Lessons Learned From An MCI in Pa.

Last month we talked about mass casuality incidents and being prepared for them. As my parents always said, “Beware of what you wish for.” Probably within 15 minutes of hitting the send button and shipping the MCI article off to the editor, I responded to a reported tour bus accident on U.S. Route 15 in our first due coverage area.

A few lessons were learned from that event. First off, congratulations to my department’s officers and responders and the mutual aid companies for a job well done. There was some luck involved, but the Gettysburg Fire Department and the assisting agencies had their “A game” on.

It was late in the afternoon approaching the dinner hour and two tour buses were returning from Washington D.C. with high school students and chaperones when something happened to the driver’s side front tire of the first bus, sending it out of control. It crossed the median into the southbound lanes, up an embankment and rolled onto the passenger side along the shoulder of U.S. 15.

We all caught a break in that the bus driver must have been incredibly skilled as he did not strike any other vehicles – a major feat during rush hour.

Another major break was a quick establishment of command and size-up, which is important in how an incident plays out.

The Chief’s Size-up

Gettysburg Fire Chief Ken Kime made that go very easily as he was on his way home from work when he encountered the bus at rest on its side. Equipped only with his Nextel, he was able to alert communications with a size-up, establish command and start to evacuate the bus.

Prior to the chief’s arrival communications had received calls reporting a bus accident and had dispatched our vehicle accident assignment. With the chief’s size-up, additional EMS resources were requested.

Twelve additional ambulances and three paramedic units were sent to the scene, and the Gettysburg Fire Department response was in motion. We were able to put both EMS units on the street immediately, and one included a volunteer paramedic who was working out at the station. The paramedic assumed the triage officer’s role upon arrival.

The engine and rescue companies responded with full crews including several EMTs, which made patient care, treatment and triage go extremely well.

Another stroke of luck was that there was no entrapment. All of the patients, with exception of two, were walking wounded. The bus was being cleared by the chief and the chaperones as the first arriving units were pulling up. The engine and rescue companies checked for hazards, secured and searched the bus and assisted with patient care.

The captain who arrived with the engine and rescue companies started to do accountability of the students and chaperones.

When the deputy chief arrived on the scene in his privately owned vehicle, he assumed command from the chief. Additional personnel responded in support vehicles providing extra EMS providers and a cache of backboards, C-collars and related equipment and supplies, which were kept at the station for such an event and never been used until the bus accident.

Staging Officer

The assistant chief responded with the department’s duty vehicle and assumed the role of the staging officer. The availability of personnel at that time of day was another stroke of luck.

With so much in our favor that day, we learned some things both good and bad. One of the first is that being prepared pays off. We had stockpiled a little extra EMS equipment for just such an event, and we were glad to have it. Having cross-trained personnel as firefighters/EMTs was an advantage too.

The early establishment of a strong command structure and a good size-up always sets the stage, and in this case the dust hadn’t settled when the chief pulled on scene.

Triage was handled very well, but there were some challenges. Traffic on both the north and southbound lanes was still active when triage was started, and it was confined to a very small area, making it difficult to keep everyone sorted. Triage tarps were used, but initially, there were more patients than tarp space available. Once we were able to get traffic stopped, things worked much better.

One problem during the initial size-up was the arrival of onlookers and unsolicited help. Couple that with chaperones from the second bus crossing traffic in both the north and southbound lanes, and it’s a miracle we did not have any other incidents.

One well-meaning person kept cornering the chief, telling him he could smell gasoline and predicting the bus was going to blow at any minute. For all his good intentions, the bus was diesel-powered, and his distraction just caused more confusion. That’s why scene security is always a good idea.

Communications was an issue. Command staff had to work with portable radios due to the initial locations of the first response vehicles. The duty vehicle arrived with extra portables and another vehicle repeater, which helped improve communications. There was repeater on the scene before the duty vehicle arrived, and we realized that we need to train our personnel on the repeater’s use, as one could have been put to use earlier in the call.

We also realized the need for additional operations channels. Initially, we were on one channel, but later stage and transport were moved to a separate channel to free up radio space.

We found out that we keep all our command support on the duty vehicle, which has a whole host of command boards and support equipment. It didn’t do us any good for the first 10 minutes of the incident. We decided it would be better to have some command paperwork and support equipment on each piece of apparatus. At the very least, we want a command and an operations vest initially. We had the needs of some 40 students, 50 responders and countless bystanders to keep track of. Talk about getting lost in a crowd.

Apparatus staging was another issue. For the most part, things went well, but we need to remind ambulance drivers, particularly those that get lined up, that someone should remain with the vehicle so that as everything is moved up, one isn’t holding up the line for lack of a driver. It only took one to mess things up.

As for transport, don’t be afraid to send more than one patient in an ambulance if you have the crew to do it. Some good things included the fact that the school district involved and the bus company were close by. We had representatives from the bus company and a spare bus to transport the non-injured students and chaperones to the hospital for a secondary triage within 15 minutes of being on scene.

Returning Equipment

The school district was able to get people to the scene and to the hospital to help coordinate and notify parents. Bus company representatives provided information on ensuring proper stabilization and securing of the bus and reviewed proper shut down procedures.

It’s important to remember the importance of returning equipment. The accident scene looked like a fire and EMS flea market. As units left, we found backboards, collars and all kinds of other supplies lying around. All the leftover equipment was gathered up and transported to our station for distribution as a safety measure. We didn’t want units coming back to the scene and potentially being in the way of traffic as we opened the road.

We broadcast a message from dispatch with instructions on where to find the gear. Unfortunately, not everyone heard it because we had one EMS unit pull up in the northbound lane, stopping along the shoulder with the crew bailing out to look for their gear. We have to remind everyone every once in a while that safety has to come first.

Response Routing

Another issue was response routing. Initially some units responded northbound in the southbound lanes, and it’s not clear whether traffic had been stopped when they made that maneuver.

A clear route was quickly established and communicated via dispatch, using the interchange north of the incident, meaning some units had to pass the incident and turn around a quarter mile up the road. It was difficult for some to pass the scene, but it was needed to maintain safety and staging.

Overall, we had good people and a strong response. The quick actions by the bus chaperones, Chief Kime and Paramedic Sarah Fishburn, who was the triage officer, definitely put the incident in our control, rather than having the incident control us.

As always, be careful what you wish for and return to quarters.

Editor’s Note: Allen Baldwin is the manager of operations and incident response for the Pennsylvania Turnpike Commission and a volunteer assistant chief with the Gettysburg (Pa.) Fire Department. He has been a firefighter and EMT for over 25 years, served as chief of the Chambersburg (Pa.) Fire Department and is an instructor with the Pennsylvania State Fire Academy and several community colleges.

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