A male driver pulls up to a stopped car to see if the other driver needs help, he calls 911, the other man bashes in his window with a shovel and hits him in the head, he then pulls the injured man out of the car and hits him three more times and we see the man unconscious and in the trunk of the car with a teen girl, who screams causing the unconscious man to wake up and shout loudly; the attacker pulls the car over, opens the trunk and stabs the injured man in the stomach half a dozen times with the screwdriver, killing him in a gush of blood as the girl screams and the killer shuts the trunk again.
At a gas station, a teen girl trapped in a car trunk pulls out a panel and crawls into the back seat to yell for help; the attendant sees her, pulls out a box cutter to defend himself from the driver, and tries to open the car door but the driver pumps gas onto the attendant and lights him on fire with his cigarette lighter (we see the attendant completely on fire, flailing and falling to the ground as the car drives away).
A man uses a scalpel to cut a teen girl's hairline in order to remove her hair and scalp: her eye is badly swollen and bruised and her forehead bleeds until a woman rushes up and knocks the man out with a piece of crockery, the man recovers and fights with the woman, crashing into several walls, shelves, the floor and furniture (we see previous pools of blood on the floor from past crimes as paint cans and tools come crashing down loudly); the teen girl rushes forward, slicing the man's face deeply all the way down the side with sharp shears and then stabs them in his side (we see a lot of blood on his face and head and on his back as he shouts and pulls the shears out), he chases them, scrambling and grabbing, the woman kicks the man backward down a ladder, and she binds and shackles him into a bloody chemotherapy chair (he comes to and spits blood on the floor).
Two teen girls argue at a mall as one girl tries to provoke the other girl to use profanity, especially F-words, and the second girl refuses; walking to her car in the parking garage, the second girl is nearly hit by a car that backs out quickly, the driver exits his car and grabs the girl as the scene abruptly ends and we later see the girl wake up inside the trunk of the man's car and panic, crying, kicking and flailing her arms.
A teen girl locked in the trunk of a moving car calls 911 and the dispatcher tells her to kick out a tail light and wave her hand around to attract attention, which she does; the girl sees a shovel in the trunk and cries that the driver is going to bury her until the driver pulls over under a bridge, opens the trunk, and tells her to shut up or he'll kill her right there with a screwdriver.
A serial killer stops his car in a rural area, pulls a teen girl from the trunk and holds her on the ground with his hand covering her mouth as he looks around and the scene ends.
A teen girl home alone at night calls 911 as we see the shadow of a man break in the front window of her home, the intruder searches the house twice and finds the girl under a bed, from where he pulls her out by the ankles (she screams), he holds the girl by the throat on the floor in the dark and looks like he has a knife to her throat and in a longer shot he stabs and punches her, but we don't see blood; the phone goes dead and the 911 operator panics, cries and hurries off to the Quiet Room to recover, shaking and we later see a pixelated video of the girl, found by police officers in a shallow grave with a large mound of dirt beside it, ready to be shoveled in (the camera cuts to the 911 operator waking up in a cold sweat).
A cell phone line stays open during a kidnapping and the 911 operator can hear the driver's heavy breathing and the girl's cries and whimpering.
A woman drives to a rural cabin at night and finds a large trap door in the ground that leads to a subterranean level of rooms and we hear a female voice crying somewhere; a man wheels a teen girl in a wheelchair to a room at the far end of the place where he gives her nitrous oxide as a sedative (please see the Substance Use category for more details), forcibly washes her hair and cuts it with long sharp shears; the girl escapes and walks into another room where she stops, shakes and screams until the man comes and says, "You're not gonna want to see that" and we later see that the room is a mock-up of the man's sister's room before she died of cancer, decorated in pink, but blood-splattered over bed linens, makeup table and walls.
A man kisses a Styrofoam wig head that wears a human scalp, and taking the blonde-haired scalp in his hands, lies back and inhales from the bloody scalp area as a woman watches from a hiding place.
We see a small refrigerator that contains longhaired scalps of women with blood around the scalps.
Over the opening credits, we hear several 911 calls: "There's been a stabbing and someone is dead; my girlfriend jumped off the 12th floor ledge; I hit someone with my car; you shot your wife? daddy's on the floor... how old are you?; someone's been shot in the arm and face and there's a lot of blood; I think I overdosed and I think my wife did too."
Several scenes feature a 911-dispatch office and parts of emergency reports: A man stabs his wife; a woman screams that she ran over someone with her car; a woman screams that a bat is flying around her sister's bedroom; a woman says she thinks she hears a burglar; a drunken man asks why he is in jail; a woman says that her mom was stabbed; a dispatcher tells a potential suicide to put down his gun, but the call is disconnected and she groans; on big screen monitors along the walls, we see enlarged photo IDs of crime victims and criminals, news clippings about the kidnapping and murder of a teen girl and newscasts of police finding missing crime victims.
A serial murderer with a kidnapped teen girl taunts a 911 operator, saying, "It's already done" to indicate that he has killed the girl; he later repeats the call to the same operator after having kidnapped another teen girl.
Police and SWAT teams raid a cabin and find nothing.