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 Chile
Prison Fire in Santiago de Chile

Country: Chile  •  Report published: April 17, 2015

Reporter

Dr. Patricio Cortés Picazo
Director EMS SAMU Metropolitano Santiago de Chile 2010-2013
Emergency Medical Services SAMU Metropolitano Santiago de Chile

Role in incident:
Chief Operations Network Emergency Medical Services And Hospital System

Co-authors:
Dr. Carlos Becerra, Dr. Luis Herrada, Mr. Roberto Araneda, Ms. Carolina Astorga

Summary: Prison Fire in Santiago de Chile

On December 8, 2010 (6:12AM), the SAMU Metropolitan Santiago de CHILE (EMS) was alerted of a fire in the Prison of San Miguel with 1,900 inmates and guards inside. Most of the victims died of inhalation of smoke or toxic gases and burns (81 deads).

In addition to ambulances in EMS of Santiago de Chile with advanced life support (ALS) and basic life support (BLS) hospitals with burn units, general public and private hospitals, other EMS [100 km +/-] as well as the "centralized beds unit" were activated.

The "Centralized Beds Unit" was a unit created 5-6 years ago to coordinate needs and costs due to ICU beds always being full. It is a unit managed by nurses and doctors that overviews availability of public and private Intensive Care Units beds in the city and some regions of the country. This unit is in constant communication with EMS communication centre, Emergency Rooms and ICUs. Both are in the city and located away from the incident. Other relevant organizations like Civilian Protection and Ministry of Health were alerted of this Mass Casualty Incident in progress from EMS coordinating centre (131).

On scene work consisted of: primarily triage of 466 patients who were burned (using START triage), of whom 81 were declared dead on-scene, 20 patients were evacuated to 9 different Emergency rooms. There were 7 ambulances with ALS competency and 13 ambulances with BLS competency on-scene. No patients were transported more than 17 km in the primary evacuation, none died after 24 hours. All patients were discharged from secondary health care facilities alive.

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 Finland
School shooting in Jokela

Country: Finland  •  Report published: April 17, 2015

Reporter

Dr. Timo Jama
Medical Director of EMS
Päijät-Häme Social and Health Care Group

Role in incident: Incident Commander (working duty officer/HEMS physician at that time)

Summary: School shooting in Jokela

On November 7th 2007 a student at Jokela high school opened fire on students and employees inside the school building. He also attempted to start a fire, but did not succeed.

Eight people (the principle, school nurse and six young high school students) were killed by a student at the school who opened fire on school premises. The shooter shot himself and died afterwards in hospital.

Challenges were that it took 2 hours to secure the site for Emergency Medical Services to access. TETRA radio was periodically not working.

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Plane crash exercise Oulu *

Country: Finland  •  Report published: December 29, 2015

Reporter

Mr. Lasse Viljam Raatiniemi
Chief of Medicine for ground EMS at Oulu University Hospital, Division of Pre-Hospital Emergency Care

Role in incident: Author works as Chief of Medicine for ground EMS units in health care district and as HEMS doctor in FinnHEMS 50. The author did not directly participate in the excercise.

Summary: Plane crash exercise Oulu

The disaster exercise was organised on the coast of Oulu, the largest city in northern Finland with 196,382 inhabitants. There is a university hospital located in Oulu and it functions as a major trauma center for the entire northern part of Finland with about 750,000 inhabitants. The land area of the catchment area is about 50% of the land area in Finland. Oulu is known as a technology city and is also an important university city (Oulu University).
Oulu airport is located in Oulunsalo, about 15 kilometres from Oulu center. It is the second largest airport in Finland. The road-network is well-developed and the university hospital is easily accessed by ground ambulance. Hailuoto is the third largest island of Finland with a population about 1000 inhabitants. Hailuoto is accessed by ferry and transport from Hailuoto center to Oulu center (ferry and driving time by car) is about one hour. The organisation responsible for administration of pre-hospital emergency medical services is Oulu University hospital (Northern Ostrobothnia Health Care District). Emergency medical services are operated by Fire Brigades (urgent missions) and privatists (non-urgent missions). The physician-staffed helicopter emergency medical services are operated by FinnHEMS. The only HEMS unit, FinnHEMS 50, has its base in Oulu airport. EMS have four tiers: first responders (fire brigade), basic- and advanced level ambulances and FinnHEMS 50. Field commander on duty has the operational commando for EMS- units on daily basis. Field commanders have education as paramedics. Dispatch center has catchment area for the whole of the North of Finland. All 112 calls are answered by specially-educated operators, units are dispatched based on risk evaluation and operational procedures.

