Smalltown, USA, 1978. High-school senior Victoria Vahtes becomes the target of escaped psychotic Morgan Miller. In a one-night spree of butchery, the masked Miller murders Victoria's best friend, boyfriend, and parents before attempting to kill her. Rescue arrives in the form of Miller's pistol-packing psychiatrist, Dr. Harriett Gordon-Lewis, but Miller escapes and disappears without a trace. Six years later, violent psychotic escapes from understaffed insane asylums and the ensuing murder sprees have become a national epidemic. When a mysterious masked female vigilante starts killing fugitive psychotics mid-rampage, Dr. Gordon-Lewis suspects former patient Victoria Vahtes. After a spectacularly bloody asylum escape by psychotic Wayne Walton, Dr. Gordon-Lewis follows Walton's trail of destruction back to his childhood hometown, certain he will be pursued by the vigilante known to law enforcement as The Final Girl.