Shortly before 11:29 a.m. on June 24, 2011, Amtrak’s “California Zephyr” was en route from Chicago to Emeryville, Calif. The train was carrying 204 passengers and 14 crew members. As it was traveling through the desert near Fallon, Nev., it was struck by a tractor trailer that was unable to stop at a railroad crossing. The crash ignited a fire that engulfed some of the train’s cars. Nineteen people were seriously injured, 52 patients suffered minor injuries and six were killed.
Banner Churchill Community Hospital EMS (BCCHEMS) provides EMS to that area. BCCHEMS’ primary response area is more than 4,900 square miles (approximately the size of New Jersey). The department staffs two ambulances (usually at the ALS level) and can bring in off-duty personnel to staff another two ambulances if needed.
Steve Towne, senior manager of BCCHEMS, also served as medical group supervisor at the incident. Towne says that when the call came in, it was simply dispatched as a truck vs. train crash, and EMS providers didn’t know the incident involved an Amtrak passenger train until they were en route. They also didn’t know the truck had struck the train, assuming instead that a train had struck a truck. About halfway to the scene, responding units learned the train was also on fire.
The incident was approximately 23 minutes from the closest EMS units. BCCHEMS units received more information from their dispatcher regarding the scope of the incident and decided—while en route—to call in additional off-duty personnel to staff two more ambulances and to call for mutual aid. This decision probably saved about 15 minutes in response time from mutual-aid agencies. Two ambulances responded from Lovelock (about 50 miles from the incident), and Winnemucca EMS (about 120 miles north of the incident) sent four ambulances.
Arrival on Scene
Two BCCHEMS ambulances and the sheriff’s department unit arrived on scene at the same time. Responding units could clearly see the burning train, access to the scene was difficult because there wasn’t an access road along the track. One passenger car was already fully engulfed, and fire was spreading to another car. Evacuation was in progress and most of the passengers were already out of the train, which was about half a mile down the track from the crossing. Emergency personnel had to commandeer four-wheel-drive to get down to the train or had to walk in.
The first-on-scene EMS providers knew it was going to be a large incident. An initial priority was to try to find out how many passengers were on the train to determine how many patients were outside—and therefore, how many could still be inside. Triage was started, and a treatment area was established. Amtrak personnel were already trying to move some passengers to a rally point at the railroad crossing. The initial triage was done as patients walked down the tracks. EMS providers identified some critical patients and started managing them right away. Nevada uses the SMART mass casualty incident (MCI) system, and all the ambulances carry some triage equipment.
EMS providers primarily tagged red and yellow patients, but did not have enough triage tags for all the greens BCCHEMS hoped to identify all passengers who had been evaluated, but this wasn’t possible without enough tags. Ambulances didn’t have enough tags because they carry tags based on the premise that a typical MCI in that area would involve 50–60 patients. Initially, 19 patients were triaged as red and yellow. Most injuries included fractures, multi-system trauma and some smoke inhalation.
Challenges & Successes
An MCI drill conducted less than two months before the incident contributed to this incident’s success. BCCHEMS manages smaller multi-patient incidents on a regular basis. The drill allowed EMS providers to practice managing a larger MCI. Other departments participated in the drill as well, and this allowed them to practice inter-departmental operations and to be evaluated. The drill also helped BCCHEMS focus on command functions.
Prior to the drill, they had already identified the need for additional training on the incident command system (ICS), and had therefore conducted ICS review sessions before the drill so participants could apply the principles during the exercise. Having these experiences fresh in mind allowed providers to apply lessons learns to managing the incident. As important as it is to regularly review MCI management concepts in a classroom setting, it’s also necessary to conduct periodic drills to “put it all together.”
Another factor that contributed to the success of the incident was the support BCCHEMS has received from the hospital. Because the hospital is part of Banner Health, two years ago a business plan was developed for the EMS. Part of the plan included an assessment of the service’s needs, including equipment. The plan ensured financial support would be available. Good progress has been made to address the needs identified—a fact obvious at both the drill and the incident.
BCCHEMS had already identified a problem: a limited supply of portable radios. Although they were in the process of adding radios, this problem really affected the Amtrak crash because the incident was so spread out. Command personnel were able to compensate by using a lot of face-to-face communication.
While still en route to the incident, BCCHEMS requested two helicopters from CareFlight in Reno. They also requested three Navy search and rescue helicopters. A sixth helicopter from CalStar was also responding, but it was diverted to a serious motor vehicle accident, along with two ambulances from Winnemucca. (An important lesson here is that we must always remember that other EMS calls will still occur during the MCI, and we must always be able to manage these as well.) The Navy helicopters have a flight crew, but because U.S. military personnel on helicopters are certified at the EMT level, BCCHEMS also sent a paramedic with each patient. Although military helicopters aren’t often used in the area, they were involved in the earlier drill, and this contributed to the successful interaction between civilian and military resources at the scene.
Being part of Banner Churchill Community Hospital, the EMS enjoys good communication with the hospital administration. While en route to the scene, Towne notified Mary Hum, the hospital’s chief nursing officer, of the incident. This gave the hospital time to prepare and to bring in additional staff and to set up treatment facilities in a clinic that’s part of the hospital. Although all the critical patients were transported to Renown hospital in Reno (a Level II trauma center), 52 patients with minor injuries were transported by bus to BCCH.
This incident presented many challenges most of us will never face—a remote location, difficult access, limited resources and an accompanying fire. Despite all this, BCCHEMS was able to manage the situation successfully, thanks to training and preparation.