Field Triage and Transport:Field Triage and Transport: A Case Study ofA Case Study of

Good PreGood Pre--Incident PlanningIncident Planning

J. J. Jones, LPMJ. J. Jones, LPMFire Chief Fire Chief

Sherman TexasSherman Texas

Donna Glenn, RNDonna Glenn, RNEmergency Preparedness Emergency Preparedness

CoordinatorCoordinatorTexoma Medical CenterTexoma Medical Center

Denison TexasDenison Texas

Sherman FireFire

EMS

Texoma Medical CenterTMC

PrePre--Incident EffortsIncident Efforts

2004 Ten People killed in single MVA2004 Ten People killed in single MVA2005 Hurricane Katrina & Rita2005 Hurricane Katrina & Rita2006 County Wide Fire Radio Channel2006 County Wide Fire Radio Channel2007 June 18, 100 Year Flood 2007 June 18, 100 Year Flood

2 Deaths in the community2 Deaths in the community109 NH patients evacuated to WNJ109 NH patients evacuated to WNJ

June 21, power outage TMCJune 21, power outage TMC89 hours on emergency generators89 hours on emergency generators

PrePre--Incident EffortsIncident Efforts

20082008January NIMS 300 and 400January NIMS 300 and 400June MACC trainingJune MACC trainingJuly 22July 22--23, Regional EOC 23, Regional EOC Communications ExerciseCommunications ExerciseJuly 30, Regional Hospital July 30, Regional Hospital Communications ExerciseCommunications Exercise

Goals for TodayGoals for Today

Specific lessons learned from theSpecific lessons learned from theBus Crash, 08/08/08Bus Crash, 08/08/08

–– Communication: Internal and ExternalCommunication: Internal and External–– Patient / Clinical Support: Patient TrackingPatient / Clinical Support: Patient Tracking–– Resource and AssetsResource and Assets

Scene TransportScene Transport

55 Passengers on the Bus55 Passengers on the Bus32 Patients Transported by Ground32 Patients Transported by Ground16 Air Ambulances16 Air Ambulances–– 11 Patients Flown from the Scene11 Patients Flown from the Scene–– 1 Patient transferred by Air1 Patient transferred by Air

12 Patients Category IV12 Patients Category IV5 Patients Later Died5 Patients Later Died

CommunicationCommunication

From the scene, Incident From the scene, Incident Command (IC) called the Command (IC) called the hospital with a reporthospital with a report

FASTFAST

CommunicationCommunication

The IC called the ERThe IC called the ER…… not the not the House Supervisor or Bed ControlHouse Supervisor or Bed Control

–– EMS is ALWAYS going to call the EREMS is ALWAYS going to call the ER–– Hospitals need to route the call internallyHospitals need to route the call internally

CommunicationCommunication

Call from the IC to the ER, was Call from the IC to the ER, was answered by the clerk.answered by the clerk.

When IC asked,When IC asked,““how many patients can you take?how many patients can you take?””

The clerk counted and reportedThe clerk counted and reported……only open staffed beds in the ERonly open staffed beds in the ER

CommunicationCommunication

Scene transport decisionsScene transport decisionswere based on these bed countswere based on these bed counts

––IC will now say, bus accidentIC will now say, bus accident…… ““we we are sending you are sending you ““##”” patientspatients””

–– In addition to hospital efforts to route calls, In addition to hospital efforts to route calls, this language should communicate gravity of this language should communicate gravity of situation, prompting a call for guidancesituation, prompting a call for guidance

CommunicationCommunication

Call from IC did not mention Call from IC did not mention language barrierslanguage barriers……..

VietnameseVietnamese speaking passengersspeaking passengers

CommunicationCommunication

To address appropriate routing of call to To address appropriate routing of call to House Supervisor and or Bed Control, and House Supervisor and or Bed Control, and to assist collecting appropriate to assist collecting appropriate information, TMC is using a software, to information, TMC is using a software, to bring all the pieces together, bring all the pieces together, LiveProcessLiveProcess..

CommunicationCommunication

FYI: The emergency response at FYI: The emergency response at hospitals was NOT based on the ER hospitals was NOT based on the ER bed availability report.bed availability report.

Disaster plans were activated, staff Disaster plans were activated, staff were notified and responded were notified and responded appropriately.appropriately.

