On Dec. 1, 2011, at approximately 6:58 a.m., emergency response agencies in Sumner County, Tenn. (near Nashville) were dispatched to a 55-car crash on Vietnam Veterans Boulevard. The incident, which was actually four multicar crashes in about a one-mile stretch of road, was caused by thick fog and icy patches on the roadway. A crash of this magnitude presents many challenges to EMS responders. Mike Cook, EMT-P, public information officer for Sumner County EMS, provided some details about the response and also shared some of the lessons learned that can benefit all EMS providers.
Due to the number of calls that were coming in, the initial EMS response consisted of four ambulances. Shortly after arrival, three additional ambulances and supervisory and administrative/support personnel were dispatched.
The first units to arrive were confronted with a scene spread over a large distance. EMS providers began performing triage using the simple triage and rapid treatment (START) system. Patients were also tagged with triage tags. Using the START algorithm, two patients were categorized as green, 13 as yellow and one as red. Most patients were removed from their vehicles soon after being triaged.
Cook mentioned an interesting observation related to the triage categories. The 13 patients tagged as yellow were placed in this category because they were non-ambulatory. Medically, all these patients had minor injuries and could actually be considered green patients. The lesson for departments that use START is simple. Although START works well when performing an initial triage, patients should be re-triaged as the incident proceeds; if appropriate, patients can be downgraded or upgraded to a different color category. This is especially important in incidents with many patients because the accurate assessment of patient acuity levels affects hospital use.
Because access to the scene was impeded by not only the number of vehicles involved in the crash but also the gridlock created by the crash, staging areas were established at both ends of the incident. A single command area was also established at one end. A communications captain in dispatch was used to communicate with local hospitals and relay patient transport availability.
Seventeen patients were transported to area hospitals. This included one patient who required CPR after being extricated and later expired. EMS providers were able to treat this patient without negatively affecting their ability to manage other patients because of the amount of resources on scene.
Sumner Regional Medical Center received eight patients with minor injuries. Hendersonville Medical Center received the critical patient who later died and eight additional patients with minor injuries. All 17 patients were removed from the scene by 8:21 a.m. Sumner County EMS also documented 31 occupants of damaged vehicles who initially denied injuries. This is a good practice at such an event, because it helps protect EMS providers should there be later claims of injuries and that medical care wasn’t offered. As it was, two of the 31 later drove themselves to the hospital to seek medical care after leaving the scene.
After all patients initially complaining of injuries were transported, Sumner County EMS staged a unit at each end of the crash scene to care for any vehicle occupants who might later present with a medical complaint. This proved to be a wise move because one person began to have some complaints and was transported at 10:27 a.m.
Challenges & Observations
Sumner County EMS encountered numerous challenges with this incident. The greatest was definitely the total distance the incident covered. The incident involved pockets of wrecked vehicles and also vehicles with no damage at all. Also, several tractor trailers and a school bus full of children were present. EMS providers had to evaluate all the vehicle occupants. Also, many of the patients who were transported had to be properly immobilized on backboards, so equipment had to be carried a long distance in some cases.
The second challenge was the weather. It was cold that morning, but many motorists were unprepared for the cold because they didn’t expect to be suddenly exposed to it. As emergency responders worked their way through the scene, all the vehicles were ordered shut off because of leaking fluids and other possible hazards. Most vehicle occupants didn’t have coats or blankets, so the loss of heat from their vehicles created problems.
To manage with the situation, Sumner County Emergency Management Agency (EMA) ordered a school bus to the scene to be used as a warming area for motorists. EMA also used buses to shuttle motorists to restrooms as needed. This aspect of the operation emphasizes the need for resource preplanning. Agreements should be in place and a procedure established ahead of time to request such non-emergency resources. Cook mentioned they could have dispatched the communications command post and possibly the mobile command post to assist with shelter, but they found that the school bus worked just fine.
One aspect of the operation that wasn’t particularly an issue but that could have been involved communications. Responding agencies on the scene used a combination of UHF, VHF and 800mhz radios. Because the incident occurred early in the morning and call volume was low, however, a common tactical channel didn’t need to be used. One possible consideration for future events is that Sumner County EMS has a communications command trailer that has the ability to combine those bands into a central tactical channel using crossband repeaters. The trailer wasn’t used at this incident, but it may be something to consider for future events.
Unfortunately Sumner County EMS has experienced three devastating tornadoes and a "100 year" flood in the last several years. As a result, their ability to respond to large-scale disasters has been tested. Because of these experiences, and thanks to preplanning and training, Cook noted that the overall operations went well.