The victims from Sunday's deadly bus crash streamed into the Desert Regional Medical Center trauma's unit around the early-morning shift change.
Because of the scope of the tragedy, the hospital summoned chaplains and additional social service workers, extended overtime and made sure there was enough blood to treat the wounded.
Bilingual nurses and lab techs helped doctors communicate with many of the injured Spanish-speaking passengers. Other hospital workers provided transportation and meals for the patients' family members.
"Everyone was involved today — from X-ray to lab to housekeeping," said Dr. Ricard Townsend, a trauma surgeon.
Those who were easily removed from the twisted wreckage were the first to arrive. Judging from the injuries, Townsend said, it appeared the passengers were not wearing seat belts. He said the language barrier and lack of identification for some passengers complicated matters, especially when patients were transferred to other units within the hospital.
Shortly after the accident 14 patients — ranging in ages from 20 to 70 — arrived at the hospital. Many had facial injuries, involving soft tissue and bone, and some had to undergo plastic surgery.
By Sunday evening, four patients remained in critical condition while one patient listed in serious condition arrived as a transfer from another hospital, according to Richard Ramhoff, spokesman for Desert Regional Medical Center.
Another person had been transferred to a Los Angeles hospital for ongoing treatment; overall, nine patients were treated and released from Desert Regional, Ramhoff said.
Townsend said he had never seen an accident quite like this one. But he was proud of the way the hospital responded.
"We respond to crisis with teamwork," he said.
8:55 p.m.: This article was updated with the status of the injured patients.