When a LifeFlight helicopter landed carrying critically injured Yehoshua Hoffman, the first casualty taken from an accident scene on Interstate 95 in Argyle on Monday, Eastern Maine Medical Center was ready.
Patient care administrator Karen Clements and Dr. Jonathan Busko, the hospital's emergency department physician, had set the hospital on an increased-readiness level. St. Joseph Hospital of Bangor, the regional trauma center's backup, was notified.
Patients who could be moved to make room for the 12 remaining van accident survivors were identified. The operating room, radiology and intensive care units were standing by. A trauma team - a surgeon, anesthesiologist and respiratory, X-ray and lab technicians - was activated, and the pediatric department was getting ready to handle 10 teenage boys injured in the crash who would come pouring through the emergency room doors at any minute.
"When you have a mass casualty, initially there's chaos at the scene until an incident command is set up," Clements said Tuesday. "The first responders do a great job alerting the trauma center of basic information to get us started preparing for impending trauma.
"That's why there's no details about injuries," she added. "There's just some basic, 'get ready, here we come' that really helps us to gear up and be ready for a large amount of trauma."
Emergency responders gave themselves high marks Tuesday for wading through the sudden chaos of the tragedy.
"We have had one short debriefing yesterday, but from all accounts, we feel that from our standpoint everything went very well," said Donald O'Halloran, Old Town's public safety director. "Within a matter of minutes, whoever needed assistance got it."
"It was a lot of teamwork on all parts," said Melissa Preble, a dispatcher with the Penobscot County Sheriff's Department, which dispatched emergency responders to the scene with Maine State Police.
The effort gratified the victims and their parents. Only one accident victim remained hospitalized Tuesday night. The patient, whose name was not released, was in critical condition, according to an EMMC spokesman.
"My son, who Thank G-d was not critically injured, reported that everyone was treated professionally and with the utmost compassion," e-mailed Ira and Leah Davidson of New York on Tuesday. "We thank all of you very much."
Passenger Gedalia Rosenblatt, 15, of New York died in the crash, while van driver Yehoshua Hoffman, 22, and passengers Daniel Gabay and Yakov Kahan were seriously injured. The 10 remaining Orthodox Jewish youths ages 14 to 18, who were headed to camp at Baxter State Park and canoe the Penobscot River, suffered broken bones, sprains and cuts.
As far as could be determined Tuesday, the closest responder to the accident, Old Town, arrived with police and ambulances first, although an unidentified volunteer firefighter from Etna in his own vehicle might have beat them there, Penobscot County dispatchers said.
A passer-by reported the accident at 7:03 a.m. Old Town's first ambulance radioed arriving at 7:14 a.m., dispatchers said.
Old Town police Officer Brent Fournier arrived first among police, at 7:20 a.m., with Officer Lori Renzullo and Officer James Slauenwhite, a former Lincoln officer in training with Renzullo, arrived shortly thereafter, O'Halloran said.
Capital Ambulance Services of Bangor sent two ambulances, as did Old Town and Orono, while Brewer, Glenburn and Hampden sent single rigs. The helicopter is counted as an ambulance. Fire departments responding included Alton, Old Town, Orono and Veazie, dispatchers said.
Some departments dispatched trucks to towns that had sent everything they had to the accident, dispatchers said. Dispatchers dismissed some apparatus en route when they learned they weren't needed.
State police dispatched several officers and an accident reconstruction team, which assumed responsibility for investigating the accident and controlled traffic. That investigation continues.
Not everything went perfectly at EMMC, Clements said. Too many staffers flooded the hospital's Emergency Department, so officials will refine the hospital's mass casualty plan to create another area, near the emergency room, where extra staff can congregate for assignment.
Some staffers who had to track Monday's accident victims through the hospital's computer system suggested creating a mass casualty victim icon that would help them track patients better, which Clements called brilliant.
"Once they are in the system, they are flagged like every other patient," she said. "Now we'll know at a glance who they are and where."
All emergency responders must have and continually update mass casualty incident plans, but actual incidents involving more than a dozen injured or killed are rare, said Frances Loring, EMMC's pediatric department patient care administrator.
EMMC activated part of its plan when a red tide incident poisoned four people who had eaten shellfish in Washington County on July 31.
On the cruise ship Regal Princess a stomach virus struck about 20 percent of the ship's passengers in 2003, but the incident concluded before the ship docked in Bar Harbor. A 50-vehicle, 3-mile pileup in an I-95 northbound lane in Hampden caused by fog and black ice injured 22 people in 2001.
EMMC conducts mass casualty drills twice annually, but activates parts of its plan six or eight times a year to handle incidents such as Monday's accident.
"We do disaster drills, we try to be prepared, and people are often surprised at the range of things we do here," Loring said. "People think of us as a small community hospital. They don't realize that we service two-thirds of the state. LifeFlight lands here every day. We do things like this on a small scale every day."
The hospital's proximity to Bangor International Airport, one of the Federal Aviation Administration's designated landing points for international jets in distress, forces EMMC to have plans for handling a huge array of disasters and cultures, Loring said.
Much disaster response is improvisation, Loring said. Monday's victims being Orthodox Jews made it essential to contact leaders of Bangor's Jewish community for guidance. Hospital officials turned a pediatric floor conference area into a family room, with four extra telephone lines for the families' use.
"So I was able to say to one mom, 'Hold on, I'll go see how he's doing,' and go talk to his nurse, who was right there," Loring said.
"Do we have issues that we could do better? Always," said Clements, who has worked at EMMC for 17 years. "We're not perfect, but that's how we get better, by taking the minor issues and flaws and talking about them and making them better.
"We have never had a major system flaw that has hurt patient care."