This derailment was not the first time a majority of patients were transported by police vehicles during an MCI. According to the after-action report following the shooting of 70 people in a movie theater in Aurora, Colorado, police officers and a paramedic independently chose to utilize police vehicles to transport injured survivors when ambulances were unable to get close to patients because of traffic and pedestrian congestion. Of the 60 people who reached the hospital, 27 were transported in police vehicles, 20 by ambulance, and the remainder by private vehicle or on foot. The use of police vehicles in that situation was unplanned, but the swift transport was credited with saving at least two lives. All injured survivors were transported from the scene within 52 minutes.[1]
EMS transport in MCIs typically requires staging ambulances and removes all of the involved ambulances from use by the rest of the community for the duration of the MCI. This may mean the response times for 911 calls for unrelated medical assistance become delayed. While most communities have a complex web of nearby agencies they can call upon for mutual aid, adding to the pool of available EMS transportation, using these resources may increase the size of the population with temporarily diminished access to EMS resources. On the other hand, using police vehicles to transport the injured increases transport resources and likely means the scene will be cleared of injured persons more quickly. For example, following the derailment of train 188, records show the first person was registered at the hospital at 9:57 p.m., the same time on-scene triage stations became operational. Therefore, the NTSB concludes that transportation of injured victims by police or other municipal vehicles early in an MCI may be a reasonable use of resources.
However, successful use of police transport in an MCI requires integration of police into patient transport coordination and the incident command system. This did not occur during the response to the derailment of train 188. One reason is the divide between the PPD and the PFD/EMS personnel. Each department has its own command structure and policies (described below), which do not align with one another. In addition, PPD and PFD personnel are dispatched through separate dispatch centers (known locally as the police radio and the Fire Communications Center) that do not routinely communicate with each other.
Prior to this accident, in the PFD policy on MCI response, the only mention of police was to coordinate with the police to: establish a perimeter, identify a staging area for transport vehicles, and allow patients triaged as green to be transported using nontraditional means such as a SEPTA or school bus, private ambulances, or police wagons. However, these green patients were to be accompanied by at least one certified EMT or paramedic.[2] Following the accident, the PFD updated its policy (September 2015) to state,
Police vehicles will only be used for patient transportation with the permission of the EMS Branch Director or Patient Transportation Group Supervisor [the transport coordinator]. Only patients who have been properly assessed and triaged as Priority 3 [green] will be transported by police. The Transportation Group Supervisor in consultation with the Medical Communications Coordinator will
- ↑ Aurora Century 16 Theater Shooting After Action Report for the City of Aurora, Colorado. 2014 https://www.auroragov.org/CityHall/StatsReportsandSurveys/025372 Accessed February 9, 2016.
- ↑ PFD Operational Procedure: Multiple Patient/Mass Casualty Incidents (OPS-35-11. June 2011).
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