Disaster on the Rails

Training, teamwork & unified command lead to success at California multiple-train MCI

 

 
 
 

A.J. Heightman, MPA, EMT-P; Scott Mohlenbrok, EMT-P & Marc Eckstein, MD, FACEP | | Tuesday, April 7, 2009


Setting the Stage

Moments earlier, a distraught man parks his Jeep Cherokee straddling a set of railroad tracks and facing north, pointed in the direction of an approaching southbound commuter train headed for L.A.'s Union Station. The driver exits his vehicle, pours gasoline in and around the SUV, and then flees.

The three-car Metrolink train, with more than 200 commuters aboard, is operating in a push-pull configuration (with the locomotive pushing the passenger cars on its southbound route and then pulling them on its return trip northbound). On this leg of its journey, it_s being pushed by a locomotive, with the flat front, lead car and its small engineer control cockpit destined to hit the SUV head-on.

At almost the same time, a northbound Metrolink commuter train, being pulled by a locomotive, approaches the SUV's location in the dark. The engineer notices the flashing red light of the Jeep's turn signal, left on by the driver, radios the approaching southbound train that something is on the tracks and alerts his own passengers to brace themselves because he fears a collision and potential derailment.

This heroic action probably saved many of his passengers' lives. However, his warning to the southbound train is too late. Even though traveling only 50 miles an hour, 20 mph below the speed allowed along this section of track, the southbound train can't stop, and the 60-ton lead passenger car hits the Jeep, causing the gasoline-soaked vehicle to explode as it wedges under and gets chewed up by the train rolling over it.

The chassis of the SUV causes the train to derail and travel off the right (west) side of the tracks where, ironically, a locomotive attached to two fully loaded gravel cars sits on a controlled railroad siding.

The lead passenger car hits the parked locomotive and knocks it off the west side of the tracks onto its side. The passenger cars begin to crumble and tear apart from the massive energy transmitted by the impact with the engine anchored in place by the attached gravel cars. The parked locomotive's 5,000-gallon load of diesel fuel spills out, fueling the existing fire.

Scores are injured; several are killed on impact. Some of the victims work for the agencies that will soon respond to try to save them. Others are FBI agents, deputy sheriffs and police officers commuting to work and now separated from their weapons in the wreckage.

But the damage and devastation isn't over yet. The impact energy also causes the lead and second car of the southbound train to bend and crack like sticks, tearing open the rear section of the lead car and the front of the car connected to it.

The northbound train's engineer, seeing the initial explosion, throttles up his train to try to move out of harm's way, but he cannot escape involvement. The fast-evolving derailment, second impact and subsequent derailment, causes the front of the southbound train's second car to jump the tracks and fly over to the east side, striking the last car of the northbound train, tearing open the lower passenger area like an aluminum can. The car derails and rolls over on its side on the east side of the tracks, like a model train falling off its platform (see photo, May 2005 JEMS, p. 47).

As the second (northbound) train comes to a stop, its middle passenger car derails and is crushed by a collapsing railroad tower (knocked over by the impact of the collision), killing and trapping passengers inside.

Tracking the passengers proves challenging. The walking wounded and non-injured passengers crawl out of the mangled wreckage and wander along the tracks like a scene from the movie Night of the Living Dead. But they can't go far or walk into the nearby industrial area because the tracks are lined on both sides by tall chain-link fences for security reasons. Emergency personnel won't have the benefit of a manifest to determine actual passenger counts because both trains are commuter trains.

What follows is an account of the worst U.S. rail disaster since March 15, 1999, when an Amtrak train hit a truck and derailed near Bourbonnais, Ill. (killing 11 people and injuring more than 100). We use first-hand accounts and scene photographs to help you learn from the responders who handled this 241-patient incident.

A main complication was that a massive barrier of twisted and torn rail cars physically separated the scene into two distinct areas, forcing the primary responding agencies to operate as two medical groups, with individual triage, treatment, staging and transportation areas. To clarify the scene details, we distinguish between action on the east (Glendale) side and west (L.A.) side of this major incident.

