The victims just kept coming.
In cars, in ambulances waiting four or five deep, from the walking wounded to the barely alive, they arrived in droves.
"I have no idea who I operated on," said trauma surgeon Dr. Jay Coates. The hospital where he works took in many of the wounded after Stephen Paddock opened fire from his 32nd-floor hotel suite on Sunday night, spraying bullets into a crowd of country music concertgoers below. "They were coming in so fast ... We were just trying to keep people from dying."
When Dr Coates pulled up to work at the University Medical Center of Southern Nevada on Sunday night, the surrounding streets were already cordoned off and ambulances lined the driveway, filled with the victims of the deadliest mass shooting in modern American history.
"Every bed was full," Dr Coates said. "We had people in the hallways, people outside and more people coming in. It was like a war zone."
He said the huge, horrifying wounds on his operating table told him this shooting was something different.
"It was very clear from the first patient I operated on that this was a high-powered weapon," Dr Coates said. "This wasn't a normal street weapon. This was something that did a lot of damage when it entered the body cavity."
The fusillade of bullets fired from the Mandalay Bay hotel into a crowd of 22,000 at a country music festival killed at least 59 people and sent more than 500 to area hospitals, severely straining the city's emergency response system.
University Medical Center is a level-one trauma centre, meaning it is staffed around the clock with surgeons and trauma nurses and personnel. But it is also the only level-one trauma centre in the whole state of Nevada. On Sunday night, virtually every available employee rushed back to work to be confronted with unimaginable carnage.
Toni Mullan, a clinical nursing supervisor for the trauma unit, had just got home after a 12-hour shift when she was called back. She drove at 175kph and stopped at no traffic lights to get back to the centre as quickly as possible.
"Chaos, that’s what I saw," she said of her arrival.
Dr Coates said that by the time he reached the hospital there were already more than 70 medical staff at work, and eight or nine surgeons helped evaluate patients to determine who was most in need of surgery. The most critically wounded sometimes had up to 20 people around their bed working on them.
"It was a trauma bay full of at least 70 people and patients stacked everywhere. It was controlled chaos," Dr Coates said. "At one time we had eight operating rooms going at the same time."
By early Monday afternoon, the trauma centre had received 104 patients, most with gunshot wounds. Four died, 40 were released, 12 were in critical condition and eight were in surgery. Some had crush injuries from being trampled.
“It was all hands on deck. Word travelled very fast. People were very proud to come in," said spokeswoman Danita Cohen.
Last year, the trauma centre had a training drill in which staff practised receiving patients after a fictional mass shooting at a concert. "This is what we do, we were prepared for this," Ms Mullan said.
It was a similar scene at Sunrise Hospital on the other side of town.
"I have never seen a scene like the one I just saw this morning," said Nevada congressman Ruben Kihuen, whose district includes parts of the Las Vegas area, when he visited Sunrise. "There were about 190 people taking up every single bed possible, every single room possible, every single hallway possible. Every single nurse, every single doctor from all over the city came and are assisting a lot of these victims."
Friends and relatives searched frantically for news of the injured, but the sheer volume of patients slowed the process. At Sunrise, Mr Kihuen said, more than 90 of the 190 patients had no identification.
Las Vegas police urged family members not to inundate local hospitals in search of the missing, and telephone hotlines were set up to help locate missing loved ones. Police asked those wanting to donate blood not to go to the hospitals where the staff were overwhelmed with patients, and directed them to clinics in the area instead.
Paul Hwangpo, a Las Vegas Uber driver, said he had spent the day ferrying tourists and residents to the clinics to give blood. One had a six-hour wait, the other four hours, he said.
Ms Mullan said that emotionally the most difficult moments were when it came time to fill out paperwork for patients known only as Jane or John Doe because they had no identification on them.
"When we have families coming up looking for loved ones and we have Does, that’s overwhelming. I’m human. I cry. I’m sad for the loss," she said.
But she was proud of the way hospital staff had responded to the emergency.
"I've been a nurse for 30 years, and on the most tragic moment I've ever been involved in I was most proud to be a nurse," she said.
Paddock, 64, a high-stakes gambler and retired accountant, killed himself as authorities stormed his hotel room at the Mandalay Bay hotel casino.
He had 23 guns — some with scopes — in the room where he had been staying since Thursday, four days previously. He knocked out two windows to create the sniper's perches he used to rain bullets on the crowd of 22,000 nearly 500 metres away.
He also had two "bump stocks" that can be used to modify weapons to make them fully automatic, according to law enforcement officials. At Paddock's home, the authorities found 19 more guns, explosives and thousands of rounds of ammunition. His car contained several kilos of ammonium nitrate, a fertiliser that can be turned into explosives.
The FBI discounted the possibility of international terrorism, even after ISIL claimed responsibility for the attack. But beyond that, the motive remained a mystery, with Sheriff Joseph Lombardo saying: "I can't get into the mind of a psychopath at this point."
His brother was equally mystified. When asked what might have motivated then Paddock, his brother Eric, who lives in Florida, replied, "I can't even make something up. There's just nothing."
While Paddock appeared to have no criminal history, his father was a bank robber who was on the FBI's most-wanted list in the 1960s.
President Donald Trump on Tuesday called the gunman "demented" and a "very, very sick individual." Asked about gun laws, the president said, "We'll be talking about gun laws as time goes on."
Mia Man’s tips for fermentation
- Start with a simple recipe such as yogurt or sauerkraut
- Keep your hands and kitchen tools clean. Sanitize knives, cutting boards, tongs and storage jars with boiling water before you start.
- Mold is bad: the colour pink is a sign of mold. If yogurt turns pink as it ferments, you need to discard it and start again. For kraut, if you remove the top leaves and see any sign of mold, you should discard the batch.
