Taking Another Look at Mass Casualty Incidents

In case you missed it, the NTSB issued their findings and recommendations relative to the derailment of Amtrak 188 in the City of Philadelphia last May, which resulted in the loss of eight lives and injuries to over 200 other passengers.

The NTSB surmised that the engineer was distracted by reports over Amtrak’s radio of a nearby train having rocks thrown at it, which is apparently a common occurrence on a certain stretch of tracks through Philadelphia.  His distraction resulted in him speeding up the train, rather than slowing it prior to heading into a curve.  Taking the curve at high speed led directly to derailment of the train.  It has been pointed out that the presence of an automatic Positive Train Control system, not installed on many trains, would have slowed the train and likely prevented the derailment.  A rail industry union consortium indicated that the presence of two engineers on the train may have also mitigated this incident.

What I found most interesting in the report was that after listing findings and recommendations related to the derailment itself, the NTSB report identified issues beyond the crash.  The report states that

“…as a result of victims being transported to hospitals without coordination, some hospitals were over utilized while others were significantly underutilized during the response to the derailment.  The NTSB further found that that current Philadelphia Police Department, Philadelphia Fire Department, and Philadelphia Office of Emergency Management policies and procedures regarding transportation of patients in a mass casualty incident need to be better coordinated.”

Why is the NTSB providing recommendations on how mass casualty incidents are handled?  These recommendations are, in fact, fully within the scope of their mission statement as they address, ultimately, how victims are cared for.  The NTSB has also brought us best practices that extend beyond crashes, such as Family Assistance Centers.

The recommendations the NTSB provides in this report are spot on.  Mass casualty incidents MUST be coordinated.  Triage, treatment, and transport.  We’ve all heard of these three key activities.  Yes, it’s excruciatingly difficult to not ‘Scoop and Run’ when we encounter an injured victim, but let’s consider a few reasons why we shouldn’t:

  1. Patients with certain injuries, such as those to the cervical spine, are not being stabilized, and could have their injury worsened.
  2. A patient could ‘crash’ from a multitude of causes, which require the resources of an ambulance and paramedic to address, absent being in a hospital.
  3. Scoop and Run violates the concept of triage, which is intended to provide care and transport for the most critically injured first.
  4. The emergency personnel and vehicles involved in Scoop and Run may be otherwise needed at the scene.
  5. Depending on the incident, victims may be contaminated. Scoop and Run can endanger personnel who are not aware of this.
  6. Scoop and Run circumvents patient tracking and accountability, which is important for on-scene operations, liability and insurance, post-incident medical monitoring, and investigation.
  7. Scoop and Run, as the NTSB report pointed out directly, doesn’t account for spreading patients among receiving hospitals, meaning that some patients can end up at hospitals unequipped for their type of injury as well as overcrowding of hospitals.

While the City of Philadelphia did a great job overall, this gave them cause to take another look at their mass casualty plans and procedures; resulting in Philadelphia Office of Emergency Management asking for better coordination of the multiple entities involved in a mass casualty incident.  While this incident provided some great lessons learned for the City of Philadelphia, it also provides lessons learned for all of us.  It’s a good opportunity to convene your mass casualty planning group and give a review of your plan.  Any jurisdiction can be susceptible to a mass casualty incident.

In need of a structured plan review, planning, training, or exercises involving mass casualty incidents?  Emergency Preparedness Solutions can help!  Contact us now!

© 2016 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLCYour Partner in Preparedness!

2 thoughts on “Taking Another Look at Mass Casualty Incidents

  1. Hi Tim,

    I would like to first start out by saying that I agree with your points. The S.T.A.R.T. triage model trains the user to identify the most critical patients’ in an effort to save the ones that they can. Those with “distracting injuries,” but are able to walk and move on their own, should be reserved for the last people transported. The effort here is to maintain the integrity of the “golden hour” which is a precident when dealing with trauma patients.

    Triage is overwhelming, and if you’ve ever done it on an Mass Casualty Incident (MCI) then you can agree, that it takes focus and determination to move through everyone, and to keep moving regardless of the patient or their presentation. Being able to maintain the resolve to find the critical patient’s that need immediate attention, and will require the least amount of interventions prior to transport.


    1. Hi Gary,
      Yes, the START triage model is certainly a best practice. It’s something that should go hand-in-hand with the policies of a jurisdiction regarding who will transport victims.

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