The Fort Hood Massacre:  Lessons learned from a high profile mass casualty.
BACKGROUND
On November 5, 2009, an army psychiatrist at Fort Hood in Killeen, TX, allegedly opened fire at the largest US military base in the world, killing 13 and wounding 32.


METHODS
Data from debriefing sessions, news media, and area hospitals were reviewed.


RESULTS
Ten patients were initially transferred to the regional Level I trauma center. The remainder of the shooting victims were triaged to two other local regional hospitals. National news networks broadcasted the Level I trauma center's referral phone line which resulted in more than 1,300 calls. The resulting difficulties in communication led to the transfer of two victims (one critical) to a regional hospital without a trauma designation.


CONCLUSIONS
Triage at the scene was compromised by a lack of a secure environment, leading to undertriage of several patients. Overload of routine communication pathways compounded the problem, suggesting redundancy is crucial.


METHODS
Prognostic study, level V.
Division of Trauma and Acute Care Surgery, Department of Surgery, Texas A&M Health Science Center, Scott & White Hospital, Temple, Texas 76508, USA.
Jeffrey
J
Wild
Janae
J
Maher
Richard C
RC
Frazee
Michael L
ML
Craun
Matthew L
ML
Davis
Ed W
EW
Childs
Randall W
RW
Smith
D000328:Adult; D004189:Disaster Planning / Q000458:organization & administration*; D004630:Emergencies; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality* / Q000706:statistics & numerical data; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D020380:Needs Assessment; D018570:Risk Assessment; D016019:Survival Analysis; D013781:Texas; D014187:Transportation of Patients / Q000458:organization & administration; D014193:Trauma Centers / Q000458:organization & administration; D014218:Triage; D014948:Wounds, Gunshot / Q000209:etiology / Q000401:mortality / Q000628:therapy*