A terrified little girl with her hand pressed against the window of a school bus. Lines of children being evacuated across a parking lot. Police officers running into the shooter’s house. The glass doors to The Covenant School shattered by bullets. A sea of flowers and teddy bears laid as a memorial outside the gates. These are the images of the Nashville school shooting that people across the country saw.

What we didn’t see was the scene inside the pediatric ER at Vanderbilt University Medical Center — where 30 surgeons, nurses and other medical professionals had assembled and just stood there waiting, hoping against hope that children might arrive for them to save. But none came.

A child weeps while on a bus leaving The Covenant School, following a mass shooting at the school in Nashville, Tennessee, March 27, 2023. 

Nicole Hester/USA Today Network via Reuters

“It was a Monday like any other Monday, when we’re busy going between clinic and operating room and consults and so forth. Then all of a sudden, I look down to get six texts right in a row: ‘Hey we’re in the ER. There’s a mass casualty event,'” Dr. Jay Wellons, Vanderilt’s chief of pediatric neurosurgery, recalls. “Thirty seconds later, I got a phone call from the chief of staff and it was, ‘Jay, this is not a drill. This is real. There’s been a school shooting.'”

The team rapidly assembled in the emergency room, as they were trained to do. Dr. Wellons tells CBS News that they do drills to simulate precisely this sort of event. A pediatric trauma surgeon was there. A pediatric ER specialist. A pediatric neurosurgeon. An airway specialist. Scores of nurses. All waiting.

“We’re ready,” Wellons told CBS News. “We had heard that there were some fatalities, but maybe there were not. And we waited. And we waited. And we waited, until they said there’s nobody else coming because they all died.”

It’s a phenomenon that emergency room teams across the United States have experienced — and one that with the prevalence of school shootings, still more discover all too often.

“We had trained for this — for the ability to save children. You know, the desire that we had to be able to do something was really strong,” Wellons said. “That silence and sadness just pervaded the whole area. Everybody just kind of sagged and walked away.”

After the school shooting in Uvalde, Texas, less than a year ago, Wellons said he received countless emails from his colleagues in the American Society of Pediatric Neurosurgeons, expressing feelings of helplessness and frustration. They debated what could possibly be done. They lamented that if only the politicians could see what they see in the operating rooms when assault-style weapons are used on children, then perhaps that would be enough to finally inspire change. The unthinkable damage done to tiny bodies, in spaces like schools where they are supposed to be safe.

“A good friend of mine who’s the chief of pediatric neurosurgery at Connecticut Children’s talked about how he was there after Sandy Hook — and he was waiting and waiting and waiting. You know, that happened 10 years ago. Uvalde — waiting and waiting and waiting. And now, here we are [in Nashville] waiting and waiting and waiting. It’s clear that there’s not a lot that we can do in the trauma rooms, unless the people get to us so that we can help save them and do what we have been trained to do. The challenge is, with these really destructive weapons, we can’t do that work. Children die at the scene.”

The issue has to do with ballistics, Wellons explains. These are high capacity, high velocity and low recoil weapons. 

“What that means is you have a lot of bullets; they move very fast, which means they’re destructive; and there’s not a lot of kick to it. So, you can point a weapon at a target and put a lot of bullets into it quickly, and the bullets are destructive.”

Because the bullets are so high velocity, he explains, when they hit tissue, “they fragment and they tumble.” And any time a bullet goes into a body, the issue of “cavitation” occurs. 

“This cavity of air forms around [the bullet] and even the tumbling pieces or the fragmented pieces. And so the destruction is not just from the bullet itself — it’s from that body of air that’s moving around it. So you can imagine, where the bullet enters is one thing… the exit side is giant.” 

When that “exit side” is in a child’s chest or brain, there’s very little doctors can do to save them.

“These types of weapons are designed to kill,” Wellons said. “These are weapons that were obviously not meant to be used how they’re used against children. You know, children and teachers don’t have body armor.”