The morning a gunman opened fire on a Republican congressional baseball practice in Alexandria, Babak Sarani cleared three operating rooms and readied his team.
But the shooting victims, which included House Majority Whip Steve Scalise, needed to be airlifted from the open field. That meant they couldn't be taken to George Washington University Hospital.
For Sarani, chief of the hospital's trauma and acute care surgery, that was frustrating.
GW is one of two Level 1 trauma centers in the District. But of the two, only MedStar Washington Hospital Center has a place for helicopters to land. Airlifted trauma victims headed for GW are dropped off miles away near Nationals Park and then loaded into an ambulance to try to get across the oft-congested city.
"Can you imagine being driven at 6 p.m. on a Friday?" Sarani said. "That will kill you."
So the hospital has reignited a 30-year-old debate to bring a helipad to GW so that it can be a direct destination for serious trauma patients. It has wide support from elected community leaders, but many residents are furious that the noise would disrupt their quality of life in the historic district surrounding the Foggy Bottom neighborhood.
In 1987, GW received permission from the Secret Service and the Federal Aviation Administration to open up restricted airspace around the hospital for medevaced transport. But local residents successfully stopped the project then, and it even resulted in a city law prohibiting helipads in residential areas because they are a "public nuisance."
Now the hospital is trying to get that law overturned.
The renewed debate has been going on for about a year. It began last fall when a bill was introduced in City Council to allow GW to build the helipad, but concerned neighborhood leaders demanded hearings and a public approval process.
Since then, the Advisory Neighborhood Commission (ANC) debated the issue at several meetings. Next week, the ANC will take a vote and kick it back to the City Council.
ANC President Patrick Kennedy intends to support it, though he said he understands why residents would be wary of being awakened in the middle of the night by the whirring blades of a helicopter.
"The people opposed have a legitimate concern," Kennedy said. "Those of us who have thought about this understand there is a lot of anxious people. But at the same time, there is some measure of sacrifice on the quality-of-life issue [to save lives]."
That is the conclusion Marina Streznewski came to after initially opposing the addition of a helipad in her back yard.
Streznewski, president of the Foggy Bottom Association, lives 400 feet from where the helicopter would land on New Hampshire Avenue NW. She shared her thoughts as a resident, not as a representative of the association, because the issue has become so divisive that the association's official position is neutral, she said.
After attending several ANC hearings, she concluded that the chance to save lives outweighed her discomfort.
"The difference that rapid transport can make in someone's life is tremendous. I know from that perspective that minutes do count," Streznewski said. "I agree the city does not have enough capacity in the case of issues like mass shootings. In the [2013 shooting at the] Navy Yard, they had to come by ambulance, and that's not good."
The hospital did a test flight on April 1 to measure the noise levels at several local sites at the request of a resident, according to Mike Conklin, an aviation consultant for the hospital. At all of them, the noise of an ambulance was louder than the helicopter, except at Streznewski's house, where it was five decibels louder.
The majority of emergency transfers are during the day, so Streznewski weighed the occasional sleep disruption "against saving lives, and it wasn't really a decision for me," she said.
But many residents feel their concerns are not being heard and intend to fight.
Among them is Barbara Kahlow, who sits on the West End Citizens Association. She said those opposed to the helipad are concerned not only about the noise but also the helicopter's vibrations damaging their historic rowhouses and the safety of flying in such a densely populated neighborhood.
The proposed law would cap the number of helicopter landings per year at 175. But it would allow transfers at all hours of the day — something that even Reagan National Airport doesn't permit because of residential noise concerns, she said.
"This is serious; people are scared," she said.
Opponents also say that the high cost of air transport would be better spent to equip ambulances with improved resources and medical professionals to treat victims on-site. They also have accused the hospital of wanting to medevac patients to generate revenue and not improve outcomes.
But a 2012 Johns Hopkins Medical Center study found that trauma victims were 16 percent more likely to survive when airlifted to the hospital than similarly injured patients taken by ground transport.
Other complaints are coming from inside the hospital — from surgeons saying they don't have the capacity to take on more trauma patients. But Sarani said GW would not add trauma beds or take on more patients. The goal, he said, is getting those in need of immediate medical care into surgery as quickly as possible.
Meanwhile, the hospital has been talking with federal agencies to determine what it would take to get renewed permission to fly medical helicopters in the restricted area.
Conklin, who piloted Marine One during President Bill Clinton's second term, said he is "100 percent confident operations can be conducted safely in and out of the proposed GW helipad."
It's a different world post-9/11 than it was when the government gave GW its approval 30 years ago. But although airspace security is greater, so is the threat of mass-casualty incidents.
"It's not 'if' something is going to happen here, it's 'when' something is going to happen here," Sarani said, "and we're not prepared for that as a trauma system."