On Tuesday, May 31, 2011 at 4:55 a.m. a charter bus traveling north on I-95 in Caroline County, Va., overturned and crashed along the right shoulder. The bus was carrying 57 passengers and a single driver. It was en route to New York City when the crash occurred. Acting Fire Chief Mark Garnett of Caroline County Fire-Rescue and Emergency Management shared some of the details of the incident and some of the successes and challenges.
Fifty-three of the passengers suffered injuries and were transported to 10 different hospitals. Four patients were pronounced dead on scene. Ten fire and EMS agencies and three law enforcement agencies responded to the incident.
By coincidence, a Virginia State Police Trooper was working in the area and arrived on scene within a minute of the call. The bus was literally still rocking on the trooper’s arrival. At this time, numerous patients were self-extricating from the front of the bus windshield onto the shoulder and right lane of the interstate. The officer’s rapid response and early traffic control were critical in the prevention of further injuries immediately following the crash.
Because the location of the incident was about three miles from the Hanover County line, resources were dispatched from both Caroline and Hanover counties. The first medic unit, Caroline Medic 228, arrived on scene at 5:11 a.m. and established command. Shortly thereafter, Hanover Battalion Chief 3 arrived and implemented a unified command structure. Additional units and resources were requested and arrived from throughout the region. Triage and transportation incident command system functions were implemented. Commercial, heavy-duty wreckers were called to assist with vehicle stabilization, and this proved invaluable. The final “green” patients were transported from the scene at 9:34 a.m.
The management of this mass-casualty incident (MCI) incident included many successful strategies, but we’ll highlight three.
The first was the use of specialized mass-casualty resources. Caroline County operates numerous MCI trailers that are strategically located throughout the county. These trailers carry 25 backboards and various other medical supplies. The trailers provided much-needed equipment to supplement the equipment carried on responding ambulances.
Another resource used was an ambulance bus operated by Staffford County Fire & Rescue. The bus was called to the scene and used to transport green patients, thereby freeing up ambulances to transport patients with more serious injuries.
This highlights the importance of knowing what regional resources are available. Also, we shouldn’t necessarily discount a resource simply because it seems to be located too far away. Some resources, such as ambulance buses, may be useful even later in the incident. MCI operations tend to be lengthy, so ambulance buses can be useful for transporting the remaining green patients. Also, their use will reduce the number of ambulances needed to manage the patient load.
The second successful strategy was sharing command responsibilities. The time of the day greatly affected the number of Caroline County staff available to respond to the incident. Career personnel staff three stations 24/7 and three stations from 6 a.m. to 6 p.m. on weekdays. This incident happened when many Caroline County volunteers were unavailable to respond because of work commitments and before 50% of the career staff was on duty. Therefore, Caroline County had limited volunteer and officer participation.
This affected the number of personnel who could be assigned to command positions. Fortunately, the cooperation with neighboring jurisdictions was excellent, with everyone coming together to support a single mission. Therefore, personnel were assigned to command positions based on experience levels and not geographic boundaries.
For an MCI to be managed successfully, especially in areas in which multiple smaller agencies service an area, EMS providers must all be able to work together to achieve a successful outcome. In previous columns, we’ve discussed the need to make assignments based on ability rather than simply using rank or agency affiliation as the determining factor. This incident highlights the reasonableness of this approach.
The third successful strategy involved family reunification. Reunification efforts began at the incident scene and continued into the evening. Unfortunately, tour bus regulations didn’t require the operator to maintain a passenger manifest, and this complicated the process. Other complicating factors included language barriers. Some passengers spoke Spanish, Chinese and Middle Eastern languages. On scene, Caroline County had two Spanish speaking EMS providers who initially assisted. Once at area hospitals, language services were used.
Another challenge was that patients were spread out over a distance of 97 miles because so many hospitals were used. As news of the incident spread, many out-of-state families desperately called, seeking reunification with passengers. The American Red Cross (ARC) assisted patients by providing temporary housing and transportation needs after the patients were discharged from Richmond area hospitals.
This aspect of the incident emphasizes the importance of good patient tracking and the need to have a reunification plan in place. In aviation incidents, the ARC is responsible for setting up family assistance and reunification centers. Many ARC chapters are willing to assist in a similar manner at other MCIs. However, EMS agencies need to determine whether this resource can be used prior to an MCI. EMS agencies should involve their local ARC chapters when developing MCI response plans and determine how to use this resource.
Radio communications presented some challenges for responders. Responding agencies came from a wide geographical area. Eight different radio systems were used, including UHF, VHF, 800 analog and 800 digital. Some mutual-aid agencies lost contact with their dispatch centers simply because they traveled outside their system’s intended foot print. To address this, Caroline County is developing a regional interoperability communications plan.
Garnett mentioned that the level of cooperation among all responders and disciplines was second to none. By no means would the incident have been mitigated as well without the assistance of their neighbors. This type of cooperation doesn’t happen overnight, but it must be developed. We can all benefit from a review of our own systems to evaluate whether the same cooperation is available in the event of an MCI in our own jurisdictions.