To easily identify these action areas, we refer to the L.A. side as the ˙Costco (west)Ó side, because the L.A. forces used a Costco store on the incident_s west side to centralize their resources close to the worst impact area.

We refer to the Glendale side as ˙Magnolia (east)Ó because arriving Glen_dale fire commanders captured the end of Magnolia Street as their central access, treatment and transportation point (see photo, May 2005 JEMS, p. 52).



Response & Command

The initial alarm was dispatched at 0603 hrs by the L.A City Com_munications Center. The Verdugo Fire Comm Center dispatched Glendale to the same incident at 0606 hrs. (The Verdugo Dispatch Center dispatches resources for Burbank, Glendale, Pasadena, South Pasadena, San Gabriel, Sierra Madre, Monrovia, Arcadia, Monterey Park and San Marino.)



Both comm centers received numerous calls about the incident but were not fully aware of the patient volume until firefighters began to arrive on scene. Initial 9-1-1 callers reported a train locomotive on fire, so incoming engine personnel did not expect the devastation that greeted them.

Los Angeles Fire Dept. (LAFD) truck Capt. Larry Schneider and the Task Force 50 crew arrived first at the Costco (west) side of the incident at 0608 hrs and used bolt cutters to gain entry through the chain-link fence. Schneider reported a locomotive on its side and on fire with diesel fuel leaking.

As his crew extinguished the fire, Schneider observed 20Ï30 people lying on the tracks, and others walking up the tracks—just like moulaged victims would during an MCI drill. He ordered 10 additional ground ambulances and one air ambulance, then began to survey the scene and perform triage. He had his crew put down their heavy tools and begin packaging and moving patients to the treatment area.

Glendale Fire Dept. (GFD) Capt. Bill Lynch, public information officer, was driving to work when he heard the initial call. He responded to the initial dispatch location, the intersection of San Fernando Road and Chevy Chase Road. He arrived at 0612 hrs andreported that the incident was one-quarter mile south of his location, with ˙smoke showing.Ó

While Lynch reported his findings, he heard a knock on the side window of his Crown Victoria. He looked out and saw a man with lacerations and blood all over his face, asking for help. It was a moment he'll never forget.

GFD Capt. Dan Nichols (Eng. 25) had his engine company enter farther south of the scene via Magnolia Street and open up the chain-link fence. His crew began triage from the southern end and determined that Magnolia was an ideal location for Glendale_s Medical Group because of a nearby open parking lot. He then was assigned to serve as ˙Magnolia DivisionÓ by Unified Incident Commander BC Don Wright.

GFD BC Bob Doyle arrived and took over Magnolia (east) Division, keeping Nichols as his assistant. Doyle had been on his way to the station to meet another GFD firefighter for a run before starting his tour of duty and found himself on scene and in command wearing running shorts and without his radio or operational clip_boards. He opened his trunk, donned his turnout gear and commandeered a radio and clipboard. ˙It was hard to get the big picture of this incident,Ó says Doyle. ˙There was a sea of people. I can't remember a single face because there were so many, and so many other concerns [were] on my mind.Ó

Quest for Interoperability

GFD BC Don Wright was listening to Glendale police radio traffic while responding to the call and heard that the train derailment with numerous critical patients was near the Costco parking lot, so he proceeded to that location. On arrival at 0614 hrs, Wright joined LAFD BC Jay Turner (Battalion 2), already on scene, and the two established a unified command post (UCP).

They backed their respective command vehicles close to each other, began to assess the scope and magnitude of the incident, and assigned incoming personnel from both agencies to key tasks. Wright says, ˙There was no mating dance of ÂWho's in charge? at this incident. Jay and I knew each other and decided the patients on one side of the trains would be Glendale's and those on the other side would be L.A. City's.Ó

At 0615 hrs, the UCP announced that the incident would be referred to as ˙Railroad Incident,Ó and they were establishing a unified ˙Railroad IC.Ó The command personnel, seeing the extent of the damage and number of injured passengers exiting the trains, initially thought this could be a terrorist incident similar to what had occurred in Madrid, Spain. But Costco employees soon clarified that it was the result of a derailment.

