It was Friday afternoon rush hour in Los Angeles on Sept. 12 when Los Angeles County’s emergency system flashed an alert to hospitals — a Metrolink train carrying 220 commuters had crashed head-on with a freight train near Chatsworth, and there were multiple casualties.
At Providence Holy Cross Medical Center in Mission Hills, the day shift was about to sign off when the ReddiNet disaster communications alarm sounded, alerting the ED to prepare for casualties.
There’s never a good time for a tragedy like this, but 4:30 on a Friday is a really bad time, says Marisela Doyle, RN, MICN, charge nurse on duty.
Doyle spent the next five hours rearranging the ED, notifying the blood bank, and directing a nursing staff that grew from nine to 17 because the day shift remained on duty. Also, surgeons were still on campus, and came to the ED to help.
After about 45 minutes, the first group of six critically injured patients arrived with collapsed and punctured lungs, broken ribs, and flailed chests, Doyle says. Altogether, Providence received 17 of the 86 patients hospitalized, the most of the 13 hospitals used in the emergency. Another 49 passengers were treated for minor scrapes and bruises at the scene and released. There were 25 fatalities.
Los Robles Hospital & Medical Center in Thousand Oaks received 12 passengers, all of whom were treated and released the next day. Northridge Hospital Medical Center, the nearest hospital to the wreckage scene, waited for more than two hours and finally treated eight patients, two of whom came in on their own. Trauma victims were flown to Ronald Reagan UCLA Medical Center, Cedars-Sinai Medical Center, and LAC+USC Medical Center.
Distant Hospitals Used FirstCathy Chidester, RN
A recently revised policy by the county Emergency Medical Services called for helicopter ambulances to fly many of the injured to more distant hospitals before using EDs or trauma centers closer to the accident. The change was the result of local hospitals receiving a surge of injured passengers in a Metrolink collision in Glendale three years ago that killed 11 people and injured 140.
Under the new multi-casualty response plan, seriously injured passengers were flown to the furthest hospitals first, which left nearby facilities available for walk-ins, says Cathy Chidester, RN, MSN, director of the county’s Emergency Medical Services Agency. The distribution plan went smoothly, unlike the 2005 Metrolink accident, where hospitals nearest the scene were inundated with injured patients.
The street traffic was bad, but we were lucky because we had a lot of ambulance helicopters respond from different agencies, Chidester says. There was a large landing area near the crash scene to mobilize the evacuation of injured passengers to hospitals, she adds.
Hospitals really stepped up to the plate to care for the injured, Chidester says.
Overall Tweaking Needed
During the incident, Chidester went to the county Medical Alert Center to support the staff, field questions from hospitals and other agencies, and look for areas to improve. One thing she learned was the need to beef up emergency response training programs across the network, which ranged from emergency medical technicians at the scene to admitting personnel at receiving hospitals.
We have established policies at a core group of provider agencies and base hospitals, but this needs to be expanded, so that’s one example of what we’ll be doing, Chidester says. Watching the response unfold, I realized the need to expand mandatory training programs to a wider base.
At a debriefing in early October, emergency services, hospitals, and other county agencies came up with recommendations on improving response and efficiencies. The recommendations will be presented in December to the county Board of Supervisors, she says.
I’d certainly give an ‘A’ for how emergency services and hospitals responded, Chidester comments. There were some issues with communications and some patient distribution problems, but it went pretty well. The sickest patients got to the trauma centers, and helicopters were utilized appropriately. I’m very happy with the overall response.
EDs Were Ready
At Harbor-UCLA Medical Center, Julia Goto, RN, the prehospital care coordinator, says the staff was alerted to the accident, but didn’t expect to receive any injured victims because of the distance from the crash. I went home and had to come back, Goto says. While five people were flown to the facility by helicopter, none of the injuries were major, she adds.
Goto says the ED staff was ready, two surgeons were on standby, and the trauma team was notified. There were also prehospital care coordinators to quickly assess the injured and send them to the appropriate department.
If the accident had happened at midnight, an auto call system would have activated to call staff at home, Goto says.
Lila Mier, RN, a prehospital care coordinator at Henry Mayo Newhall Memorial Hospital, where only two patients with minor injuries were treated, says a weak link was the facility’s helipad being down due to construction. This may be why we didn’t get any trauma patients, although we could have shut down streets and landed a helicopter near the fire station.
Teamwork Is Key
At Providence, Doyle recalls the evening of the crash being hectic, but says training and teamwork kept things running smoothly. One thing staff learned as the night progressed was that a lot of information calls didn’t need to be routed to the ED, where extra people had to go on phone duty.
Nurses who had the day off showed up, and the night shift reported early without being asked, Doyle says. Respiratory therapists dropped by and helped move gurneys, and lab technicians pitched in where needed.
People act so awesome when tragedy hits, Doyle says. Hearts open up, and everybody just comes together, willing to give it their all to help.