title: Hospital response to a major freeway bridge collapse.
abstract: BACKGROUND
  We describe the hospital system response to the Interstate 35W bridge collapse in Minneapolis into the Mississippi River on August 1, 2007, which resulted in 13 deaths and 127 injuries. Comparative analysis of response activities at the 3 hospitals that received critical or serious casualties is provided.
  
  
  METHODS
  First-hand experiences of hospital physicians, issues identified in after-action reports, injury severity scores, and other relevant patient data were collected from the 3 hospitals that received seriously injured patients, including the closest hospitals to the collapse on each side of the river.
  
  
  CONCLUSIONS
  Injuries were consistent with major acceleration/deceleration force injuries. The most critical patients arrived first at each hospital, suggesting appropriate prehospital triage. Capacity of the health care system was not overwhelmed and the involved hospitals generally reported an overresponse by staff. Communication and patient tracking problems occurred at all of the hospitals. Situational awareness was limited due to the scope of structural collapse and incomplete information from the scene.
  
  
  CONCLUSIONS
  Hospitals were generally satisfied with their surge capacity and incident management plan activation. Issues such as communications, patient tracking, and staff overreporting that have been identified in past incidents also were problematic in this event. Hospitals will need to address deficiencies and build on successful actions to cope with future, potentially larger incidents.
authors.affiliation: Department of Emergency Medicine, University of Minnesota Medical School, USA. john.hick@hcmed.org
authors.forename: John L
authors.initials: JL
authors.lastname: Hick
authors.forename: Jeffery
authors.initials: J
authors.lastname: Chipman
authors.forename: Gregory
authors.initials: G
authors.lastname: Loppnow
authors.forename: Marc
authors.initials: M
authors.lastname: Conterato
authors.forename: David
authors.initials: D
authors.lastname: Roberts
authors.forename: William G
authors.initials: WG
authors.lastname: Heegaard
authors.forename: Greg
authors.initials: G
authors.lastname: Beilman
authors.forename: Michael
authors.initials: M
authors.lastname: Clark
authors.forename: Jonathan
authors.initials: J
authors.lastname: Pohland
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Ho
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Brunette
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Clinton