Training: School bus vs. Garbage truck

[JohnnyOV 2]

Date: 5/3/2011

Time: 1345

Location: Major "T" intersection in your district

Weather: Bright and sunny, 70 degrees, no wind.

Initial Response: Your FD MVA response, your Ambulance (single BLS), your Medic (single)

You are dispatched with your department, your local ambulance and medics to a school bus vs. garbage truck involved in an MVA. School is let out at 1330 time is now 1345.

School bus was doing approx 50mph, when a garbage truck pulled out in front of the bus. The right side of the bus from the engine compartment to 7 rows back is completely destroyed entrapping upwards of 15 students. The school bus has rolled over onto its left side, and the garbage truck is resting in the road off of the bus leaking fuel from its left saddle tank. No fire at this time.

Your normal response off the initial dispatch would be in play here, your typical manpower response for a Tuesday afternoon would also be in play. You are unaware of the number of patients until you arrive on scene. When you arrive you find 12 Green, 8 yellow, 5 red and 2 black tags. All of the yellow, red and black tags are entrapped.

You arrive with your front line MVA apparatus, and you need to be honest with your manpower. You can't have 30 people show up in 30 seconds, unless your department would actually have 30 people there right away.... Call the shots.

[x635 4,066]

Excellent scenario presentation.

Besides the other protocols:

One of the first non-manpower related resources I'd call for would be a heavy wrecker, preferably a rotator. They can be invaluable in a situation like this.

I'd probaly also call for staff from the school, to help identify victims and notify parents, and set up a place for parents to go to.

[v85 212]

Some things I see immediatley off the bat

1. Additional sets of tools - be it a spare set kept on another rig, or M/A departments

2. Medevac helicopters, 5 if possible to the scene for the red tags, more on standby if possible, if not additional ALS rigs.

3. Any MCI resources (ie. trailer or rehab/support vehicle)

4. HAZ-MAT team notification/response

5. Another (school or city) bus to the scene, put the green tags on it with 2 or 3 EMTs and you get an instant MERV

Also, I would be doubling up as many rigs as I could, one on the stretcher, one on the fold-out.

Edited March 16, 2011 by v85

[x129K 1,393]

POLICE...POLICE...POLICE!!!!!!!!!

You will HAVE to keep parents out of the immediate area, for their safety and the integrity of the operations!

[v85 212]

This type of incident is also where a great dispatcher could make a difference.

I would hope the dispatcher would decide to, against normal practice if need be, stack tones.

Rather than dispatching one department, then waiting for a status report to start dispatching additional units and M/A, dispatch everyone at once, duty call, all call, and M/A tones and medevac notification all on the initial report.

This is definatley a situation where "When in doubt, send them out makes sense."

<Quote = bullseye>

POLICE...POLICE...POLICE!!!!!!!!!

You will HAVE to keep parents out of the immediate area, for their safety and the integrity of the operations!

</Quote>

Along these lines, I would also notify DPW and have them and Fire Police take as many traffic posts as possible. Reserve the armed LEO's for scene security operations and accident investigation.

I would also activate the reverse 911 system and even contact local radio stations to have them make announcements about where the family information area will be.

Edited March 16, 2011 by v85

[v85 212]

One other thing that I wonder if it would be worthwile to do, is reach out to a local manufacturer/dealer of school busses and/or heavy trucks.

They may be able to give you tips on where and how to cut, if your department doesn't have experience with these types of vehicles.

[PEMO3 523]

Based on the fact that you are dealing with kids and have 5 red and 2 black tags start out Red Cross and Chaplain services to both the local ER(s) and the closest station. Units should be advised the services are available for them as well as family members. Remember after the adrenaline rush is over we are human too. Have psych aid available for everyone.

Coordinate with the school to create an information clearing house through them for student transport location so they can direct parents to the correct ER since based on patient numbers you will be using more than one to spread the load.

[v85 212]

Agreed.

Along those lines, is the staffing you have ,really the staffing you are working with.

What happens if you get on scene and you have some of your members tell you, "Sorry chief, my son/daughter/friend/brother/sister is on that bus, I just can't do it."

Do you have the staffing to backfill that person's spot?

How about a mobile communications center, with a dedicated dispatcher for the incident? You are going to have a lot of radio traffic and representatives from a lot of agencies on scene. Standing at the tailgate of Car 1 might not cut it here.