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Plane crash exercise Kuusamo *

Country: Finland  •  Report published: December 09, 2016

Reporter

Dr. Lasse Raatiniemi

Role in incident: Treatment officer

Co-authors

Tommi pekanoja
Role in incident: Observer, Field supervisor

Pasi Lehto
Role in incident: Observer, pre-hospital anaesthesiologist

Summary: Plane crash exercise Kuusamo

The incident took place in Finland at Kuusamo Airport. A passenger aircraft with 20 passangers and four crew members had a tough landing after light contact with another aircraft in the air. In the secondary triage: three red, seven yellow, 12 green and two black patients.
The success factors in this major incident excercise were very fast initiation of major incident protocol, the use of local emergency medical response team and good communication. Another success factor was that EMS units also from other hospital districts were dispatched and they communicated and worked effectively during the exercise. In a very rural area, with limited number of EMS units, co-operation with other hospital districts is of great importance. The mandatory major incident communication simulation trainings have probably improved the communication during full scale excercies. The EMS communication plan is similar in all hospital districts in Northern Finland.
HEMS unit was not able to fly to the scene due to weather restrictions. However, HEMS doctor (DOC) and HEMS crew member (HCM) responded using a rapid response unit.

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 Mexico
Gas explosion

Country: Mexico  •  Report published: September 27, 2016

Reporter

Dr. Fernando Román-Morales
Coordinator of Prehospital and Disaster Medicine for the Health Secretariat

Role in incident
Coordinator of Prehospital and Disaster Medicine for the Health Secretariat. At his arrival on scene he tried to stablish a Medical Command Post and worked as the Medical Command Officer.

Co-authors
Mr. Martín Durán-Lara &
Dr. J. Sebastián Espino-Núñez

Summary: Gas explosion

An initial gas leak from a gas tank vehicle caused a gas explosion on the premises of a hospital in the periphery of Mexico City on January 29, 2015. The gas explosion destroyed 70% of the hospital building and an estimated number of 71 persons were injured, 27 of them neonates. Evacuation of injured from the scene was quickly established, but was uncoordinated and ad hoc. Major challenges in the MI management on scene were hazards from biological and infectious residues and radiation from diagnostic equipment, fire and collapsed building structures.  Access to the scene was impaired by traffic, evacuation was done by road and helicopter EMS to nearby hospitals. Allocation of patient to hospitals was not coordinated, and there seems to have been a significant under- and overtriage. Communication between emergency units was challenging because two emergency communication systems were in use, but communication to the public seems to have been adequate with the use of social media and television. Incident command was established approximately 2 hours after the incident, at that point all victims had been evacuated. The major issue to be addressed in the management of the MI is the fragmented emergency care and general health care system in Mexico City and the lack of a unified MI plan and lack of coordination on scene.

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 Norway
Bus rollover in Skaidi

Country: Norway  •  Report published: April 17, 2015

Reporter

Mrs. Hanne Rikstad Iversen
Chief physician
Finnmarkssykehuset

Role in incident: HEMS doctor

On November 19th 2011 a buss with twenty three passengers rolled over in Skaidi in the county of Finnmark in Northern Norway. Twenty two persons were transported to either Hammerfest or Tromsø hospital. Finnmark is characteristic for bad weather conditions such as snow shower and reduced visibility. The road traffic is often difficult during winter. This part of Norway is vulnerable concerning resources and long distances. The risk of hypothermia was a challenge. The Emergency coordinating center did not summon their doctor or additional resources which lead to a lack of resources available in the response phase. It was pure luck that the first ambulance on-site used the same triage system as the first air ambulance to arrive on-site.

There were relatively good telecommunications network at the accident site.

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Truck and tunnel fire

Country: Norway  •  Report published: October 3, 2015

Reporter

Dr. Jon-kenneth Heltne
MD
Haukeland University Hospital

Role in incident
Consultant at the Air Ambulance, one of several HEMS physicians on scene. Took part in the rescue efforts, triage and treatment of victims from Gudvanga tunnel fire.