CommunicationCommunication

VoceraVocera facilitated facilitated communications communications with staff and with staff and members of members of hospital commandhospital command

Hospital communication: InternalHospital communication: Internal

This is always a struggleThis is always a struggle

CommunicationCommunication

Hospital communication: ExternalHospital communication: External

Notification to other hospitals in Notification to other hospitals in region delayed.region delayed.

–– Comprehensive training on Comprehensive training on EMResourceEMResource–– Regional MOC, 24 hour contactsRegional MOC, 24 hour contacts

CommunicationCommunication

IC did not make call to hospitals IC did not make call to hospitals when last victim transported.when last victim transported.

Liaison position not filled at scene.Liaison position not filled at scene.

–– Hospital augmenting radio capabilities to Hospital augmenting radio capabilities to monitor radio traffic at scenemonitor radio traffic at scene

–– Liaison position will be filled in future Liaison position will be filled in future

Communication & The MediaCommunication & The Media

Patient TrackingPatient Tracking

Patients were not appropriatelyPatients were not appropriatelydistributed and or transported distributed and or transported

between local hospitals.between local hospitals.

–– Have created large patient tracking boardsHave created large patient tracking boards–– After Action Reports have discussed the need After Action Reports have discussed the need

to coordinate patient distribution. Progress to coordinate patient distribution. Progress will be ongoing effortwill be ongoing effort

Patient TrackingPatient Tracking

Trauma tags from scene were Trauma tags from scene were removed/replaced at hospitalsremoved/replaced at hospitals

–– Hospitals need to associate scene tag number Hospitals need to associate scene tag number with any other tagging system usedwith any other tagging system used

–– Hospitals should associate scene tag number Hospitals should associate scene tag number with the medical recordwith the medical record

Kkk

f

Triage Tag number goes here

Patient TrackingPatient Tracking

On July 30, less than 10 days before On July 30, less than 10 days before the Bus Crash, members of TSA E, the Bus Crash, members of TSA E, North Central Texas Trauma Regional North Central Texas Trauma Regional Advisory Council, over 100 hospitals Advisory Council, over 100 hospitals in 19 counties, participated in an in 19 counties, participated in an interoperable communication drill. interoperable communication drill.

Patient TrackingPatient Tracking

The drill objectives:The drill objectives:Entering patients,Entering patients,Transferring patients,Transferring patients,Receiving patients, in Receiving patients, in WebEOCWebEOC

Patient TrackingPatient Tracking

Hospitals in the local area did enter patients Hospitals in the local area did enter patients into into WebEOCWebEOC..

However, many hospitals in the region, for a However, many hospitals in the region, for a variety of reasons, did not enter Bus Crash variety of reasons, did not enter Bus Crash patients timely into patients timely into WebEOCWebEOC..

At NCTTRAC, guidance has been issued At NCTTRAC, guidance has been issued related to use, with emphasis on patient related to use, with emphasis on patient tracking. tracking.

Resource/AssetsResource/Assets

There was no local stockpile of There was no local stockpile of resources and assets to support this resources and assets to support this many victims. Hospitals had assets many victims. Hospitals had assets that could be used at the scene, but that could be used at the scene, but EMS was not aware of them.EMS was not aware of them.

–– Inventory has been exchanged between Inventory has been exchanged between hospitals and EMS.hospitals and EMS.

Resource/AssetsResource/Assets

There was no mechanism to There was no mechanism to transport large quantities of transport large quantities of

supplies and resources.supplies and resources.

Texoma Region

MCI Trailer

Some Final NotesSome Final Notes

Our goal today was to share some Our goal today was to share some lessons learned from the bus lessons learned from the bus crash.crash.

Most of our lessons have come Most of our lessons have come from our mistakes, because we all from our mistakes, because we all learn more from our mistakes. learn more from our mistakes.

So, Where are we today……

Seat at the tableSeat at the table

Your EOC…

Who is at the table?

In ConclusionIn Conclusion

Special thanks to all the Fire Departments, the EMS Special thanks to all the Fire Departments, the EMS providers, the law enforcement agencies, the hospitals providers, the law enforcement agencies, the hospitals who received patients and the citizens who support who received patients and the citizens who support these organizations.these organizations.

Questions?Questions?

Thank you all and be safeThank you all and be safe