The Fort Hood Massacre: Lessons learned from a high profile mass casualty

J Trauma Acute Care Surg. 2012 Jun;72(6):1709-13. doi: 10.1097/TA.0b013e318250cd10.


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.

Level of evidence: Prognostic study, level V.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Disaster Planning / organization & administration*
  • Emergencies
  • Emergency Medical Service Communication Systems / organization & administration
  • Emergency Medical Services / organization & administration*
  • Emergency Service, Hospital / organization & administration
  • Female
  • Humans
  • Male
  • Mass Casualty Incidents / mortality*
  • Mass Casualty Incidents / statistics & numerical data
  • Middle Aged
  • Military Personnel / statistics & numerical data
  • Needs Assessment
  • Risk Assessment
  • Survival Analysis
  • Texas
  • Transportation of Patients / organization & administration
  • Trauma Centers / organization & administration
  • Triage*
  • Wounds, Gunshot / etiology
  • Wounds, Gunshot / mortality
  • Wounds, Gunshot / therapy*