Summary: Truck and tunnel fire

Truck and tunnel fire in Gudvanga tunnel in Western Norway.

On August 5th 2013 a fire started in a truck inside the Gudvanga tunnel in Western Norway.

The Gudvanga tunnel is the second longest tunnel (11 kilometers) along the ferry free Europe road 16 between Oslo and Bergen. The incident happened in a sparsely populated area 40 kilometers from Voss with 14000 inhabitants, nearest large city Bergen has a population of about 300 000 people. Nearby several beautiful tourist attractions and fjords.

Traffic authorities measured 1995 vehicles per 24 hours in average. There were 66 casualties, all of them taken to nearby hospitals some with serious inhalation injuries, but no fatalities. Although the biggest tunnel fire seen so far it has been hailed a miracle that there were no deaths.

Emergency services communicated via old analogue network and local coverage in the area was poor. Challenges were communication systems not working inside tunnel and 2 evacuation sites, one on each side of tunnel reporting to 2 different dispatch centers. In addition, the electrical system melted and lead to no light or fans working inside the tunnel. Heavy smoke made access difficult.

Effective triage by HEMS, appropriate use of transportation and several hospitals involved in patient distribution made the evacuation successful.

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Utøya shootings

Country: Norway  •  Report published: April 14, 2015

Reporter

Dr. Stephen J.M Sollid
Consultant at the Air Ambulance Department of Oslo University Hospital, Norway.

Role in incident: One of several HEMS physicians called in extra following the terrorist attacks of July 22, 2011. He took part in the rescue efforts, triage and treatment of victims from the Utøya shooting both on the first triage point and on the island itself.

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Train collision

Country: Norway  •  Report published: February 1, 2016

Reporter

Dr. Marius Rehn
HEMS SpR, Assoc Professor
Norwegian Air Ambulance Foundation

Role in incident
Participated in immediate rescue operations as winchman on Sea King 330 Sqn, Rygge, RNoAF
The content of this report is based on the report: Åstaulykken. Norges Offentlige Utredninger 2000: 30. and the personal accounts of the reporter (MR)

Summary: Train collision

On January 4th, 2000, two trains collided at Åsta station between Rudstad and Rena.
The locomotive of the southbound train was severely crushed and tilted to its side. The engine car of the northbound train was completely destroyed, the two front carriages derailed, while the remaining cars received minor damage and stayed on the tracks. The crash resulted in an immediate major fire burning the locomotive and spreading through the trains. The collision and the subsequent fire resulted in 19 fatalities, whereas 67 passengers survived the accident with only minor injuries.

Population density, terrain: The area is a rural, farmland region with combined forest and cultivated grounds. The scene was situated close to a main road (State Highway 3) and was directly accessible from the road. Distance from scene using roads are: 7,9 km to Rena and 25,5 km to Elverum

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 United Kingdom
Sheppey Crossing Bridge Road Traffic Accident

Country: United Kingdom  •  Report published: April 16, 2015

Reporter

Dr. Sophie Elizabeth Hardy
A&E core trainee
Medway Maritime Hospital, Medway nhs trust

Role in incident: Junior Doctor on duty in A&E at time of Major incident

Summary: Sheppey Crossing Bridge Road Traffic Accident

On 5th September 2013, a road traffic accident involving 150 cars and 200 people occurred on the Sheppey Crossing bridge in Kent. It occured at 7:15 am under thick fog where visibility was reduced to 25 yards. Cars continued to impact each other for a further 10 minutes following the first collision and as the fog lifted, it was evident that the pile up involved cars extending across most of the 1270 metre long bridge. There were 69 casualties: 37 were taken to surrounding hospitals, 8 of them with serious injuries but no fatalities. 32 were directed to minor injuries by critical care paramedics on scene.

The crash was one of the worst seen on British roads and it has been hailed as a miracle that there were no deaths and very few serious injuries. Although declared a major incident, there was minimal disruption to the routine emergency and healthcare services. This was in a large part due to the effective triage by paramedic practitioners and critical care paramedics on scene and to appropriate use of ambulances and the patient distribution to various receiving hospitals.

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