Salem, OR – On Sunday night, Salem Hospital activated its mass casualty protocol for the first time in at least eight years after a mass stabbing at the Union Gospel Mission left a dozen people injured. Eleven victims were transported to the hospital, located just two miles south of the stabbing scene near downtown Salem.
Emergency department staff had mere minutes to prepare for the influx of critically injured patients. According to Dr. Libby Windell, the medical director of trauma services, the hospital typically has 20 minutes to clear treatment bays and ready equipment under the mass casualty plan—but on this night, they had less than five.
The hospital’s charge nurse, who monitors community emergencies, initially learned responders were heading to a stabbing incident. The situation quickly escalated from one stabbing to three, and then to ten victims, prompting immediate activation of the Mass Casualty Incident protocol—an event unseen by the team since at least 2017.
This protocol enables staff to streamline care under pressure, focusing resources on patients with the highest chance of survival. Upon arrival, Dr. Windell found the emergency department already immersed in triage, sorting patients by injury severity. Four were categorized as “red,” meaning their injuries were life-threatening within the hour. One was “yellow,” requiring urgent care but stable enough to wait slightly longer. The remaining victims were considered “green,” or “walking wounded,” who could wait for further evaluation.
Adding to the challenge, a simultaneous car crash brought three more patients to the emergency department.
In rapid succession, doctors assessed patients’ airways, breathing, and circulation—the vital “ABCs” of trauma care—followed by mental status checks and comprehensive evaluations to ensure no injuries were overlooked. Mobile ultrasound devices proved critical in detecting internal bleeding, such as blood around the heart that signals urgent surgical intervention.
The response team included 10 surgeons, eight emergency doctors, and six anesthesiologists—significantly more than a typical night’s staff. Despite the intense pressure, Dr. Windell praised the hospital’s teamwork and efficiency. Laboratory results were expedited, blood bank supplies rushed in, and diagnostic imaging performed swiftly.
“It’s all hands on deck,” Dr. Windell said. “There’s really no ego. Everybody’s there to do the best care, and it’s remarkable to see people unite together to save lives. When you have a really good team, it’s almost like a beautiful symphony.”
The mass casualty protocol was officially called off at 8:53 p.m., after just over an hour of intense triaging and treatment. Despite the chaos, the emergency department never felt overwhelmed, according to Dr. Windell.
“It was kind of another day in the ER—organized chaos,” she said. “It was really great to witness.”
