# So, when you pull up on an overturned tour bus...what's your first move?



## abckidsmom (May 31, 2011)

http://www.jems.com/article/news/multiple-injuries-after-tour-b

I95, overturned bus with 58 passengers, 5 entrapped on arrival, 4 dead. 

It apparently happened at 0455, the state trooper was on scene in about 5 minutes, and the first medic unit was on scene about 12 minutes later, and was the sole unit on scene for about 5 minutes.

The dispatch audio is available in that link, kudos to that first arriving medic, he kept his cool and made a list for the dispatcher that was pretty comprehensive.  Within 7 minutes of being on scene, he was calling for mutual aid from 4 counties up and down I95.


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## jjesusfreak01 (May 31, 2011)

Panic until the district chief arrives???

Probably just triage like crazy until a DC or APP unit arrives to take scene command from my medic.


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## Pudge40 (May 31, 2011)

The most important part would be scene command. Even if you don't want to keep it you must establish it early in the incident. The IC should not be doing anything other than commanding.


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## Shishkabob (May 31, 2011)

"Damnit, I was 1 hour away from getting off shift!"



Granted my MCI was 'only' 9 people with 1 fatality, but an MCI is an MCI is an MCI.  Establish command, triage the crap out of people, do what you can until there's no more patients.


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## dixie_flatline (May 31, 2011)

Pudge40 said:


> The most important part would be scene command. Even if you don't want to keep it you must establish it early in the incident. The IC should not be doing anything other than commanding.



Agree, but it's hard to keep that in mind when you are the only one on the scene of something out of _Trauma_ and people are screaming for you to help them (or worse yet, help their injured children).


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## Shishkabob (May 31, 2011)

dixie_flatline said:


> Agree, but it's hard to keep that in mind when you are the only one on the scene of something out of _Trauma_ and people are screaming for you to help them (or worse yet, help their injured children).



Not really any different from most of our (true) calls.


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## NomadicMedic (May 31, 2011)

We just had one a couple of days ago...

http://www.komonews.com/news/local/122785794.html


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## Shishkabob (May 31, 2011)

So, been listening to the radio broadcast.


For you guys who have also done an MCI, do you keep dispatch up-to-date on patient counts?  When we're first on scene, we get a quick count of patients, relay it to dispatch, and request additional resources.  We also throw in the triage colors of the patients when we get an initial count done, like "3 red, 2 yellow, 4 green,  one black"


I never heard any patient counts on the radio for them... 99% of the radio traffic consisted of "Highway is closed" or additional units being called out / calling en-route.   First actual patient related radio dispatch was at 74 minutes when an ambulance said they were transporting a patient.



EDIT:  Actually, dispatch finally asked for a patient count at 79 minutes after being requested to by supervisors.  I just find it odd that they took so long/ had to be prompted.


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## lightsandsirens5 (May 31, 2011)

jjesusfreak01 said:


> Panic until the district chief arrives???
> 
> Probably just triage like crazy until a DC or APP unit arrives to take scene command from my medic.



This sounds about right.


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## abckidsmom (May 31, 2011)

Linuss said:


> So, been listening to the radio broadcast.
> 
> 
> For you guys who have also done an MCI, do you keep dispatch up-to-date on patient counts?  When we're first on scene, we get a quick count of patients, relay it to dispatch, and request additional resources.  We also throw in the triage colors of the patients when we get an initial count done, like "3 red, 2 yellow, 4 green,  one black"
> ...



In these rural central VA systems, the dispatchers aren't the team members that they could be.

If I told the dispatcher, "We have 30 patients total, 10 red, 5 yellow, 15 green," they wouldn't be able to figure out that we'd need, at total most, 15 ambulances, and probably less.  That doesn't mean you shouldn't say it on the radio, cause there are lots of people who need to know:  the ones getting the MCI trailer (oops, can't find it in the event of an MCI?), the ones who are coming in and need to get in the mindset before they get there, etc.

It was odd that they didn't at least provide a rough count from the outset.  "Onscene with overturned bus on it's roof which is collapsed, with apparently several dozen patients.  More info to follow."  That's something like I might have done.  I want everyone to know as much about what I see every time I talk on the radio as possible, cause I'm not going to have a lot of time to spend just talking on the radio.

I want to emphasize that we can think and plan and train for this event, but in the event of it actually happening, anything that involves a calm head and work getting done is actually a job done adequately.  These people did a good job, from all appearances already.

I believe it's really valuable to look at these big incidents and rehearse in your head what you might have done in various roles.  These large incidents are few and far between, but when the pressure's on, you have to perform well.  My only MCI that I was "in command" of was a ride malfunction at a county fair where we had 15 green and 3 yellow patients to transport.  Several others I was a part of, but using that many resources and controlling that many people is different than every other call.  I think it's really fun, but it's different, and if you haven't embraced your possible reactions and planned what you'll do at that time, you can be at a disadvantage.


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## DrParasite (May 31, 2011)

Linuss said:


> For you guys who have also done an MCI, do you keep dispatch up-to-date on patient counts?  When we're first on scene, we get a quick count of patients, relay it to dispatch, and request additional resources.  We also throw in the triage colors of the patients when we get an initial count done, like "3 red, 2 yellow, 4 green,  one black"


speaking as a dispatcher who has been on the other end of an MCI, I can tell you that it would make my life SOOOOOOOOOO much easier if field units would give us size ups and patient counts. 

First arriving unit should give a size up ("Onscene with overturned bus on it's roof which is collapsed, with apparently several dozen patients. More info to follow" is perfect!!!), establish command and continue size up. that tells dispatch to start getting at least a dozen ambulances, as well as update the MVA crash to a bus rescue assignment, as well as start notifications for MCI situations.   The dispatcher should then tell command what units are responding "2 BCs, 1 EMS BC, 2 Rescue companies, 3 Engine Companies and 15 ambulances, will you need more?"  Better to over send than undersend.

I wouldn't give the triage colors to dispatch, because, quite honestly, they don't care.  tell them what you need.  how many of each type of ambulance.  15 Red, 5 yellow, 30 green doesn't help.... do you need 20 ALS ambulances and a school buss for the greens?  or 8 ALS ambulances, 14 BLS ambulances, and a van for the walking wounded.  overall patient counts help for the hospitals so they know how many patients to expect, but for the initial reports (defined as before the first ambulance leaves the scene), just tell dispatch exactly what resources you need at the scene.

not only that, but when you have major incidents like this, dispatch needs to backfill the surrounding areas. the more heads up you give them, the easier it will be to do their job.


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## Shishkabob (May 31, 2011)

DrParasite said:


> I wouldn't give the triage colors to dispatch, because, quite honestly, they don't care.  tell them what you need.  how many of each type of ambulance.  15 Red, 5 yellow, 30 green doesn't help....



Company policy to, actually, and dispatch will ask for it if we don't give it.  I don't expect them to know what to do with red/yellow/green/black, but as a responding unit I like to know what I'm getting in to.


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