Turner says, ˙I had a lot of obligations [that] I realized en route. I changed our radio channel to channel 9, determined the magnitude of the incident, processed information and established the CP in a safe location in a unified command [configuration] with Glendale. I then ordered four additional battalion chiefs, two USAR task forces [and] a hazmat unit.Ó Before he knew the total patient volume, Turner also ordered the dispatch of 40 additional ambulances, something he referred to as ˙a gutsy callÓ that had to be made early.

The LAFD dispatch center switched the incident to a Channel 9 dispatch, which dedicated a dispatcher and one dispatch console solely to this incident.

LAFD BC Craig Fry arrived one minute after Turner and was initially assigned to oversee search-and-rescue operations. Due to the larger USAR and heavy rescue components that complement the LAFD, all physical rescues/extrications were assigned to LAFD.

Fry says, ˙Early in the incident, passengers were crowded along the fences, seeking a way to get clear of the hazardous scene.Ó He gives credit to LAFD Capt. Schneider_s early radio reports and actions: ˙Schneider_s cool demeanor and approach to the incident set a positive tone.Ó

Time & Location Help

Luck is always welcome at a disaster. This incident occurred at about 0600 hrs, a time when fire, EMS, police and hospital personnel normally prepare for shift change. The extra staffing afforded by the time of day when this incident occurred allowed the involved agencies to immediately send more personnel to the scene and maintain their ability to handle other incidents occurring throughout their systems.

Hospitals held over their night-shift personnel. Non-trauma centers, not accustomed to receiving serious trauma patients, were able to do so and render appropriate care because most of their specialty physicians, such as orthopedic and vascular surgeons, were in-house on rounds when the incident occurred.

A major portion of the incident ended up 50 feet from a massive Costco store, with an enormous, unoccupied parking lot that accommodated command, staging, treatment and incident logistics for the LAFD operations.

The Costco staff opened up exterior snack bar areas for use by LAFD as patient collection and assessment areas, and the tire center for the processing of patients who could be treated and released. They also provided cases of water and other needed supplies throughout the incident.

On the Glendale (east) side, fire and police officials took control of Mag_nolia Street and its numerous industrial parking lots for treatment, staging and transportation. The nearby Glen_dale City Public Works Yard was opened up to accommodate the large volume of walking wounded and non-injured passengers who needed to be assessed and processed.

Triage & Treatment

Because the wreckage divided the scene, the establishment of two distinct, remotely located medical divisions was necessary. Each had its own triage, treatment, staging and transport areas.
 

In his initial scene survey, LAFD Engine 50 Capt. Joe Moreno walked to the opposite side of the locomotive and saw at least six wrecked passenger cars and 100 patients. He was then assigned to travel one-quarter mile along the tracks to further survey the scene and triage patients.

His engineer went to a USAR vehicle, retrieved spray paint and marked all cars and locomotives to display information regarding search completion and victims found (see photo, May 2005JEMS, p. 50).

At 0615 hrs, LAFD EMS Captain Keith Douglass (EMS5) established the main triage and treatment area near the Costco loading docks on the northwest side of the incident and assumed the role of treatment manager.

LAFD Capt. Dave Soto helped Capt. Douglass set up the treatment area. As he did so, he found walking wounded and backboarded patients already flowing toward the area on the flatbed pushcarts. ˙We thought we might just have 20 patients, but they kept coming and coming and coming.Ó

Soto adds that he was glad to see multiple LAFD EMS captains arrive on scene. ˙The expertise of the L.A. City EMS captains at the incident proved invaluable.Ó

On the Magnolia (east) side: GFD Capt. Greg Godfrey arrived and was assigned to walk the tracks and assess the scene. Godfrey says, ˙My initial assessment revealed more than 100 patients. It was a surreal scene, with the smoke, rain and fog kept low to the ground by inversion that day.Ó

The first-arriving GFD paramedic unit (RA25) was assigned to serve as medical communications coordinator. Ambulance staging was already assigned to a GFD captain, designated as the Ground Ambulance Coordinator.

