Under fire in Iraq, then Las Vegas
Oscar Monterossa served in the U.S. Army for four years as a combat medic, but it was the Route 91 Harvest music festival shooting where the paramedic felt most vulnerable
Paramedic Oscar Monterossa didn't hear the first volley of gunshots.
“What the hell was that?” asked a police officer taking a break inside the medical tent. They both stopped and listened.
It was just after 10 p.m. on Oct. 1, 2017, the night of the Route 91 Harvest music festival in Las Vegas.
The second time, they both heard it. Another volley of gunshots filled the air. The officer rushed out of the tent, leaving Monterossa alone. The former combat medic began grabbing supplies, intending to go search for victims, when a man with a gunshot wound to his arm walked into the tent.
Monterossa instructed the man to lay on the ground and used his knee to stop any arterial bleeding.
“To this day, the ability for people to follow your commands when they’re injured is just amazing to me. They will do anything you ask, and it’s very humbling,” he said.
Before he could apply a tourniquet, another victim entered the tent.
“They were holding their loved one,” he remembers. “I don’t know who it was – a father or brother – who was shot in the head.”
As the lead paramedic in charge, Monterossa began to delegate and triage, handing off his patient to an EMT while he tended to the second patient’s head wound.
More victims began streaming into the tent. A gunshot wound to the chest. A gunshot wound to the upper back.
Amid the chaos, Monterossa recalls family members screaming at him to help their loved one, who was already dead, and forcing them out of the triage tent.
“That sits with me to this day because the family members would be yelling at me, ‘Help him, this is my dad, help him!’” he said. “But there was nothing I could do for him. To push somebody out of the medical tent because they’re deceased is one of the hardest experiences that I’ve had to face.”
Monterossa and the medical staff set up a "black area" outside the triage tent to collect the bodies of the dead, which he dubbed the "corridor."
"I took someone out there, and it was so quiet in comparison to the tent," he recalled. "The tent was full of yelling, screaming people talking really loud. And then you go over to the deceased area and you would have [people] there with their dead family members. They'd be crying softly, but it was so quiet."
Back inside the medical tent, helpers were abundant, including volunteer firefighters, off-duty doctors and others with medical backgrounds.
"The natural human component of all this is there were people at the concert that had experience, and they were coming in to help," Monterossa said. "I'm very grateful for that because we definitely needed the help."
Despite the extra hands, what they really needed was a way to transport their critical patients out of the active scene.
"We essentially had people dying in front of us and we couldn't get them out because we didn't know if there was still an active shooter," Monterossa said. His operations medic was in radio contact with law enforcement, but they were told to wait until they received clearance the gunman had been neutralized before attempting to evacuate patients.
Eventually, those in the medical tent decided to take matters into their own hands, and began loading critical victims in privately owned vehicles in hopes of getting them to a hospital before it was too late.
"They said, 'Screw it, we're not going to wait on the ambulances. These people have got to get out,'" Monterossa said. "So we started loading people into private vehicles and pickup trucks."
The move went against Monterossa's professional training, but it was a necessity.
"We're always told that we've got to clear the scene before we can move," he said, "but in these circumstances, we had to get people out."
Later, once the scene was cleared, bullet holes were found surrounding the tent, but Monterossa said he never heard them.
"In the moment, once you start working, you get in your tunnel vision of just doing what you need to do," he said. "I couldn't even tell you how long it was going on for; I felt like it was hours, but looking back at reports, it wasn't that long. But it felt like it was all night."
That long evening would ultimately become the deadliest mass shooting by an individual in U.S. history, leaving 60 people dead and more than 800 injured.
EMS under fire
The deadly October 2017 festival was not the first time Monterossa provided EMS care under duress. He served as a combat medic in the U.S. Army from 2007 to 2011, including a 2009 combat deployment to Iraq where he trained Iraqi military personnel in Combat Lifesaver Course (CLS) – the Army’s version of BLS.
During his combat tour, Monterossa was involved in several convoy trainings to help prepare the Iraqi army to take over after the U.S. military withdrew from the country.
I feel that anyone who’s deployed to Iraq probably had a rougher experience when it comes to combat,” he said. “It’s not the conventional combat, where you’re getting small arms fire and you know everything that everyone wants you to do. It’s, you’re driving along, and the next thing the vehicle in front of you explodes, and you don’t know where it’s coming from, you don’t know who placed it. You don’t know if there’s secondaries. There’s a lot of unknowns and that significantly increases your anxiety levels.”
Despite that level of uncertainty while overseas, Monterossa felt more vulnerable during the Las Vegas shooting than he did while in the middle of a war zone. In Iraq, Monterossa was protected by 80 pounds worth of gear, including a helmet, protective vest and his weapon – a far cry, he said, from his attire during the gunfire at the festival.
“I was wearing my Community Ambulance polo shirt and a blue hat,” he said. “I was surrounded by EMTs that were just out of high school. You’re not in the ideal situation when it comes to patient care or personal protection.”
Not having that expertise to fall back on was also unfamiliar territory for Monterossa under such chaotic conditions.
“When you’re deployed in any combat situation, you’re surrounded by some of the most experienced people on this planet when it comes to tactics, safety, protection and defense,” he said, "like my platoon sergeant, who had four combat deployments under his belt. He had that intuition that I would follow to this day into battle if I had to."
Unbeknownst to Monterossa at the time, an EMT who was working with him in the medical tent during the Las Vegas shooting later told him that his ability to stay calm and continue communicating matter-of-factly helped her remain calm throughout the incident.
Her gratitude touched him.
"That's a very moving compliment," he said. He now holds a deeper appreciation for his prior military training and what his time in a war zone taught him. "If I did that with any patients that I treated, I think that all of my experiences are worth it."
Figuring out what comes next
From combat medic to paramedic, EMS instructor and volunteer firefighter, Monterossa was not done exploring medicine.
At the time of the shooting, he was retaking a few courses to improve his chances of getting into medical school – courses he ultimately had to drop.
“I couldn’t focus on the classes anymore,” he said. With midterm exams scheduled for the week after the shooting, Monterossa was forced to withdraw and reassess his future.
But while attempting to self-reflect, his mind repeatedly returned to the shooting victims he hadn’t been able to save that night while second-guessing his work.
“I would think, ‘Did I do everything that I was supposed to do? Did I do things the right way? Did I apply that tourniquet tightly enough? What if after they went out it got loose and that’s the reason that somebody died?’”
Ultimately, it was because of his experiences that night that he decided to pursue a career as a doctor and enter medical school.
“I came to the understanding that I want to be in this field,” Monterossa said. “I want to expand my knowledge base; I want to do the greater good, essentially.”
As a third-year medical student, he hasn’t specialized in any one area, and he’s keeping his options open – even if he can almost feel the ED calling him.
“I love emergency medicine; I feel immersed in it in a lot of ways,” he said. “But I’m trying to go into this with an open mind to be able to experience every specialty and give it an honest opportunity.”
His personal history suggests that is a successful strategy.