title: Rural hospital mass casualty response to a terrorist shooting spree.
abstract: BACKGROUND
  Civilian mass casualty incidents may occur infrequently and suddenly, and are caused by accidents, natural disasters or human terrorist incidents. Most reports deal with trauma centre management in large cities, and data from small local hospitals are scarce. A rural hospital response to a mass casualty incident caused by a terrorist shooting spree was evaluated.
  
  
  METHODS
  An observational study was undertaken to evaluate the triage, diagnosis and management of all casualties received from the Utøya youth camp in Norway on 22 July 2011 by a local hospital, using data from the hospital's electronic records. Descriptive data are presented for patient demographics, injuries and patient flow.
  
  
  RESULTS
  The shooting on Utøya youth camp left 69 people dead and 60 wounded. A rural hospital (Ringerike Hospital) triaged 35 patients, of whom 18 were admitted. During the main surge, the hospital triaged and treated 22 patients within 1 h, of whom 13 fulfilled the criteria for activating the hospital trauma team, including five with critical injuries (defined as an Injury Severity Score above 15). Ten computed tomography scans, two focused assessment with sonography for trauma (FAST) scans and 25 conventional X-rays were performed. During the first 24 h, ten surgical procedures were performed and four chest drains inserted. No patient died.
  
  
  CONCLUSIONS
  Critical deviation from the major incident plan was needed, and future need for revision is deemed necessary based on the experience. Communication systems and the organization of radiological services proved to be most vulnerable.
authors.affiliation: Department of Surgery, Vestre Viken HE Ringerike Hospital, Hønefoss, Norway. steffenwaage@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Waage
authors.forename: J C
authors.initials: JC
authors.lastname: Poole
authors.forename: E B
authors.initials: EB
authors.lastname: Thorgersen
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D004189:Disaster Planning / Q000458:organization & administration / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D008505:Medical Staff, Hospital / Q000458:organization & administration; D009664:Norway; D023481:Terrorism; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration / Q000592:standards; D014948:Wounds, Gunshot / Q000628:therapy*