The GFD Engine 26 crew started triage in the passenger cars on the Magnolia (east) side when they arrived, moving from car to car along with personnel from GFD Trucks 21 and 26, and Engine 22. Triage personnel found patients with fractures, impalements, head injuries and lacerations.

Passengers were helping each other, and Glendale Police assisted GFD with moving patients into the Magnolia (east) treatment area set up in a parking lot at Magnolia Street and Los Angeles Ave. Scene tape was deployed to create a visual walkway into the treatment area.

The joint crews used plywood and any other flat objects they could find as improvised backboards to move patients through the opening cut into the fence by GFD Engine 21.

Burbank BC Bob Trowbridge arrived on scene and was assigned to the medical officer position in the Magnolia (east) Division. As treatment areas were set up, personnel realized that a significant number of the patients were walking wounded and causing congestion in the critical and intermediate areas. In addition, the minor injured were wandering into the red and yellow tarp areas, looking for friends who had also been on the trains. So Trowbridge elected to move all walking wounded to the parking lot of a local business located on an adjacent corner. GFD Engine 22 was assigned by the Magnolia division commander to manage the area, and the congestion disappeared.

On the Costco (west) side: LAFD Capt. Greg Olsen (Eng. 56) was initially assigned to triage patients in the passenger cars. ˙The toughest decision that had to be initially made was that patients with agonal respirations would not be managed,Ó says Olsen. ˙We had uninjured passengers assist walking wounded to the treatment area, gave car-by-car reports to IC and had police officers posted to guard the deceased.Ó

LAFD Capt. Rick Godinez helped set up a M*A*S*HÏlike forward triage area adjacent to the final impact zone at the overturned locomotive on the Costco side. This forward treatment area, although limited in size, was initially effective because crews could move critical patients only a short distance for immediate airway management. However, due to a steady flow of diesel fuel leaking from the locomotive and encroaching on the area, crews abandoned that site and used the larger treatment area set up around the corner, near the Costco loading docks.

Godinez noticed passengers loading and moving injured people in Costco shopping carts and flatbed pushcarts. He felt the carts would be a great resource in an area where primary stretchers were unavailable, so he commandeered several flatbed pushcarts to wheel patients over to the west-side triage and transport areas.



Because passengers were separated from their purses, briefcases, backpacks, coats and other personal effects during impact, rescuers and hospital personnel had difficulty identifying several victims.

LAFD's Ed Elguea (Eng. 44) arrived and began to assist Soto in the treatment area. He helped re-triage multiple patients placed within each patient category, to properly prioritize them for departure from the scene. ˙Just when we thought the flow of patients [had] stopped, more began to arrive,Ó says Elguea. ˙So we realized that the critical and intermediate care areas needed to remain staffed by at least a skeleton crew throughout the incident to be prepared to manage patients that [might] be found or arrive later.Ó

Despite scene debris, difficult extrications and the enormous scope of the incident, treatment and transportation crews were able to assess, treat and transport more than 200 patients from the scene in less than two hours.

Physician response

Godinez credits the arrival of LAFD Medical Director Marc Eckstein, MD, with the efficient, expeditious movement of patients from the scene. ˙Having Dr. Eckstein on scene was beneficial. By triaging patients along with us, [he] sped up our triage process.Ó

L.A. County Fire Dept. Medical Director Frank Pratt, MD, learned that physicians had been requested to respond to assist in triage, so he reported to the command post and was directed to Eckstein. Despite his tenure in the region, Pratt points out that at this scene he was there to assist Eckstein. ˙Marc and I work together often, and this was his scene, so I worked for him. He would do the same with me if he came to an L.A. County incident.Ó

Extra EMS Captains

The availability of an EMS captain in each L.A. City fire battalion was of great benefit at this incident. Prior to July 2003, LAFD had only six EMS captains to cover the entire L.A. system. Now, however, the department has 16 EMS captains on duty at all times, one per battalion.

