This was no drill, Dr. Chadwick Smith realized, and he reached out for help.
As Dr. Michael Cheatham answered the call shortly after the first shots were fired early Sunday and headed to Orlando Regional Medical Center, driving his normal route, he came upon the "sea of blue lights" around the Pulse nightclub. Police had to tell him a back way to reach the hospital, which sits about three blocks away.
"I knew we were in serious trouble," Cheatham said.
Three of the trauma surgeons who worked as the horror of America's largest shooting massacre unfolded talked to CNN on Monday. Together they recounted an experience unlike any they had experienced before.
On a busy night, this trauma center might see six gunshot wounds. But in the early hours of Sunday, 44 victims were brought to the hospital. They arrived in a span of less than two hours.
Those with head injuries could not be saved. They could only be made comfortable. Instead, the emergency room teams of physicians and nurses turned to patients where bullets had torn through chests, abdomens and extremities.
The usual capacity of three running operating rooms doubled. Staff from adjacent medical centers rushed in to offer a hand. It became a team effort with players pitching in from all sides.
EMS workers were tapped to put in IVs and rotate patients to help check wounds. Cleaning personnel hustled to get slots ready for new patients. Stocking personnel made sure supplies, including chest tubes, were at the ready. All the residents at this teaching hospital hurried through the doors.
"The entire team came together," said Cheatham. "Everyone knew that they had to bring their 'A' game."
Bullets fired from the shooter's military-grade AR-15 meant a greater severity of injuries, Cheatham explained. He said he respects the right to own guns, but he can't comprehend why anyone would need an assault rifle. Each time another mass shooting happens, he counts himself among those who ask, "When is it going to stop?"
Because of the extensive injuries of the nightclub victims, the blood bank kept in constant communication. One patient with a shattered pelvis, who required four surgeries to stop his bleeding, needed 15 coolers, or 90 units, of blood.
Amid the chaos, there even came a rumor: An active shooter had entered the emergency department. Staffers barricaded the two doors to their trauma bay with X-ray machines and continued operating.
Some of the patients who were awake grew frightened and confused. Several even asked if they were going to die. They wanted to know about the whereabouts of friends and people they loved. Then there were the families and friends that filled the waiting rooms, desperate for information.
"You just have to be human ...and be as compassionate as you can," Dr. Joseph Ibrahim said. "Fortunately, we've been able to give a lot of good news."
Other than the nine victims who died almost immediately, and were inoperable from the start, nobody else shot at Pulse has succumbed to their injuries at this Orlando hospital. In fact, Ibrahim shared that they are now moving patients out of ICU, decreasing medications and no longer giving anybody "massive amounts of blood."
There's an optimism to these surgeons, even if they haven't fully absorbed what they've been through.
"It will hit us a little bit later this week, I suspect," Cheatham said.
He said the three of them rely on their families and faith. And if that's not enough, Smith said, human resources at the hospital is offering up counseling. Every two hours in a conference room, there are sessions inviting people to talk to one another. And one-on-one meetings with counselors are available to those who need more.
But that business isn't top of mind for them right now.
"You don't have time to slow down," Ibrahim said. "We're so focused on making sure the patients are getting what they're needing, and we'll deal with the rest later."