St. Johns County, FL, Fire Rescue (SJCFR) was presented with challenges it never faced before. An overloaded 22-foot Crownline Bowrider with 14 people on board rammed a moored, unoccupied tugboat on the Intracoastal Waterway about one mile north of the Palm Valley Bridge, approximately 25 miles...
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Area departments, including the SJCFR, train for mass-casualty incidents using the Simple Triage and Rapid Treatment (START) team. START consists of rapidly triaging victims. The system allows a rescuer to assess and classify each victim into one of four categories in less than 60 seconds: green, red, yellow or black. Within 12 minutes of arrival, all of the victims were assessed and triaged.
"They did a triage on the barge to determine which patients were going to be taken off and across the improvised dock...to be able to get them up to a treatment area," SJCFR Chief Carl Shank said.
Robshaw said another challenge the first rescuers faced was the psychological impact of the conscious victims. "Most of the deceased victims were killed instantly and, as a result, the conscious victims were found to be hysterical, insisting to be removed from the environment," he said. "It was truly a challenge to attempt to stabilize the situation until the bridge could be built. In addition, all critical patients were removed prior to removing the stable patients. Most of the deceased were found in the front of the boat, the only area rescuers could make access to the viable victims."
A post-incident analysis was conducted three days after the incident. The following factors were identified:
- Section officers assigned to manage mass-casualty incident operations should not be directly involved in the care of individual patients.
- Personnel working around water need to use the personal protective equipment (PPE) provided. Provided on each apparatus for all personnel are personal flotation devices (PFDs), trauma sleeves and safety goggles.
- Section officers assigned to manage mass-casualty incident operations should not change the format of management as long as the system is working.
- When using air transport units, fire-rescue personnel should be assigned to the landing zone in order to report conditions to command. The area should be managed as a staging area with reports of the number of transport units available versus the number of transport units needed.
- Documentation of the victims' location after leaving the incident is needed. Initially, victims on the boat reported that 12 people were involved. Following the last victim to be removed from the treatment section, rescuers identified 14 total victims. SJCFR identified through analysis that its communication center was best suited for accountability of the victims' destination. As a rescue transport departed the scene, some were diverted from their original destination, leaving the transport officer unaware of the victims' final destination.
MICHAEL GARLOCK is a Florida- and New York-based writer specializing in fire service responses to major incidents.