Keep the Kids Together

     A beautiful May morning is unfolding as Attack One changes over crews at 0700 hours. House duties for the day look light---it's a great opportunity to have breakfast outside and enjoy a spectacular morning.

     Then the dispatch frequency crackles with a call for a motor vehicle accident. The location is familiar: a curve on the main north/south state route through the area where the two-lane road twists through some rolling hills. This site is a frequent accident location during night hours and in icy conditions, but neither applies this morning.

     As Attack One crests the hill from the north, a horrible scene is unfolding. Traffic is stopped, the road is full of children, and a school bus lies on its side in the field adjacent to the road. Adult bystanders quickly guide the crew to the rear of the bus, where a young lady is trapped. Approximately 15 children are lying or sitting in the roadway, removed from the bus by the bystanders.

     A quick scene survey finds a small amount of leaking fuel, but no electrical or fire exposures. Traffic is stopped on the road. Only one patient is trapped in the bus. The bus driver is able to communicate that 16 children of various ages were on the bus when it rolled off the road. With the driver, this means 17 victims. Bystanders have calmed the 15 children in the roadway, and the scene is eerily quiet.

     The Attack One crew members force their way into the back of the bus and find a 17-year-old student wrapped around the rear seat in an awkward position. She stirs as the crew arrives, her discomfort resulting in piercing cries for help. The quiet scene now becomes painful, as the trapped young lady has suffered a major back injury.

Scene Management
     As other resources arrive, the three Ts of multiple-casualty incident management are initiated: Triage is assigned to two paramedics from the engine crew-one in the bus and the other on the roadway. The Attack One crew assumes responsibility for the Transport Sector. When the next medic unit arrives, its crew is assigned the Treatment Sector. Triage identifies 17 victims, with one classified red (the entrapped victim, who has a serious spinal column/spinal cord injury), eight tagged yellow, and eight green. The crew working in the bus requests a helicopter for transport of the trapped girl. They estimate that the anticipated extrication time of about 20 minutes will match the arrival time of the helicopter.

     The Treatment Sector can only be organized where the children are already located: in the roadway. No other locations further from the scene can accommodate them. Unfortunately, this location is within hearing distance of the wreckage, and the badly injured girl being extricated is in severe pain. Her cries become upsetting to the other children, especially the younger ones. The bus had picked up children from kindergarten through high-school ages for a private academy. A number of the victims are siblings. Treatment Sector personnel have organized the siblings to stay together, so as parents arrive, they can match the children with the adults, and allow all of them to console each other as the extrication is carefully completed.

Focus on the Transportation Function
     Transport operations will require coordination unique to this incident.

     The two-lane road, now filled with victims, bystanders, rescue vehicles and law enforcement, has no flow-through for transport vehicles. Command has assigned responsibility for helicopter landing zone operations to the Transport Sector, and the only available safe landing area is just adjacent to the roadway on the south side. The Attack One crew divides their roles to have one member oversee destination and medic assignments and one document patient and transportation information. The critical patient will require transport in the helicopter to a trauma center. The other 16 victims will need spinal immobilization and transport to other local hospitals. Transport Sector personnel request nine transport vehicles from Command, allowing one vehicle for contingency in case the helicopter has any delay or difficulty. Command acknowledges the request and reports that mutual-aid medics will be arriving from agencies to the north and south of the scene.