The Lifesaving Impact of CRNAs During the Lewiston, Maine Shootings

It was the 36^th mass killing in the U.S. in 2023 and the worst mass shooting in Maine history. The lifesaving actions of Certified Registered Nurse Anesthetists (CRNAs) unfolding on that dark day in October were part of the glimmers of light and hope that would help start the journey of healing in the Lewiston community.

Tina Moring, MSNA, APRN, CRNA, chief CRNA, and Megan Carrier, MSNA, APRN, CRNA, nurse anesthesia clinical coordinator, both of Central Maine Medical Center, were among the staff whose training would save lives on that tragic day.

For most of October 25, it was a normal day at the medical center, with typically routine procedures. That was until the first call around 7 p.m. that there was a potential shooting situation.  Carrier, an AANA member since 2019, was finishing cases from her 12-hour shift and giving reports to the CRNA who was coming to relieve her for the evening.

“I was working a 3 to 11p.m. shift that day, doing an ortho procedure, when I received an alert from our charge anesthesiologist,” Moring, AANA member since 2009, said.  “Then I got a call from another CRNA at her house who heard the shooting suspect was along Main Street near the hospital and multiple police cars were heading to the bowling alley.”

Within 10 to 12 minutes of the first alert, Moring and Carrier were asked to put into place as much staff as possible, learning multiple victims were expected. A CRNA night staffer was already in place as were Moring and an additional CRNA working an overlapping 12-hour shift, and a triage list of about four to five other CRNAs was activated. “We ended up with six CRNAS in house for the duration of the night and about six to eight anesthesiologists in place,” Moring said.

After the initial alert, Moring and Carrier prepared a trauma room and then readied additional trauma rooms. “When I got to the emergency room, I was already needed at the head of the bed to intubate two victims and went from trauma bay to trauma bay doing this as additional victims arrived. From there, the victims were moved into operating rooms where several CRNAs were ready to receive them,” Carrier said.

Given the rapidly-unfolding events of that evening, information was spotty, but preparations in the emergency room were made, making sure blood tubing and other items needed for intubation were ready for a second wave of shooting victims. “It was a chaotic situation, but we remained focused, relying upon our training to help these patients through to OR,” Moring said.

To keep staff safe so they could focus on their work, the hospital went into lockdown with police and security surrounding the hospital. Despite this, the initial barebones staff increased as healthcare providers showed up to help in any way they could. “We were truly working as a group, all hospital departments, people showing up to help the community, to help care for the community,” Carrier said. “A lot of people came in uncalled to help our community. To see how the staff pulled together was incredible.”

“We were functioning as a group across all hospital staff departments to get what these patients needed to survive,” said Moring. “As a Level-Three Trauma Center, this was beyond what we would typically encounter. We don’t have the resources of a Level-One Trauma Center, but we had eight operating rooms working that night. Although we don’t necessarily train for mass shooting events, we have had emergencies including multiple vehicle accidents and even factory explosions, but nothing like this. Lewiston, Maine, was not on the map for this type of tragedy to happen.”

The majority of the hospital staff are so thoroughly connected to the community that they knew many of the shooting victims, or the family and friends of the victims. “I lost two high school classmates, Megan knew some of the victims and being a small community, we all had ties to those affected by this shooting,” Moring said. “We knew these people, and we had been to these locations. It was so very hard knowing the people we were treating.”

Even after the initial crisis, the emotional impact of what happened continued to affect the community.

“There was so much outpouring for the victims and their families. Before October 25, everywhere you go in Maine, you felt safe and I felt we were robbed of that a bit by this event. I will say the entire state felt it, not just Lewiston. All of Maine is part of this community,” Moring said.

Moring and Carrier felt the support from CRNAs throughout Maine and all of New England. “As a CRNA working at Central Maine Hospital, on that night and the weeks following, the outreach of CRNAs from other hospitals were willing to come and help–I have never felt such compassion and love from fellow CRNAs,” Tina said.

When there was time to decompress and reflect, Moring and Carrier recall experiencing profound moments. “Being the person there to put someone into sedation, knowing you might be the last face they see, was an incredible experience,” said Carrier. “Then seeing and tracking their progression as they moved through surgery to recovery. The patients were scared and in pain and facing what is such a traumatic situation. It felt so good to see them survive this experience and eventually go home.”

For Moring, one of the most inspirational moments was during time with a critically-injured patient. “In this operating room, it was breathtaking to see multiple surgeons, different specialties, everything from a trauma surgeon to plastic, vascular and bariatric surgeons, and I was at the head of the bed with an anesthesiologist, all taking care of this patient in a perfectly orchestrated way,” she said. “I am so incredibly proud of our CRNAs and how the departments of our hospital came together to treat these victims with the best care possible. You never want to go through something like this, but I am so grateful to have these trusted colleagues by my side.”

“As CRNAs, we are in a unique situation where we have this critical-care training so we know what we need to do to resolve emergency situations, but we also must be able to maintain a sense of calm to get through this and maintain communications with those around us. Do what you can, including seeking out continuing education, to keep you at the top of your game,” said Carrier.

Moring credits her ‘anesthesia chip,’ or her ‘CRNA chip’ to help get through a crisis. She refers to it as almost a sixth sense where you are taking in what is happening in the room, where you are anticipating and not just reacting. “You are really never prepared for a trauma like this, you may be able to visualize it, but not until you actually go through it.“

Both Moring and Carrier are grateful to be part of teams that were able to help these patients with their lifesaving skills to bring some sense of healing to a community still struggling to come to terms with this tragedy.