From the Division of Trauma and Acute Care Surgery (J.W., J.M., R.C.F., M.L.D., E.W.C., R.W.S.), Department of Surgery, Texas A&M Health Science Center, Scott & White Hospital, Temple, Texas; and Division of Trauma Services (M.L.C.), Round Rock Medical Center, Round Rock, Texas.
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.
Data from debriefing sessions, newsmedia, and area hospitals were reviewed.
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.
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.