Updated 10:00 p.m.

The most critically injured students from Marshall County High School were all life-flighted from Kentucky to Vanderbilt Medical Center. The school shooting, which killed two and injured 17, was a first for the hospital in 30 years as a Level I trauma center.

Vanderbilt handles shootings nearly every day. But trauma chief Rick Miller says it’s different when the victims come from a mass casualty event at a school.

“Obviously, it’s not something that you look forward to,” he says. “But I think every Level I trauma center should be really prepared to do this kind of thing.”

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The five teenagers arrived on the helipad in separate choppers, according to hospital officials. Vanderbilt has trained to handle many more, if needed,” says Oscar Guillamondegui, medical director of Vanderbilt’s trauma ICU.

One of the students did not survive. His surgeon says there’s nothing doctors could have done for such a severe head wound. All five are male. Three were shot in the head. One was wounded in the chest and abdomen, and another was shot in the arm.  

The four Marshall County students who survived surgery in Nashville are critical but stable and expected to be released in three to five days. On Tuesday evening, a female student was transported by ground to Monroe Carell Jr. Children’s Hospital at Vanderbilt where officials say she is in stable condition.

“It does kind of tug at your heartstrings,” Guillamondegui says. “There’s never a day that you’re prepared to be happy about a moment like this. We’re just as devastated as anybody would be. Luckily, we’re trained and prepared.”