Command Set Up
Let us look at the scene and command actions that need to take place. The term “IAP” refers to the Incident Action Plan, something that needs to be considered and used at any major or minor incident. Most departments don’t preplan for a bus emergency, but maybe we should. Having been involved in several bus crash responses, things can get rather chaotic real fast. It is amazing how parents can find out their child has been involved in a bus wreck, show up on scene, and you are still working the wreck. Not only do you have to consider the rescue/extrication aspect of the incident, but how many medic units you will need. You need to consider if the local hospitals can handle the number of patients you will be sending. With social media as it is today, soon the media will be knocking at your door. Some years back I responded to a bus wreck with approximately 20 children onboard. All had sustained minor injuries, but I felt in my best judgment that they all needed to be checked out at the hospital. One of those CYA things, you know!
Well, to transport over 20 children to the hospital was going to tie up quite a few medic units, so I made the decision to transport all of them on one unit! I am sure you are wondering how I stuffed 20 kids in a medic unit, and somewhere along the way, I must have lost my mind. Well, since all the patients had only minor injuries, I kept them all on the bus and that became my transport unit. I had the ambulance follow me, the bus driver, and all the kids to the hospital. I had my medical gear onboard and assessed all the patients, along with taking their vital signs. I did call the hospital ahead of time and make sure we could transport them all to that one facility, instead of taking them to several different facilities. This is thinking out of the box, but it worked quite well.
You could very easily have 20 children, and they all have to be transported by ambulances. You may have to send them to different hospitals and require a multitude of medic units. This is where your IC and IAP come into play. Not only will you be dealing with the injured patients, there will be many “wanting to help” bystanders, the media, and probably some of the family of these children. Trying to maintain control and get the job done can be quite taxing. Having a bus extrication class and drill can help you prepare for this type of incident.
You will need to control the scene as soon as you can. Law enforcement will be an excellent asset for this, and don’t hesitate to call in more officers. Establish a perimeter to work in, which includes your hot zone, warm zone and your cold zone. The “hot zone” is where you will be conducting your stabilization, extrication and removing your patients and is the immediate area around the bus and any other vehicle that may be involved. The “warm zone” is where you will stage your equipment and personnel. This area is outside of the hot zone and will depend on the scene and surrounding area. The “cold zone” is where command should be set up and stationed. This is also the area where you should keep all bystanders, family and the media. The scene is subject to become quite hectic.
Command should be established as soon as the first unit arrives on scene. This can later be transferred to an officer once they arrive, if not there already. The 911 center needs a contact for additional units and agencies that may be coming to help. An “Operations Officer” should be appointed as soon as possible, as they are the one that will be running the scene operations. A plan needs to be established and implemented as soon as possible. Because of having several agencies involved, the command structure may need to be a “Unified Command.” This will give you a fire/rescue, EMS and law enforcement person in the command post. All of these folks will be involved if the bus crash is anything but minor.
You will need fire/rescue to handle the safety of the scene, any fire control, and stabilization and extrication that may be required. They will also be helping with some of the triage and patient packaging. EMS will be handling the triage, treatment, patient packaging and transport of all the patients. Law enforcement will be handling traffic and scene control. They may be able to help with some initial patient care, but they will need to handle security of the scene as soon as possible. They will be fewer in number as well. The key is all about working together for the common good of the patient.
Command can be a stressful undertaking when dealing with a major school bus wreck and the children that have been injured and hurt. This is something every department that has the probability of having a school bus crash in their respective district should practice and train on. The best plan is to set up a training drill with multiple departments in your area that would provide mutual aid. Have some outside folks come in and monitor the exercise so you can do a good critique after it is over. We did one of these down toward the coast a few years back, and provided the scenario and then monitored the drill. It was a positive exercise for all those involved.
Next time we will look at stabilizing and extrication techniques that can be used for a school bus wreck. Until then, stay safe and train hard.