it happened before 8 a.m., when we had a whole complement of surgeons ready to go."
Dr. Alarcon described the wounds of one of the more seriously injured teens and the challenges the surgical team faced in treating them as the clock ticked down.
He said the knife went through the 17-year-old boy's liver, nicked his heart and punctured a hole in the diaphragm, causing a massive amount of blood to collect in his chest and abdomen.
He said blood pressure begins dropping with the loss of 30 percent of blood volume. Death occurs at 50 percent. The boy had lost about 40 percent of his blood upon arrival to the trauma center and underwent surgery within five minutes, Dr. Alarcon said.
The team used blood products and various techniques to stop the hemorrhaging, along with blood transfusions. Fortunately, neither the aorta (the main artery from the heart to the lower body and legs) nor the inferior vena cava (the major vein returning oxygen-depleted blood to the heart) was severed. But smaller blood vessels near the heart and in the abdomen, and leading to and from those major blood vessels, were severed, resulting in serious bleeding.
During the two-hour surgery, the boy would lose his entire blood supply but it was replenished with transfusions, Dr. Alarcon said. The boy was in stable but critical condition Wednesday night.
"The bleeding seems to have stopped," Dr. Alarcon said, adding that further surgery will be necessary to repair internal damage.
In addition to caring for victims, hospitals mobilized to receive and care for parents, who began to arrive not long after the ambulances.
"The atmosphere was one of clinical skill and empathy toward this situation that has touched the community," Ms. Egyud said.
Dr. Rubino said paramedics also played a vital role, calling their work in the initial treatment of victims "unbelievable."
Christoph Kaufmann, the chief trauma surgeon at Forbes, said the three most seriously wounded victims treated there would not have survived had they not received immediate treatment. The doctor said the wounds were "impressively large holes" and were multiple inches deep.
"Our staff, our pre-hospital partners, all of the response to this incident and the true collaboration of everybody on this campus is what made the difference," said Ms. Egyud.
"It was the response that we would expect and what we prepare for during drills throughout the year. We prepare for such events that we hope never happen. Our preparation served us well today."
Jon Schmitz: firstname.lastname@example.org or 412-263-1868. Torsten Ove, Andrew McGill and David Templeton contributed.