On July 7, 2010, an amphibious vehicle, typically called a duck boat (a name derived from its original military designation of DUKW), was carrying 35 passengers and two crew members in the Delaware River when it was struck by a barge. Thirty-five of the people on-board survived, and two died. The ensuing mass casualty incident (MCI) presented challenges to the Philadelphia Fire Department, but it also provides us with some insights and considerations in managing a unique MCI.
The collision, witnessed by various people on shore and other watercraft, was reported immediately. Fortunately for rescuers, most of the people on the DUCK boat were wearing life vests and therefore were on the surface following the collision. Within minutes, Coast Guard, Philadelphia Police and Fire Department and nearby boats were on scene and started pulling people out of the water. All but the two who died were pulled from the water within an hour. In total, according to Coast Guard reports, 20 boats and six helicopters responded to the incident.
Of the 35 survivors, 11 patients were transported to area hospitals. Ten of the 11 went to Hahnemann University Hospital, one of Philadelphia’s trauma centers. Two of these patients were admitted, and the others were treated and released later that day.
This type of incident underscores the need to be prepared for MCIs not only on land, but also in the water. There are a number of lessons here for EMS agencies that have active waterways or bodies of water within their response districts. Let’s consider a few.
Personal flotation device (PFD): One key reason so many survived this incident was the availability of a PFD. Many were either wearing them or were able to quickly put one on. Rescuers don’t float any better than the patients in a water-related MCI. Enough personal safety equipment, such as approved PFDs and helmets (if appropriate), should be available for use by all EMS providers working on or in close proximity to the water.
Available resources: When an incident such as this occurs, other boats may not be nearby to quickly assist in rescuing patients from the water. But even with the help of nearby watercraft, specialized rescue boats and helicopters are a necessity, they carry useful medical and rescue equipment and are often designed to easily allow access to patients in the water.
It’s important to know all the various resources available for this type of MCI well before it occurs. These may be municipal rescue units or government-operated vessels, such as Coast Guard boats and helicopters. Ask yourself who operates the boats in your area: police, fire or an independent rescue squad? The Philadelphia Fire Department had planned for such an event; therefore, they already had an existing relationship not only with their own police marine units, but also with the Coast Guard and the neighboring New Jersey fire and rescue units. These relationships helped the rescue operation run smoothly and efficiently.
Jurisdiction: Command personnel need to be aware of who has primary jurisdiction for the body of water, or the area within the body of water, where the incident occurs. This will help avoid turf battles or other potential conflicts. Things aren’t always what they seem. For example, although it’s named the Ohio River, the state of Kentucky, not Ohio, has primary jurisdiction over the section of the river that forms the border between the two states.
Practice drills: Have local agencies conduct exercises and drills to practice not only the actual rescue operations, but also interagency cooperation. The time to meet other players who may be called—and learn what their capabilities are and how they operate—is not when an incident occurs.
Such exercises should be held on the water if at all possible. In some areas, local tour or dinner cruise operators have been more than willing to provide boats and even personnel to add realism to drills. The reason they agree to participate is simple: The lives saved in a real incident may be those of their customers, so they want providers to be as prepared as possible. And, it’s good PR for them to show that they’re also prepared for such an event.
This type of MCI also presents unique medical challenges that should be considered.
Triage techniques: Certain triage techniques won’t work the same in the water. For example, an initial global sort can’t be performed by asking all those who “can walk” to move to a certain area. However, once the patients are in a more stable location, such as on shore or on a large vessel (e.g., a ferry) it may be possible to do some global sorting using this method.
Hypothermia: This condition is more likely with an MCI that occurs in the water. Even on a relatively warm day, water temperatures may be considerably lower. Also, the body loses heat faster in the water, especially in flowing water. Cold water robs body heat 25-30 times faster than cold air. To combat the potential for continued heat loss, wet clothing should be removed. Covering patients with blankets is also important. Numerous blankets may be hard to find early on, especially if the incident occurs during warmer months when first arriving ambulances may not be carrying as many as they do during colder months. Heat packs strategically placed around the armpits, neck and groin area can also help warm patients. If a local EMS agency operates an MCI trailer, then a good supply of these items should be available.
Trauma: A situation in which a boat is struck (such as in this case when the duck boat was run over by a barge), there’s the high probability that passengers on the boat will suffer traumatic injuries, including spinal injuries. However, spinal immobilization may not be practical in the water. Keep in mind that unlike in a swimming pool, the water will probably be too deep for EMS providers to stand in. But once patients have been pulled from the water and are in boats, it may be possible to apply C-collars and place the patients on backboards.
Respiratory concerns: With a water-related MCI, the possibility of encountering airway and respiratory problems is much higher than on land due to the potential for drowning or near drowning. Providing ventilatory support for this group of patients requires pre-planning for more equipment (basic and advanced) and providers to be available.
Decontamination: If the water-related MCI involves a collision, there’s the possibility for large amounts of fuel/oil being spilled into the water. Should this occur, patients are likely to come in contact with the petroleum products and will therefore need decontamination as soon as possible. Weapons of mass destruction (WMD) decontamination units are ideal for accomplishing this but need to be called for immediately.
The Philadelphia duck boat incident was an unusual and uncommon MCI, but the potential for similar incidents in other parts of the U.S. is great. Considering some of the lessons learned and strategies for managing such incidents can allow EMS providers to have the same success as the providers of the Philadelphia Fire Department.
Among the 35 passengers on the duck boat was a tour group comprised of visitors from Hungary. Refer to last month’s column for tips on how to manage an MCI involving patients who speak foreign languages.