title: Regional health system response to the Virginia Tech mass casualty incident.
abstract: BACKGROUND
  On April 16, 2007 a mass shooting occurred on the campus of Virginia Polytechnic Institute and State University (Virginia Tech). Due to both distance and weather, air transport of the injured directly to a level 1 trauma center was not possible. The injured received all of their care or were initially stabilized at 3 primary hospitals that either had a level 3 trauma center designation or no trauma center designation.
  
  
  METHODS
  This article is a retrospective analysis of the regional health system (prehospital, hospital, regional hospital emergency operations center, and public health local and state) response. Data records from all of the regional responding emergency medical services, hospitals, and coordinating services were reviewed and analyzed. Records for all 26 patients were reviewed and analyzed using triage designations, injury severity scores (ISS), and critical mortality.
  
  
  RESULTS
  Twenty-five of the 26 patients were triaged in the field. Excluding 1 patient (asthma), the average ISS for victims presenting was 8.2. Twelve patients had an ISS of > or = 9, and 5 had an ISS score of > or = 15. Ten of the 26 patients (38%) required urgent intervention and surgery in the first 24 hours. The overall regional health system mortality of victims received was 3.8% (1 death [excluding 1 dead on arrival {DOA}]/ 26 victims from scene). The regional health system critical mortality rate (excluding 1 victim who was DOA) was 20% (1/5).
  
  
  CONCLUSIONS
  The outcomes of the Virginia Tech mass casualty incident, as evidenced by the low overall regional health system mortality of victims received at 3.8% (1/26) and low critical mortality rate (excluding 1 victim who was DOA) of 20%, coupled with a need to treat a significant amount of moderately injured victims 46% (12/26 with ISS > or = 9) gives credence to the successful response. The successful response occurred as a consequence of regional collaborative planning, training, and exercising, which resulted not only in increased expertise and improved communications but also in essential relationships and a sense of trust forged among all of the responders.
authors.affiliation: Emergency Preparedness and Response, Virginia Department of Health, 109 Governor St, Richmond, VA 23219, USA. Lisa.Kaplowitz@vdh.virginia.gov
authors.forename: Lisa
authors.initials: L
authors.lastname: Kaplowitz
authors.forename: Morris
authors.initials: M
authors.lastname: Reece
authors.forename: Jody Henry
authors.initials: JH
authors.lastname: Hershey
authors.forename: Carol M
authors.initials: CM
authors.lastname: Gilbert
authors.forename: Italo
authors.initials: I
authors.lastname: Subbarao
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration; D006708:Homicide; D054527:Mass Casualty Incidents / Q000401:mortality*; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care; D012041:Regional Medical Programs; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014495:Universities; D014768:Virginia