Charlottesville, Virginia, Aug. 12—At 1:42 p.m., a speeding car slammed into a gathering of protestors, injuring many. Within three minutes, the Charlottesville Fire Department notified the University of Virginia Health System (UVAHS) command center of the event, reporting 30 to 40 injured persons with 10 to 20 priority RED (high-priority) victims. At that time, the UVAHS command center notified the emergency department of the occurrence and activated the mass casualty incident (MCI) plan. Within 30 minutes, 20 patients with varying injury severity presented to the emergency department via EMS transport and private vehicles. Additional physicians, nurses, EMTs, and other team members responded to the MCI declaration, including 20 emergency physicians (11 faculty and nine resident physicians), five trauma teams, and additional anesthesiology and critical care physicians along with multiple nurses, EMTs, and other care providers.

This was the sequence of events:

• 1:45 p.m.: Notification of event to ED nursing and physician leadership.
• 1:47 p.m.: Activation of UVAHS MCI plan.
• 1:47 p.m.: Activation of emergency notification systems of health care providers.
• 1:48 p.m.: EMS diversion from UVAHS of non-priority patients.
• 1:48 p.m.: ED triage moved from emergency department to hospital lobby.
• 1:52 p.m.: Report of “CPR in progress” on one victim.
• 1:58 p.m.: Arrival of first priority patients at UVAHS.
• 2:25 p.m.: All priority patients had arrived and received initial care.

Approximately 90 minutes later, a Virginia State Police helicopter, deployed to the event, crashed and burned several miles from the event site. Killed in this crash were two Virginia State Police officers, Lieutenant H. Jay Cullen and Trooper-Pilot Berke M.M. Bates. At the time of this writing, the exact cause of the crash was unknown.

UVAHS ambulances staged adjacent to the medical center and ready to respond to emergency calls.

One person, Heather Heyer, died in the emergency department as a result of her injuries. Ten patients were admitted (to the operating room and critical care and acute care units), and nine individuals were treated and released from the emergency department. During this time, the UVAHS emergency department continued to provide care for “typical” non-event patients, including those experiencing anaphylaxis, chest pain, dyspnea, etc. An additional 10 to 20 priority GREEN patients were transported to another hospital in Charlottesville. As a result of the Unite the Right rally and related counterprotest, more than 40 patients were treated by both institutions that day, many with complex traumatic injuries; one person died as a result of injuries sustained from a car assault. The majority of those individuals injured by the car received treatment rapidly, and the emergency department returned to normal operations within two hours of initial notification.