Published Reports

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.

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.

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.

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.

Country: Finland •  Report submitted: June 06, 2016

Reporter

Pauliina Valkovirta Role in incident: Planner and organizer of Master degree program in Emergency Care Management.

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Summary: Merisärkkä2016 - night club fire exercise. The night club fire exercise took Place in Finland at Kalajoki Hiekkasärkät. The exercise was planned and organised by six students of the Master`s degree programme in Emergency Care Management and it was carried out in co-operation with local emergency care service, fire service, police and other authorities. Kalajoki Hiekkasärkät is popular tourist attraction on the coast of Kalajoki especially at summer time. Kalajoki is quite small town with about 12500 inhabitants and the land area is 2391,30km2. The town is known as travelling, farming and metal industry. the area of Kalajoki Hiekkasärkät is located about ten kilometres away from Kalajoki town to the south. Night club Merisärkkä is one of many restaurants anf nigth clubs of the area of Hiekkasärkät. At the best season there can be even 3000 people having a party at the Merisärkkä night club. We decided to plan and organize that kind of exercise because there has been many disastrous night club accidents around the world in recent years. As we also know there has ever been that kind of exercise in Finland before. The major incident exercice planning and organizing was part of our Master`s degree studies.Hiekkasärkät of Kalajoki is located about ten kilometres away from the town of Kalajoki by the seaside.

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.

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.

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.

Summary: Utøya shootings

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

Country: Norway  •  Report published: April 17, 2015

Reporter

Mrs. Hanne Rikstad Iversen Chief physician Finnmarkssykehuset Role in incident: HEMS doctor

Summary: Bus rollover in Skaidi

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.

Country: Norway  •  Report published: October 17, 2023

Reporter

Jan Robert Boee Nurse at AMK (113) Medical Emergency line in Norway Role in incident I am registering all the trauma incidents/patients at our district in Nordland county concerning the hospital "Nordlanssykehuset avd. somatikk, Bodø. The registering platform is "Nasjonalt traumeregister Norway" (NTR) (The National register

Summary: Tunnel Car Crash

May 15th, 2022. Nordland county. Halfway into the "Steigen tunnel" which is 8 km long) See coordinates below). A Volkswagen Multivan 2005 model with 5 tourists crashed into the back of a slow-driving tractor pulling a heavily stone-loaded wagon. 4 passengers in the Volkswagen were immediately killed. The driver was heavily wounded. The driver of the tractor was not wounded at all. Tunnel in the midst of Steigen and Hamarøy. Not a densily populated area, but the only road to get to and from Steigen (approx 2500 inhabitants). Coordinates: 67.927675, 15.759004The investigation has not yet concluded with what really happened. About 3 cars in the same area at the time have not been of any help in analyzing the incident either. The driver of the Volkswagen is still not interviewed by the police, now 11 months after the incident. This was informed in the news in our region recently.

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.