During this incident, LAFD quickly dispatched several EMS captains not originally assigned to the area to assist at the incident and tapped their field experience to manage major components of the EMS operation.

Each EMS captain carries color-coded triage and treatment tarps and MCI supplies in their response vehicle, enabling them to rapidly establish multiple, easily identifiable treatment areas. The EMS captains remained linked to each other throughout the incident via a direct tactical frequency.

EMS Staging

On the Magnolia (east) side, GFD Capt. Eric Indermill established a staging area, with police assistance. Pasadena Fire Capt. Kevin Costa responded to the scene to assist, and he attempted to have area hospitals notified of the incident as early as possible. However, the region_s Medical Alert Center (MAC), responsible for daily hospital bed availability updates and assistance during major incidents, appeared to be taxed with the volume of communications underway at the incident. Costa says, ˙I notified MAC on UHF and was told to Âstand by; we're working a major incident in L.A. City._Ó They didn't realize Costa was calling about the same incident.

On arrival at Magnolia (east), Costa was asked by GFD commanders to serve as the Transportation Group Supervisor. Because of the early request for extra ambulances by Railroad IC, transportation resources were never a problem. Costa requested and received an additional company (Burbank Truck 12) to assume the role of Recorder for the transportation area. GFD Captain Greg Godfrey was assigned as Treatment Dispatch Manager, and BFD Truck 12 recorded each patient_s triage tag number, severity of injuries, transporting unit designator, receiving hospital name and transport times.

Costa, a regional MCI instructor, quickly determined that to facilitate loading the large number of ambulances arriving in staging and because of the wide egress area available he could change the single-file staging pattern and position the arriving ambulances in a side-by-side pattern.

This enabled Costa to simultaneously load two ambulances. His recorder and medical communications personnel were able to keep up with the documentation, and the patient-to-hospital processing speed was doubled. This key operational change greatly facilitated the rapid transport of patients from the scene.

On the Costco (west) side, LAFD was blessed with a large parking lot where their staging officer could also position multiple ambulances in a side-by-side manner and place many more in a secondary staging area next to the nearby Toys ˙RÓ Us building.

USAR Teams Utilized

The USAR teams dispatched to the incident were invaluable to rescuers working to extricate trapped patients. Team members rapidly shored uneven passenger cars to facilitate the rescue operations. The teams also aided in rigging stretchers and lowering systems to move patients down from elevations of 30Ï40 feet.

One victim freed by rescue and USAR personnel felt hopelessly trapped and in danger of death, so he wrote: ˙Iheartmy KidsÓ and ˙Iheart LilÓ (his wife) on a seat frame with his own blood (see photo, p. 60). He was rescued, survived the incident and was reunited with his family.

Casualty Collection Point

Because of the high volume of walking wounded and uninjured passengers stating they didn_t require further care, officials established a casualty collection point (CCP) in Costco_s enclosed, well-lit, exterior snack bar. The area offered shelter from the rain, had picnic tables the passengers could sit at and ample space for EMS providers to simultaneously and efficiently assess dozens of patients.

Police Assistance

The involved police agencies played a major role because the incident was also a crime scene. However, they did not inter_fere with EMS or rescue operations. In fact, police commanders arriving on scene joined forces with the fire commanders and advised their dispatchers to broadcast over police frequencies that police units should avoid parking in the way of approaching fire and EMS units.



Police also helped with immediate street closures, established a perimeter around treatment areas, assisted with ambulance staging and, in many cases, helped carry immobilized patients to the treatment areas.

Crowd & Media Control

Although L.A. and Glendale police were instrumental in quickly setting up and maintaining a tight perimeter around the incident, civilians became a significant problem as they rushed to the scene insistent on finding loved ones who had been on the trains. Media also converged on the Costco parking lot because of its easy access; they had to be moved to a designated briefing area.



