On November 16, 2010, heavy fog enveloped a portion of I-77 in Carroll County, Va. This led to multiple crashes involving 70 vehicles, including tractor-trailer trucks, pickups, RVs, and even an ambulance in transport from Tennessee to North Carolina. Fortunately, only one truck transporting potentially hazardous materials was involved. There were 16 injuries, four of which were serious in nature, and two deaths. In addition, several livestock were found dead and some were injured when the truck transporting them overturned.
Initial reports were vague as to its true extent. Responding units initially thought only a few vehicles were involved, as the report was for a jack- knifed tractor trailer versus an automobile (not unusual for this area of I-77). However, once the first units arrived, the true scope of the crash became clear. The incident was actually multiple crashes for a distance of nearly 1 ½ miles. It has since been considered as three separate major accidents.
Accessing southbound lanes in this area of the interstate is difficult because there is no access from northbound lanes. The only way to reach these lanes is via the lanes themselves, which made it difficult for southbound ambulances to be able to proceed through the accident scene to reach injured persons. Additionally, emergency vehicles had to drive through thick fog, which prevented them from actually seeing the wrecked vehicles until they were within a few feet of them.
Communication with Mike Mock, Emergency Services director for Carroll County, Va., provides us with insight on the operation and can help us better manage multi-vehicle pile ups.
The first emergency units to arrive on scene were a Virginia State Police officer and Carroll County Fire-Rescue (CCFR) Unit 1000, which was staffed by Firefighter/EMT-E Andy Utt. CCFR Medic 4 arrived shortly thereafter. Incident command was established using a modified Unified Command structure due to the scope of the incident and number of agencies involved. Utt had to maneuver his unit by weaving between vehicles on the interstate from north of the incident progressing to the south. As he proceeded, the complexity of the situation became obvious, and he immediately began requesting additional assistance, including units from North Carolina. Southbound lanes of the interstate were closed approximately 30 miles to the north to prevent further crashes. Some responding units arrived and started work, while others staged at various entrances until it was determined where they were needed.
Scene size-up and triage were performed early. Multiple tractor trailers were involved, and providers had to determine if any carried hazardous cargo. Also, triage was complicated due to the size of the scene and because some patients were congregated in various areas, while in other instances, patients remained in their cars. START triage was initially used by Utt. He walked the accident scene treating those in immediate need until other EMS providers began to arrive. Patients were labeled and then moved for transport. At one point, he encountered 20 to 30 people standing together saying they were “walking wounded.” After an assessment, he determined that only a few were in need of medical care, so those with more serious injuries were treated and transported.
Formal Treatment Areas didn’t need to be established because patients generally could be loaded onto ambulances relatively quickly. However, in some cases when ambulances couldn’t get close enough, it was necessary to carry patients by hand. This included some critical patients, who were immediately carried southward down the interstate to waiting ambulances that had traveled north in the southbound lanes. Most non-critical patients were placed in ambulances that had to wait until wrecked vehicles were moved to allow them to exit the scene.
Early on, it was decided that all patients would be transported south to hospitals in North Carolina. All serious and critical patients were removed from the scene within an hour after first units arrived. This was a success considering the logistical issues and the magnitude of the accident scene. All patients were removed within about two hours of the initial arrival of EMS units.
Twelve of the 16 patients were transported to Northern Hospital in Mt. Airy, N.C. The hospital had implemented its emergency operation plan as soon as it was notified about the incident and was well prepared to receive a much larger number of patients. For a short time, Doctor Jason Edsall (who manages the Emergency Room at Northern) was at the accident scene to assist since he also serves as the Medical Control Physician for Carroll County Fire Rescue and all Carroll County rescue squads. The most critical patients were later transported to Wake Forest (Baptist Hospital) in Winston Salem, N.C.
Formal Level 2 staging areas were established at various entrances to the interstate. The largest was directed by a staging area manager, whereas some staging areas with fewer vehicles didn’t have a manager assigned. A Level 1 staging area was established in the southbound lane on the south side of the crash to receive the incoming units from the south. Additionally, to improve scene ingress and egress, Virginia State Police began instructing wreckers to begin moving vehicles, so ambulances waiting with non-critical patients could be moved.
Incident Challenges, Successes & Plans for the Future
Limited visibility due to fog was the greatest challenge. Not only did it hamper access, but it also made it difficult for providers to remain oriented to their positions on the scene. Another significant challenge was the low number of rescue personnel initially on the scene. On the initial response, only seven firefighters were available to perform extrication. Extrication efforts were further hampered because equipment had to move slowly. Some vehicles were on top of others, and stabilization and removal of patients was delayed until equipment could arrive.
Numerous successes are also related to this incident. Triage was handled quickly; all patients with critical and serious injuries were removed from the scene within an hour, and all other non-critical patients were transported within two hours. Considering the magnitude of the incident, the number of agencies involved and the work required to remove and treat the patients involved, this was remarkable. Twin County Central Communications also added staff to better manage the number of radio transmissions and phone calls related to the incident. No fire or rescue providers were injured during the operations.
Although the department doesn’t have a written MCI Response Plan, the large number of agencies on the scene worked seamlessly together. Eight agencies from Virginia (Pipers Gap Rescue Squad, Cana Rescue Squad, Cana FD, Laurel Rescue Squad, Carroll County Fire and Rescue, Hillsville VFD, Laurel Fork Rescue Squad and Galax-Grayson County EMS) and nine from North Carolina (Mt. Airy FD, Surry County EMS, Air Care Ground Ambulances, Franklin FD, Mt. Airy Rescue Squad, Pine Ridge FD, Pilot Mt. Rescue Squad, Dobson Rescue Squad and NuCare Transport) contributed to the success. No fire or rescue providers were injured during the operations.
A secondary search of vehicles was performed to ensure all patients were accounted for, and all occupants were given the chance to receive medical aid. This search resulted in no additional patients for transport.
A pre-operation plan, which will allow for pre-determined response agencies, including mutual aid from N.C., staging areas and implementation of all ICS principles is under development. It will also address how to handle situations in which participation from volunteer fire departments is low.
Ways to obtain additional experienced command personnel and improve personnel accountability procedures in similar incidents are being evaluated. This was an issue in this incident, as there were not as many experienced fire officers on the scene as they would have liked.
A number of lessons can be learned from this incident:
• Even if an area is resource rich, expect delays due to limited visibility and congestion caused by vehicles involved and response vehicles.
• Make good use of staging to reduce congestion and to be in a better position to assign limited resources to where they’re needed most.
• Make use of wreckers to move wrecked vehicles if needed to allow emergency vehicles better access to the entrapped and injured.
• Even if multiple treatment areas are established, or if patients are immediately transported from different parts of the scene, a single transportation group should be assigned to manage the entire incident. This will prevent confusing the hospitals, allow better patient destination decisions to be made and improve tracking of patients.
• Humans aren’t always the only living beings that must be treated. Have plans in place to obtain veterinary and animal control assistance. Remember, it’s not just the safety of the animals. Loose and injured animals can be a risk to rescuers if not managed properly.
• Involve the local communications center in planning, so they can bring in additional personnel if needed.
Whether from fog, snow or ice, multi-vehicle pile ups can occur in almost any jurisdiction. I’d like to thank director Mock for providing us insight that can help us all be better prepared.