The UVAHS command center closely monitored the event via several different mechanisms: real-time video monitoring, direct radio communications with unified command at the scene, on-site physician, and social media monitoring. With this multifactorial monitoring, UVAHS maintained a very high degree of situational awareness and ability to respond. For instance, within minutes of the car striking the crowd, the MCI plan was activated along with the recall of numerous health care providers and the movement of ED triage to the lobby of the hospital.

The use of the command center allowed the emergency department and greater UVAHS to adjust and respond to the changing needs of the community as the event evolved. Furthermore, the command center was able to take a range of duties and responsibilities “off the shoulders” of the emergency physician and nursing leaders, allowing the emergency department personnel to focus on patient management issues.

Looking Back

One area of planning and preparation that could have been more significantly explored was the psychological impact of the event on the health care team pre-, peri-, and postevent.

Immediately prior to the event, the team was able to focus on preparations. Members of the health care team, like many members of the greater Charlottesville community, experienced fear, anxiety, anger, and disbelief that such an event could occur in their community. Of course, the extreme beliefs, opinions, and practices expressed by some of the patients that day represented another challenge; appropriate instruction describing the care of such patients with the suggestion of appropriate strategies was available for providers. After the event, multiple debriefing sessions and after-action reviews were performed, reviewing not only the operational response and areas of potential improvement but also providing emotional support and guidance for the various members of the team.

The emotional devastation inflicted on the community caused by the injuries and loss of life will be with UVAHS for a long time. Lieutenant Cullen, Trooper-Pilot Bates, and Charlottesville-area resident Heather Heyer (the fatality from the car assault) all died that Saturday. The team learned many important lessons that day. Planning and preparation are vital not only for a planned event but also for the unplanned MCI.

The challenge for UVAHS and colleagues in emergency medicine across the nation is that we need to be prepared to react and amass the necessary resources within minutes of notification, for there is no one else who can.

Dr. Brady is professor of emergency medicine and medical director of emergency management at the University of Virginia in Charlottesville.

Mr. Berry is director of emergency management at UVAHS.

Dr. Ginsburg is an emergency medicine resident at UVAHS.

Dr. Iftikhar is an emergency medicine resident at UVAHS.

Dr. Izadpanah is an emergency medicine resident at the University of Virginia.

Dr. Lindbeck is associate professor of emergency medicine at UVAHS.

Dr. Sutherland is associate professor of emergency medicine at the University of Virginia.

Dr. O’Connor is professor and chair of emergency medicine and professor of public health sciences at the University of Virginia.