School Bus MCI Drill

On May 8, 2010, Ouray County EMS (OC EMS) produced an MCI drill that simulated a school bus going off the side of an embankment with a drop-off of 50-60 feet with 20-30 patients and no fatalities. This article is a "blueprint" for that drill, outlining all the logistics and components involved in such an operation. Agencies are encouraged to use this as a template for similar operations in their jurisdictions. Please check back for reports from the actual drill.

BACKGROUND

According to a website for trial lawyers, "In 2000, there were 9,000 (school) bus accident injuries, including 16 fatalities. School bus injuries result from several different causes. For one thing, most full-sized school buses are not equipped with seat belts."

In April 2002, on page V in the Executive Summary portion of a 54-page report to Congress on "School Bus Safety: Crash Worthiness Research," the National Highway Traffic Safety Administration states that "Over the past 11 years, school buses have annually averaged about 26,000 crashes resulting in 10 deaths: 25% were drivers; 75% were passengers."

In response to those statistics, on Saturday, May 8, Ouray County (CO) EMS will conduct a MCI field training exercise simulating a school bus going off the side of CR 1 with an embankment drop-off of 50¡Ç-60¡Ç, 20-30 patients and no fatalities.

This FTX will be the second in a series of exercises designed to address what we have identified as "worst case" events that might actually occur in our jurisdiction. Our first FTX extravaganza occurred on May 18th, 2008, when we pushed a bus off the scenic overlook above the city of Ouray to tackle the very real concern of a tour bus going over the side on Red Mountain. The exercise was designed to test access, rough terrain vehicle stabilization and extrication, with the Ouray Mountain Rescue Team working in coordination with our vehicle extrication team to get equipment to the site and assist in vehicle stabilization.

Our upcoming FTX, will be not only to reaffirm the lessons and changes we implemented from the Red Mountain bus exercise, but to test, among other things, our Rural First Responder Corps' scene size-up and communications, multi-agency coordination, vehicle extrication, patient triage, treatment and movement. It is being designed to test our regional mutual aid system with our surrounding EMS providers, patient transportation in real time to our primary and new back-up "emergency" receiving facilities, patient tracking, the communications systems, law enforcement functions for scene control at the accident site and the receiving facilities, as well as any additional investigation training they wish to conduct. We will also be training two Rural Fire Protection Districts that would be the first and second due fire-rescue agencies to an accident of this nature.

OC EMS will train its members to properly fill out and run the various roles for ICS and MCI: Medical Group Supervisor, Triage Officer, Treatment Officer, treatment area leaders and members, Transportation Officer and Staging Officer. Through a series of lectures, TTXs and training scenarios, we will also cover the hows and what-to-dos in coordinating patient care in the treatment areas, including filling out information on triage tags; monitoring ongoing treatment; protecting patients from the elements; patient movement from triage to treatment areas and between treatment areas as a patient's condition improves or deteriorates; movement to the transportation area; and patient hand-off to transport ambulances. Caregivers will have to ask alert patients if they know the names of unconscious or altered mental status patients and record that information.

We will also train our EMS staff and volunteers in the proper use of various MCI forms/templates and get them comfortable in using them. In addition, we will have to develop a system to work with law enforcement for sharing names and patient tracking in compliance with HIPAA rules and regulations (see HIPAA section later in this document).