To eliminate the civilian influx but satisfy their need for passenger information, an off-site emergency information center (EIC) was established by the Glendale police in the community room of their nearby headquarters. Red Cross personnel, police investigators, off-duty personnel, clergy and grief counselors quickly staffed the EIC.



The city of Glendale also established a Metrolink accident hotline and disseminated the number to media representatives to create a single information access point. More than 600 calls were received during the first 32 hours of the incident. The EIC provided information to the command post, the emergency operations centers, the victims_ families and the city PIOs.

The Benefits of Training

Emergency personnel in the region regularly train together for MCIs, WMD incidents and special events, such as the Rose Bowl, Tournament of Roses Parade, World Cup Soccer and the Super Bowl. In addition, GFD has a policy that requires all personnel to complete a triage tag at least once each month, during care of a non-MCI patient toensure familiarity with the tags.



The MCI practice and drills proved valuable to the agencies involved in this incident. Prior to any formal orders, all patients were triaged and tagged, treatment areas were rapidly established, ladder and rescue companies were effecting rescues, and staging areas and transpor_tation systems were established.

Post-Incident Analysis

Four post-incident analysis (PIA) sessions were conducted to assist personnel in their review of on-scene actions and to adjust plans for future incidents. Metrolink held a PIA soon after the incident, followed by internal reviews by the L.A. and Glendale fire and police departments. A joint PIA between the L.A. and Glendale fire departments was conducted on March 3, 2005.

Conclusion

The unified command initiated by Los Angeles and Glendale fire dept. command officers was a central reason for the success of this incident. The physical placement of the two command vehicles together in the initial moments of the incident, and the familiarity each department_s command officer had with the other, were key elements.



An L.A. Times editorial on Jan. 27 titled, ˙A Response of Grit and Grace,Ó commended the emergency personnel who responded to this multi-jurisdictional incident, stating, ˙It was everything the region could have hoped for. All those earlier rehearsals paid off.Ó



Emergency personnel involved in the post-incident analysis of this event, although appreciative of the praise offered for their successful incident management, were quick to remind each other that if the incident had occurred in a different location or just one hour later when the commuter trains are usually packed with upward of 1,700 passengers, their tasks would have been quadrupled in magnitude. It was a reminder that each agency must always plan and prepare for worst-case scenarios in their respective jurisdictions. JEMS

A.J. Heightman, MPA, EMT-P, is editor-in-chief of JEMS. He is a former EMS director and EMS operations director who has researched and specialized in MCI management training for 30 years. Contact him via e-mail ata.j.heightman@elsevier.com.



Scott Mohlenbrok is a fire captain/paramedic and EMS coordinator for Glendale Fire Dept. Contact him atsmohlenbrok@ci.glendale.ca.us.



Marc Eckstein, MD, FACEP, is medical director of the Los Angeles Fire Department and an associate professor of emergency medicine at the USC School of Medicine. He_s also a member of the U.S. Metropolitan Municipalities EMS Medical Directors and a JEMS editorial board member. Eckstein served as on-scene medical director for this incident. Contact him ateckstein@usc.edu.

MCI

MCI staffing resources

Los Angeles City FD 301

Glendale FD 71

Burbank FD 10

Los Angeles County FD 9

Pasadena FD 3

Private ambulance agencies 80 TOTAL: 474

Fire & EMS Resources Deployed

Command staff units 42

Engine companies 28

Truck companies 10

Light force companies 9

Heavy-duty task forces 11

Total ambulances 59

Î 18 ALS

Î 11 fire department BLS

Î 30 private BLS Helicopters 3 USAR teams 2 Hazmat teams 2

Helicopters 3

USAR teams2

Hazmat teams2

Patient Volume

Total patients treated& transported 129

Î 24 critical, life-threatening injuries

Î 34 intermediate (moderate) injuries

Î 71 minor injuries

Total deceased on scene 11

Total patients treated & released101

Total patients assessed241

Total hospitals utilized15

Total patients freed from heavy entrapment 12

Total deaths after on-scene care0

Clickhere to readTraum at the Tunnel. An article about the Metrolink train crash September 12, 2008.




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