Administration and Leadership, Expert Advice

Multi-Agency Coordination during Tennessee School Bus MCI

Multi-Agency Coordination during Tennessee School Bus MCI
The AmbuBus makes its way toward the staging area set up by Hamilton County EMS at the scene of a school bus MCI in Chattanooga, Tenn. (Angela Lewis Foster/Chattanooga Times Free Press via AP)

As the director of an EMS agency, your Mondays typically are predictably the same. What occurred over the weekend? What do I have on my schedule for this week? How is our budget looking? Do I foresee any problems that haven’t presented themselves yet? I always look forward to the end of the day on Monday so that I can get on with my week. Little did I know that Monday, Nov. 21, 2016, was destined to be anything but ordinary.

The first inkling of a tick in the normalcy of the day came at 1520 hours in the form of a page from our 9-1-1 communications center: “MVC at Talley Rd involving school bus. Possible child fatality.” This was shortly followed by a phone call from the center director, Jeff Carney, confirming that I was aware of the situation. He told me that the first reports were of a loaded school bus on its side off the road.

Our protocol response for a bus accident is two ambulances and one supervisor. I verified that we had a response and advised him that I was en route to the scene. While en route on the five minute response, radio traffic confirmed the initial report and provided additional information of a loaded bus with multiple entrapments. Given that information, I requested that our comm center notify the regional communication center at Erlanger Trauma Center of the situation, and that our regional state EMS coordinator be notified. I also requested that additional ambulances be assigned to this call and requested that communications notify our administrative staff of a mass casualty situation.

Our initial medical sector command had been established by Lt. Tony Sylvester, the first arriving EMS supervisor. He initiated triage by assigning Chattanooga Fire Department first responders to move the uninjured or minor-injured children to an area across the street and two houses down from the accident site. He also tasked firefighters to move those with moderate injuries to an area across the street and one house up from the site.

I arrived on the scene and received my first briefing from Lt. Sylvester. We were dealing with a bus from an area elementary school with 35 kindergarten-through-fourth-grade students. Our initial discovery was at least three fatalities and several critical patients entrapped in the bus, which was on its side and wrapped around a large oak tree. Our first ambulance crew was inside the bus working with firefighters and determining the best ways to remove the injured children.

I met with senior fire and police supervisors on the scene and began our incident command structure. We assigned various EMS supervisors to transport and staging positions, and designated an area two blocks away as the staging area for responding ambulances. We then notified communications of the need for all available county EMS units, as well as additional resources from area private-sector agencies. Due to this incident being on a narrow, two-lane residential street and in the middle of the block, we vectored arriving units from staging to either the north or south end of the scene as patients were packaged for transport. Various on-scene EMS supervisors, including Deputy Chief John Combes and Captain Wade Batson, served as coordinators between the various extrication sectors that had been established on separate aspects of the bus.

Other tasks, such as coordinating the placement of transporting ambulances on the loading scene, were handled by Lt. Billy Blea. Our other district supervisor, Lt. Greg Allen, was initially on scene but tasked with overseeing our county for all routine calls and responses. We were provided additional resources from two adjoining counties, Rhea County EMS and Bradley County EMS, who provided ambulances to answer our routine 9-1-1 requests.

Our logistics division responded to the scene and provided additional equipment for this MCI. Captain Eric Ethridge and specialists Bob Williams and Tim Hixson distributed backboards and restraints to the triage sector locations and facilitated needed medical supplies for those patients requiring care. Lt. David Burdette from our training division was also on the scene assisting with multi-agency coordination. Our total on-scene resources included 13 county ambulances and 10 ambulances from the private sector agencies. Additionally, we received the use of an AmbuBus to transport 10 stretcher patients.

This scene was one of the calmest and best coordinated events I have ever been a part of. I can’t begin to say enough about the professional demeanor of our AEMTs and paramedics as they tirelessly worked to provide as much aid and comfort as was humanly possible. The working efforts of the Chattanooga Fire Department providing initial treatment and evacuation of the injured children, as well as the challenges of various aspects of the extrication process used to remove the bus from the patients, was as professional as I have ever seen. The officers of the Chattanooga Police Department assisted with all manpower needs and on-scene security, making sure that all necessary personnel and equipment had ease in access to the scene. Personnel from various organizations, such as the Hamilton County Sheriff’s Department and the Tennessee Highway Patrol, stood by to support as needed. Administrative personnel from the Hamilton County School offices were on the scene in order to provide name rosters, accountability of children, and answer the needs of the vast numbers of parents and family members of patients who showed up on the scene.

During the initial aspect of this event, the Hamilton County Emergency Operations Center was activated by the Deputy Director of Hamilton County Emergency Management, Winston Shields. This location served as a clearing house for all information from the scene and worked with the receiving hospital regarding patient counts and conditions. It also became a gathering place for agency leadership in order to keep the public informed through regular press briefings.

This tragic incident finally ended almost three hours after its beginning, with the removal of the final critical patient. Our crews took a short break and then began the arduous task of removing the four small children who succumbed to their initial injuries. The feeling and exhibitions of rapid need was replaced by a sense of determination and respect. Once the final patients were removed and transported to the forensics center, each agency gathered together for a short “hot wash” and critique.

Units on the scene began cleaning up all unused equipment and we released all assisting agencies. Our ambulances returned to routine operations. All agencies involved were provided with a stress debriefing session before the night ended and further arrangements were made for those personnel requesting or requiring additional emotional assistance. We did relieve one paramedic of duty for the remainder of her shift. She was the lead paramedic on the initial ambulance and spent the entire three hours in the bus among both the living and the dead. Counselors have remained in touch with her and she has since returned to duty.

Our final results on this incident were four fatalities on the scene and two who later expired in the trauma center. We transported 14 children by ambulance and eight by AmbuBus. A total of 23 ambulances were on the scene, but 10 remained in staging and were not used.

If our agency learned nothing more than one takeaway from this incident, it is the importance of repetitive training and planning. The more agencies you include in your disaster drills, the more common ground you will have when disaster strikes. It will. It always does. And it’s not always somewhere else. But it will always be on a Monday sort of day. No matter what day it actually is.

Ken Wilkerson, EMS MCI response

Ken Wilkerson has been either chief or director of Hamilton County EMS since August 1988. Prior to his current position, he was a firefighter/paramedic with the Chattanooga Fire Department and is a veteran of the United States Air Force. He has served on the Tennessee State EMS Board and was selected as the NAEMT Administrator of the Year in 2005. He also was elected as Mayor of Lakesite, Tenn., a city of 2,000 citizens located in north Hamilton County, where he has served for the past 18 years.

Hamilton County EMS is the primary 9-1-1 provider in Hamilton County, Tenn. Covering an area of 571 square miles with a population of over 300,000, they responded on over 34,000 9-1-1 requests last year. The service is provided by 14 ALS ambulances responding from 13 stations. The service is full career and operates as a department of Hamilton County Government.

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