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Language Service Helps EMS during Bus MCI

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During wintery driving conditions on March 21, a tour bus carrying 25 Korean passengers from Quebec, Canada to Boston overturned on Interstate 93 in Littleton, N.H., says New Hampshire Bureau of EMS Chief Clay Odell. The Grafton County Sheriff’s Department Communications Center received the initial 9-1-1 call at 8:10 p.m.

New Hampshire 9-1-1 received four cell calls reporting the accident and used five emergency medical dispatchers (EMDs) in processing the initial incident reports. “AT&T Language Line” services were accessed by NH 9-1-1 on receiving a cell call from the bus operator. Nearly all the occupants of the bus spoke only Korean.

The Littleton Fire Department (LFD) was conducting a meeting at the time of the incident and was able to respond with additional personnel on the initial call.

A mass casualty incident (MCI) was declared, and the following area EMS agencies provided mutual aid ambulance assistance:

  • Bethlehem Fire Department;
  • Caledonia-Essex Area Ambulance in St. Johnsbury, Vt.;
  • Lancaster Fire Department;
  • Ross Ambulance Service in Littleton;
  • Twin Mountain Ambulance;
  • Whitefield Fire Rescue Department, and
  • Woodsville Rescue Ambulance.


In addition, a DHART helicopter was requested but unable to fly due to the poor weather.

Ross Ambulance Service personnel who were on the first ambulance on the scene immediately went into MCI mode and began tagging patients on the bus. Adam Smith, Manager of Ross Ambulance arrived on the scene and served as EMS Branch Officer. Littleton Regional Hospital Paramedic Intercept personnel provided secondary triage.

LFD personnel advised that 17 patients were transported by ambulance to the following area hospitals:

  • Littleton Regional Hospital, which admitted one patient ,and treated and discharged 10;
  • Dartmouth-Hitchcock Medical Center in Lebanon, which had two patients transferred to their facility),
  • Cottage Hospital in Woodsville;
  • Northern Vermont Regional Hospital in St. Johnsbury;
  • Weeks Medical Center in Lancaster, and
  • Dartmouth-Hitchcock Medical Center in Lebanon, which had a total of three patients transferred.


According to Adam Smith, responders extricated five patients from the bus who were red-tagged. There was some entrapment, but he noted no delays and said “things went pretty smoothly.” He said all patients were transported within an hour and 10 minutes into the incident. He said a school bus arrived on the scene according to the area’s MCI plan, which transported all the green-tagged patients.

LFD Chief Joseph Mercieri said that the department had conducted an MCI training session in January. He also noted that the community’s MCI plan had been revised within the past two weeks. As part of the plan, McMahon’s Towing Service of Littleton also was dispatched to the scene with large vehicle rescue equipment.

Follow-up with DHMC indicates that the three patients transferred there had significant spinal injuries but no life-threatening conditions. Mercieri indicated a formal critique of the incident will be conducted with area agencies in the near future.

Clay Odell, EMT-P, RN, is the EMS bureau chief, N.H. Department of Safety, Division of Fire Standards and Training and EMS.

Bill Wood, EMT-I, is the emergency preparedness coordinator of the N.H. Department of Safety, Division of Fire Standards and Training and EMS.



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