Bus Rollover

[EMT001]

You are dispatched to the entrance ramp for a major highway in your primary for a reported passenger bus rollover. Your dispatch has been getting numerous calls for this incident. They initially send out the three on-duty BLS trucks and two ALS trucks for the town. You are a fully equipped ALS unit that arrives first on scene. You observe that the bus has in fact rolled off an embankment while attempting to make the tight-turn onto the highway. The bus is at the bottom of a small hill, on its passenger-side. Damage to the bus appears minimal. You establish EMS command while you partner attempts to begin triage. Your partner comes back and says that he is unable to gain access to the bus, however he looked into the windshield and said it looks bad. What is your next move?

*** I intend this to be an evolving scenario. New information will be presented based on a general concensus of what the next move should be. ***

[whit72]

Could you elaborate on the bus a little more.

Yellow bus, white bus, green bus, short bus......No im kidding

Is it a tour bus or a school Bus. Makes a difference in my area. Not sure if all school buses in my area are equipped with seat belts. Some are grandfathered in, I believe. So if thats the case I am not really concerned with the damage to the bus more the fact, that it rolled with unrestrained little people in it. They tend to fly themselves out windows and such when there not restrained.

And eventually someone is going to have to go back down there and get a better idea. The fact that it looks bad is a good start, but we will need a more adequate assesment of the situation.

[EMT001]

The bus is a tour bus, loaded to full capacity. You are currently unable to gain access due to the position of the bus. You have requested fire for a rescue assignment. Any other additional resources you might want? You partner has gone back to the bus and reports, from what he can see, that the driver is unconscious and atleast 15 people appear to be unconscious on the ground. Some of the passengers are moving around, but they are still too confused and scared to give you an accurate size-up.

[AZCEP]

More of everything!

Notify all area hospitals of size of the incident

Keep your own head, while everyone around you is losing theirs. Turn over command to the first white helmet that shows up.

[whit72]

Get the birds in air.

[MedicRN]

Get the highway patrol out to shut down the ramp (scene safety). If it is a tour bus on its right side, the left side is still accessable through the 'escape' windows. I believe they can be opened from the outside as well as the inside.

Have one or two folks start the 'START' triage while MCI areas are set up.

[EMT001]

After your partner reports back, you realize the scope of the crap storm that you just walked into. You notify highway patrol that the ramp needs to be shut down. In addition to the EMS resources that you have responding, you request for the county task force to be activated. This will bring 35 BLS ambulances and 15 ALS ambulances. In addition, you ask your dispatch for medevac. Unfortunately, it is raining and all of the air services are grounded (welcome to my area). FD has arrived on scene and is determining extrication possibilities. The bus is unstable and will need to be cribbed before you can access the safety windows. The FD extrication team leader also suggests breaking the windshield so it will be easier to get people out of the bus, but it is your call. Local hospitals have been alerted. A level one trauma, 20 minutes away, can take 4 critical 15 minor; a level two trauma, 35 minutes away, can take 2 critical but 20 minor; a local ED, 10 minutes away, can handle no critical and 10 minor.

The FD has finally cribbed the vehicle and entry is now possible. Simultaneously to cribbing you had you originally dispatched ALS buses set up triage and treatment areas. You have a transportation area established in a local mall parking lot not far from the scene, and all resources are being asked to stage there. Highway patrol has closed the ramp. A safety officer has been established and you still retain overall incident command. (You happen to be supervisor for the tour, lucky you.) When your triage team makes entry to the vehicle they find the following: 10 P1 patients, 20 P2 patients, 15 P3 walking wounded, and the driver is DOA. How do you direct resources? You have more critical patients than the ED's say they can handle. Do you divert a significant number of minor patients from one facility so another can handle more critical? Oh, and by the way, it is 40 degrees outside, your patients are getting cold, fast.

[Ridryder 911]

I assume P1 are priorty one bad or okay?.. many systems use traffic triage green, red, black... etc.. it is more simplistic.

R/r 911

[AZCEP]

The hospitals will have to suck it up.

The 10 P1s get sent to the Level I and II centers, an even split if possible, if not more to the Level I.

First accessed P1 goes in first arriving unit with a walking wounded. I'd continue this until the P1s are gone.

Then P2s with a walking wounded, leaving the remainder of the P2s to the transport units left.

I am glad this is being managed on the internet instead of standing on the highway. Much easier to concentrate over a Starbuck's Frappacino(sp?)

[whit72]

I almost dont want to play along in fear it may jinx me........oh god there goes a bus, whooo thank god its not greasy side up