- Always use clean, closed, airtight lids and containers such as mason jars when fermenting yogurt and kraut. Keep the lid closed to prevent insects and contaminants from getting in.
COMPANY PROFILE
Name: Qyubic
Started: October 2023
Founder: Namrata Raina
Based: Dubai
Sector: E-commerce
Current number of staff: 10
Investment stage: Pre-seed
Initial investment: Undisclosed
How green is the expo nursery?
Some 400,000 shrubs and 13,000 trees in the on-site nursery
An additional 450,000 shrubs and 4,000 trees to be delivered in the months leading up to the expo
Ghaf, date palm, acacia arabica, acacia tortilis, vitex or sage, techoma and the salvadora are just some heat tolerant native plants in the nursery
Approximately 340 species of shrubs and trees selected for diverse landscape
The nursery team works exclusively with organic fertilisers and pesticides
All shrubs and trees supplied by Dubai Municipality
Most sourced from farms, nurseries across the country
Plants and trees are re-potted when they arrive at nursery to give them room to grow
Some mature trees are in open areas or planted within the expo site
Green waste is recycled as compost
Treated sewage effluent supplied by Dubai Municipality is used to meet the majority of the nursery’s irrigation needs
Construction workforce peaked at 40,000 workers
About 65,000 people have signed up to volunteer
Main themes of expo is ‘Connecting Minds, Creating the Future’ and three subthemes of opportunity, mobility and sustainability.
Expo 2020 Dubai to open in October 2020 and run for six months
The White Lotus: Season three
Creator: Mike White
Starring: Walton Goggins, Jason Isaacs, Natasha Rothwell
Rating: 4.5/5
Key facilities
- Olympic-size swimming pool with a split bulkhead for multi-use configurations, including water polo and 50m/25m training lanes
- Premier League-standard football pitch
- 400m Olympic running track
- NBA-spec basketball court with auditorium
- 600-seat auditorium
- Spaces for historical and cultural exploration
- An elevated football field that doubles as a helipad
- Specialist robotics and science laboratories
- AR and VR-enabled learning centres
- Disruption Lab and Research Centre for developing entrepreneurial skills
Formula Middle East Calendar (Formula Regional and Formula 4)
Round 1: January 17-19, Yas Marina Circuit – Abu Dhabi
Round 2: January 22-23, Yas Marina Circuit – Abu Dhabi
Round 3: February 7-9, Dubai Autodrome – Dubai
Round 4: February 14-16, Yas Marina Circuit – Abu Dhabi
Round 5: February 25-27, Jeddah Corniche Circuit – Saudi Arabia
Company%20profile
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The specs
Engine: Four electric motors, one at each wheel
Power: 579hp
Torque: 859Nm
Transmission: Single-speed automatic
Price: From Dh825,900
On sale: Now
Where can I submit a sample?
Volunteers can now submit DNA samples at a number of centres across Abu Dhabi. The programme is open to all ages.
Collection centres in Abu Dhabi include:
- Abu Dhabi National Exhibition Centre (ADNEC)
- Biogenix Labs in Masdar City
- Al Towayya in Al Ain
- NMC Royal Hospital in Khalifa City
- Bareen International Hospital
- NMC Specialty Hospital, Al Ain
- NMC Royal Medical Centre - Abu Dhabi
- NMC Royal Women’s Hospital.
The Bio
Name: Lynn Davison
Profession: History teacher at Al Yasmina Academy, Abu Dhabi
Children: She has one son, Casey, 28
Hometown: Pontefract, West Yorkshire in the UK
Favourite book: The Alchemist by Paulo Coelho
Favourite Author: CJ Sansom
Favourite holiday destination: Bali
Favourite food: A Sunday roast
The Bio
Hometown: Bogota, Colombia
Favourite place to relax in UAE: the desert around Al Mleiha in Sharjah or the eastern mangroves in Abu Dhabi
The one book everyone should read: 100 Years of Solitude by Gabriel Garcia Marquez. It will make your mind fly
Favourite documentary: Chasing Coral by Jeff Orlowski. It's a good reality check about one of the most valued ecosystems for humanity
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
Anxiety and work stress major factors
Anxiety, work stress and social isolation are all factors in the recogised rise in mental health problems.
A study UAE Ministry of Health researchers published in the summer also cited struggles with weight and illnesses as major contributors.
Its authors analysed a dozen separate UAE studies between 2007 and 2017. Prevalence was often higher in university students, women and in people on low incomes.
One showed 28 per cent of female students at a Dubai university reported symptoms linked to depression. Another in Al Ain found 22.2 per cent of students had depressive symptoms - five times the global average.
It said the country has made strides to address mental health problems but said: “Our review highlights the overall prevalence of depressive symptoms and depression, which may long have been overlooked."
Prof Samir Al Adawi, of the department of behavioural medicine at Sultan Qaboos University in Oman, who was not involved in the study but is a recognised expert in the Gulf, said how mental health is discussed varies significantly between cultures and nationalities.
“The problem we have in the Gulf is the cross-cultural differences and how people articulate emotional distress," said Prof Al Adawi.
“Someone will say that I have physical complaints rather than emotional complaints. This is the major problem with any discussion around depression."
Daniel Bardsley
Ms Yang's top tips for parents new to the UAE
- Join parent networks
- Look beyond school fees
- Keep an open mind
COMPANY PROFILE
Name: Kumulus Water
Started: 2021
Founders: Iheb Triki and Mohamed Ali Abid
Based: Tunisia
Sector: Water technology
Number of staff: 22
Investment raised: $4 million
Election pledges on migration
CDU: "Now is the time to control the German borders and enforce strict border rejections"
SPD: "Border closures and blanket rejections at internal borders contradict the spirit of a common area of freedom"
