Three-step method aids in successful
management of bus collisions
By Rommie L. Duckworth, LP
Every day in every community, large vehicles travel the road filled with potential patients: some children, some elderly, some with special medi- cal issues—all are potentially your responsibility. 1, 2 These mass casualties
on wheels present a host of problems for EMS responders.
If you’re the head of your agency, you may wonder how you can prepare your
system. If you’re a frontline supervisor you may wonder what tools you should
have on hand to manage such an incident. If you’re a field provider you may wonder what you can do to prepare yourself for response.
Bus collision incidents may be inherently complex, but the techniques to manage each part are simple so that they can be used quickly and with confidence. 3
CHALLENGES FOR EMS
Even minor bus collisions can present a variety of scene management issues including accident investigation, traffic flow, secondary collisions, rescue and extrication,
interagency communication, hazardous materials release, cargo security, media and
bystander management and, of course, patient care. 4 The key to successful management of a bus collision incident is to break the larger incident into smaller,
more manageable chunks.
The three primary issues responders face can be quickly categorized as: 1) lots
of patients; 2) lots of problems; and 3) lots of partners. Details will vary depending on needs, resources and conditions specific to each incident, but broadly categorizing patients, problems and partners will make it easier to begin to delegate,
coordinate and take action to resolve the incident. 5–7
The first thing to consider at all bus collisions is the large number of potential patients. Although the number may range from fewer than 10 to more than
100, effective use of an MCI system will streamline prioritized patient assessment
and treatment and continue the forward movement of patients. 3, 4 This forward
movement will help get patients to definitive care, reconnect them with friends
and loved ones and resolve the overall incident faster.
Keep in mind that all the incident problems one might encounter at a motor
vehicle collision (MVC) may be present, and at a much larger scale than usual.
These may include having to work in areas with foul weather, unstable surfaces,
physical hazards such as broken metal and glass and downed power lines, as well
as hazardous materials from the vehicles. 4
As with any MVC, EMS providers must remain aware of the hazards in their
area, report critical issues up the chain of command, render safe any hazards where
they can do so safely and coordinate with other resources where the hazard is
beyond their capability to safely address. 7
Although an early concern for a
bus collision incident may be lack of
resources, this problem often quickly
shifts to one of communication and
Coordinate with recue crews if you don’t have adequate access to perform vital care to entrapped
patients. Photo Andrew Klein