At hospitals across the Inland Empire, nurses constantly monitor computer screens on which ambulance calls typically stream in one by one. They can see what's happening throughout the region. On Wednesday morning, all was quiet.
Then just after 11 a.m., an emergency flash: MASS SHOOTING. THIS IS NOT A DRILL.
Two assailants had opened fire with assault rifles at an office party at a county facility in San Bernardino, leaving 14 dead and 21 wounded. Surrounding hospitals were immediately flooded with police, reporters and grief-stricken families.
For emergency room nurses and doctors, coping with high-pressure situations and patients near death is familiar.
But usually, the danger doesn't hit so close to home.
With the shooters still on the loose, those caring for victims on Wednesday couldn't help but worry, "What about our own families? Could they potentially be shot?" said Dr. Kathleen Clem, chair of the emergency medicine department at Loma Linda University Medical Center.
Most hospitals now regularly hold active shooter drills. But still, the attack in San Bernardino ushered in a new level of anxiety for hospitals in the region.
"I live right here," Clem said. "This is my home."
On Wednesday morning, she raced to find the hospital's on-call emergency room physicians. Ambulances would be arriving soon with wounded patients. Loma Linda hospital is only three miles from the Inland Regional Center, the site of the attack.
Luckily, the on-call physicians were already in the hospital for a morning talk with doctors-in-training. "I pulled them out of the lecture hall," Clem said.
She assembled 12 physicians -- triple the number that usually staff the ER -- and stationed trauma teams at the front entrance of the emergency room, ready to tend to patients as soon as ambulances pulled up.
As patients began arriving at the hospital, chaos descended on the community.
A manhunt for the killers unfolded close by. Loma Linda hospital received a bomb threat.
Little was known about how many people had been killed and who or where the shooters were. Inside the hospital's emergency room waiting room, patients watched news clips, scoured social media sites and fielded phone calls and texts from relatives asking if they were alive and safe. Reporters began showing up.
Nurses warned against photographing or filming. Staff shielded a patient with white sheets as they rushed him inside.
Then, about 2:30 p.m., police stormed the facility, responding to a bomb threat. They searched the corners of each room for explosive devices.
Clem recalled seeing bomb-sniffing dogs at her feet as she treated patients. Though police determined within an hour that there were no bombs, the scare was yet another reminder of what felt like imminent risk nearby – and to be "at the ready for whatever else might come, and not knowing what that would be," Clem said.
Many didn't find it.
San Trinh raced from hospital to hospital in the San Bernardino region, looking for his girlfriend's name on patient rosters. A county health inspector, Tin Nguyen had been in the room where the attack happened.
Trinh – along with Nguyen's brother, Trung -- ticked off the names of medical facilities they visited, but their search yielded no clues. Trinh knew something was wrong.
"We were always in touch," he said of his girlfriend, whom he had been dating for more than five years. Still, family members said that instead of sitting and waiting with terrified relatives, he preferred to check the hospitals.
Trinh, along with four generations of the Nguyen family who gathered at her Santa Ana home waiting for updates, eventually learned that Nguyen was never taken to a hospital. She was killed at the scene.
For hospital staff, reuniting patients with their families often felt like the most pressing task Wednesday.
San Antonio Regional Hospital in Upland received two shooting victims, both of whom were discharged the same day. Because the hospital is 25 miles from the attack site, families hadn't yet reached the patients, who were "quite anxious to get back to their family," said Dr. Kevin Parkes, the emergency room department's medical director.
Parkes said a taxi was called for one of the patients, so the patient didn't have to wait for family to drive all the way to Upland.
As the day went on, nerves remained tense across the Southland. An hours-long search for the killers was underway. It was revealed that they lived in an apartment in Redlands, a city about 10 miles east of San Bernardino.
Though Redlands Community Hospital didn't treat any patients, the hospital went into partial lockdown, not allowing any visitors in. Located so close to the shooters' home, "we weren't sure exactly what we were going to be getting," said Pam Allen, the hospital's director of emergency services. The lockdown remained in place until 8:30 p.m. the next evening.
At most facilities, security precautions were eased after the two killers died in a shootout with police later in the afternoon.
All day, Loma Linda staff waited to receive more patients. But by the evening, they had treated only five from
Clem said she wished the hospital could have tried to save more lives, that fewer victims had died on scene. Her doctors had been prepared to triage as many as 50 patients.
"We deal very well with tragedy when we can help," she said. "It's when we can't that it's hard for us."