Edited March 16, 2011 by v85

[ny10570 745]

I disagree on getting the wrecker in there ASAP. Cribbing and airbags are faster and more stable than a lone rotator. How long is it going to take to get the wrecker there? Even in Pleasantville the wreckers never came close to beating us to the scene and they were usually buffing the radio. Besides, the bus resting on its side is a very stable structure.

You need buses and lots of them. Your first unit is going to be triage. Your second unit will become the treatment area. So it not until you get to your third arriving unit can you begin transporting and there are 5 patients that need transport right now. What about your two black tags? How old are they and how obvious is their death. If someone gets it in their head that they're working up this dead child good luck changing their mind. At every MCI involving a child fatality I've been involved in, someone took a child in arrest over a red tag to the ER.

If you're on scene its WAY too late to be calling for help in cutting and stabilizing.

[firemoose827 324]

Tuesday afternoon with that many injuries? We are in trouble.

We would probably have 3 maybe 4 firefighters with any knowledge of extrication in our engine and rescue. Our ambulance is BLS and we would have 1 maybe 2 EMT's available to respond. I would hit our three nearest MA depts (about 20 minutes response time) immediately for rescue trucks and manpower, as well as EMS units. Than call for immediate response from all county EMS and Fire coordinators to assist with MA units and logistics, our officers will be either not there or real busy working the scene. We have 3 Life Net choppers all within 10 minutes response time, plus additional choppers about 20-30 minutes away which would all be requested, they would land at the Duanesburgh airport about 10 minutes from our town which is on the way to our nearest level one trauma center. All other patients go ALS on the ground to the level II trauma center about 20 minutes away.

Scene security and public info would be a nightmare depending on how many fire coordinators and EMO personnel, and LEO's show up. I THINK our county has like 3 troopers and 2 sherrifs on during daylight hours??? Could be wrong, but if they are on prior calls or tied up we have to wait for the next county to send us LEO's.

Its real backwoods here, we would have major issues but we have had one bus accident before, no black tags though, with about 15 patients and it went well luckily, everything went smooth and all agencies worked well.

The key here is to set up a unified command with a CP set up nearby, with our new county comms unit called for radios and phones and computers.

Tough to call without knowing for sure how many units I will have on scene, but good scenario to practice.

[rutola413 5]

On the initial tone, I would have about 4 memebers (including myself) responding and 1 Police. Sate PD is automatic whenever we get a call, so they'd be 20 Minutes out depending where they are. I would have our dispatch contact our primary M/A companies to respond with rescue and manpower. One M/A engine company to establish an LZ. We have 3 Choppers we can call in. The others that we could TRY to get are about 30 Min out.

Local DPW is EXTREMELY well at blocking roads and setting up detours for us.

Would have to call in the MA Fire Services Mobile Command post.

Other than that, I really do not know how I would handle this situation.

[mstrang1 213]

I see a lot of people saying to call in medevac helicopters. Unless there is a large distance to cover, I would think that a helicopter landing would be too manpower intensive for this situation. You would tie up an engine company, maybe an LEO (or 2) for traffic, EMS to transport to the LZ, etc. Most, if not all of them can only carry 1 patient as well. I would think getting as many EMS units and then obviously not overloading one ER is the best route. How many airports have a helipad? Maybe in rural areas they are more common.

[Bnechis 3,961]

Initial Response: (4-6 minutes from dispatch)

2 engines, 1 ladder, 1 rescue, 1 DC w/aide

1 ALS ambulance

Dispatcher may upgrade or ask DC if they should based on calls.

Initial response personnel: 14-16 FF/EMT’s (including 4-5 officers), 1 paramedic, 1 EMT

Upon Confirmation of need: (6-10 minutes from dispatch)

2 additional ALS ambulances

2nd Alarm: 3 engines, 1 ladder (both ladders have full extrication set, air bags, cribbing, etc.) that’s 12-14 additional FF/EMT’s (including 3-4 officers), 2 paramedics, 2 EMTs

1 MCI unit (contains enough supplies for 25 patients)

Chief of Dept

Support Services Chief, Training Officer, Safety Officer, OEM/EMS Coordinator.

Automatic Fire Mutual Aid:

2 Engines, 2 Ladders for citywide backfill.

Initial Recall for 4 guides, 1 DC & Aid and additional 6-10 ff’s/officers to man spare apparatus.

