April 28, 2009 Multiple Casualty Incident

1. April 28, 2009 Multiple Casualty Incident Highway 101 and Front Street Soledad Monterey County

2. Objectives • Historical overview of the April 28, 2009 bus crash in Soledad • Greater understanding of the challenges found in managing an MCI in a primarily rural county • Have an appreciation for the impact of an MCI

3. Setting • Tour bus crash • Bus rolled over after striking the guardrail • Bus came to rest on the bridge • Occupants of the bus were thrown from the bus • Four of the people ejected went over the bridge and landed on the ground below • 36 people on the bus • Three fatalities on scene

4. Soledad Fire Dept. Salinas Fire Dept. Salinas Rural Fire District Gonzales Fire Dept. Greenfield Fire Dept. King City Fire Dept. Cal Fire Marina Fire Dept. Presidio of Monterey Fire Dept. Fort Hunter Liggett Fire Dept. CTF-Soledad Fire Fire Agencies

5. Ground Ambulance AMR: Medic 35 Medic 47 Medic 45 Medic 20 Medic 43 Medic 31 Medic 48 Medic 40 Medic 44 Medic 39 Medic 57 Medic 36 Medic 46 Medic 49 Medic 41 Air Ambulance Calstar 5 Calstar 2 Calstar 1 Calstar 8 Stanford Lifeflight Mediflight 1 Mediflight 2 Ambulance Providers

6. Law Enforcement • Soledad PD • Monterey County Sherriff • CHP • Gonzales PD

7. Agencies Involved • County 911 communications • AMR EMS dispatch • Monterey County EMS Agency • Monterey County OES • Cal Fire Communications Center • CHP Communications Center

8. Hospitals • Salinas Valley Memorial • Natividad Medical Center • Community Hospital of the Monterey Peninsula • Mee Memorial • Watsonville Community • Regional Medical Center • Santa Clara Valley Medical Center • Stanford • Saint Louise • Community Medical Center-Fresno

9. Other Support and Affected Agencies • Calstar 7 • AMR Santa Clara • AMR Santa Cruz • San Luis Ambulance • Carmel Regional Fire Ambulance • Regional Disaster Medical Health Coordinator • Dominican Santa Cruz Hospital

10. Challenges • Two separate patient locations • The crash occurred in a rural area • Extended travel time for additional resources • Limited road access • Staging

11. Challenges • French speaking patients • Identifying the patients from the convergent volunteers • Commuter traffic increasing into the area

12. Incident issues • International news story • Local government’s need for information • Train?

13. What went well • Two ambulances in the vicinity • First ambulance on scene provided a good initial size-up • First-in engine had four people and split the crew between the two patient locations • Triage tags deployed

14. What went well • No patients trapped • Multiple ambulances available to respond • Multiple air ambulances available to respond • Early notifications to the hospitals allowed for increased staffing. Day shift held over at most hospitals. • All patients transported within two hours

15. What went well • Use of Disaster Medical Support Unit • PIO on scene • Opening of the EOC

16. Areas of improvement • Use of triage tags for patient tracking • Tracking of patient distribution • Unequal distribution of patients • Transport of seven patients to Watsonville Community Hospital caused diversion impacting the Santa Cruz EMS system

17. Areas of improvement • Freelancing • Difficult to locate specific patients to facilitate family reunification • Communication with mutual aid resources • Use of the Disaster Medical Support Unit • Control of airspace

18. Areas of improvement • Must establish staging areas • Need for strong Transportation Group direction • Use of 800MHz radio

19. Follow-Up • Debriefings • Revised MCI Plan • Enhanced roll of the EMS Agency in an MCI • Identified training needs • Training together

20. Epilogue • CHP concluded their investigation and recently released their findings • Reported suicide attempts by survivors • Revised Monterey County MCI Plan • Improved interagency cooperation through training • Secondary transport management

21. Thank you.Any questions?