The civilian surgeon overseeing the care of some of the most gravely wounded victims from Thursday’s Fort Hood shootings warned Sunday that the death toll from the incident could still climb.

Dr. W. Roy Smythe, chief of surgery at Scott and White Hospital, which holds the nearest trauma center to the massive military post, said that six military personnel cut down by the shooter remain in hospital.

“I would say that some of them are out of the woods, but some of them, their injuries are so severe that only time will tell how they’ll do in the long run,” he said. Two patients remain in surgical intensive care and others may never fully recover.

“Some of these patients are young and sometimes young patients surprise you in regards to their rehabilitation. But there is a possibility that some of these patients will be physically impaired for the rest of their lives,” he said.

“And there’s certainly no doubt many of them will be psychologically impaired for the rest of their lives.”