Additional EMS Mutual Aid:

1 Transcare Supervisor

1 EMS Zone Coordinator

2 ALS Ambulances, 3 BLS Ambulances – Transcare

2 ALS Ambulances, Empress

1 ALS Ambulance – L/M VAC

1 ALS Ambulance – MEMS

1 BLS Ambulance – EVAC

1 ALS Ambulance – SVAC

1 ALS Ambulance – WP Transcare

1 ALS Ambulance – Harrison

1 ALS Ambulance – PC/Rye/Rye Brook

1 NYC EMS TF – (2 ALS, 3 BLS, 1 Supervisor)

Other Resources:

PD (scene control)

DPW supervisor

Transportation officer (B.O.E.)

[PEMO3 523]

Bnechis, your post is excellently detailed and shows the value of having a pre-set alarm resource list. Valuable and vital is knowing who your EMS mutual units are ahead of time even if it is ballparked it is something to work with.

Also one point I note consistently throughout was everybody launching 2 -3 birds on the initial call but although the script shows 5 red tags and 2 black those would not be called until after the first EMS resources start triage and evaluate patients. Full patient status may take upwards to 15 minutes before an accurate Red-Yellow-Green-Black count is made and those are dynamic and change as patient conditions do.

Edited March 16, 2011 by PEMO3

[Bnechis 3,961]

General Comments:

One of the first non-manpower related resources I'd call for would be a heavy wrecker, preferably a rotator. They can be invaluable in a situation like this.

Not needed till after we are done, School busses are easy to deal with without a roatator.

I'd probaly also call for staff from the school, to help identify victims and notify parents, and set up a place for parents to go to.

Very important.

2. Medevac helicopters, 5 if possible to the scene for the red tags, more on standby if possible, if not additional ALS rigs.

Waste of resources they suck up engine companies and ground tx is faster.

4. HAZ-MAT team notification/response

Its just a saddle tank, we will assign an engine company to handel.

5. Another (school or city) bus to the scene, put the green tags on it with 2 or 3 EMTs and you get an instant MERV

Good idea.

POLICE...POLICE... POLICE !!!!!!!!! You will HAVE to keep parents out of the immediate area, for their safety and the integrity of the operations!

YES....YES....YES!!!!!!

I would also activate the reverse 911 system and even contact local radio stations to have them make announcements about where the family information area will be.

Interesting idea. Our concern is 5,000 bus riders and 5,000+ crazed parents in our system, with 1 bus involving 30 patients. Let school notify the families, maybe the reverse 9-11 after everyones notified to advise, there child is not affected, stay away. or call school, if need be.

One other thing that I wonder if it would be worthwile to do, is reach out to a local manufacturer/dealer of school busses and/or heavy trucks.

They may be able to give you tips on where and how to cut, if your department doesn't have experience with these types of vehicles.

If you have school busses in your community you need to know this today, not will learn it when the time comes. When there is a fire do you call someone to ask what to do?

Red Cross and Chaplain services to both the local ER(s) and the closest station. Units should be advised the services are available for them as well as family members. Have psych aid available for everyone.

Coordinate with the school to create an information clearing house through them for student transport location so they can direct parents to the correct ER since based on patient numbers you will be using more than one to spread the load.

Both good ideas

What happens if you get on scene and you have some of your members tell you, "Sorry chief, my son/daughter/friend/brother/sister is on that bus, I just can't do it." Do you have the staffing to backfill that person's spot?

Just rotate them out.

[PFDRes47cue 653]

One other thing that I wonder if it would be worthwile to do, is reach out to a local manufacturer/dealer of school busses and/or heavy trucks.

They may be able to give you tips on where and how to cut, if your department doesn't have experience with these types of vehicles.

Good point, however, I feel it would me more worthwhile to bring in a local manufacture/dealer ASAP and make a drill out of it. Why wait until the day you need to know, when you can be proactive and learn what is necessary now?

It is definitely a great idea to bring in a specialist and learn the tactics. Especially since as another poster said, your kid might be on the bus.

[v85 212]

Here are some photos of two drills that was conducted by my town's emergency services , the school bus one is fairly common choice for an MCI drill , the radioactive substance one was a new twist on the MCI drill:

http://www.1stresponderweb.com/wfd/arles_gallery_101009/

http://warwickfire.com/2007/Gallery/Archive/bus-mvatraining/index.html

[osufire90 18]

I feel like medivac choppers are useful if the nearest trauma center is a substantial distance away. If it is close, ALS medic units will usually be the faster, lower manpower option.