Firefighters and EMS responders dispatched to a report of a one-car accident on an icy Wisconsin highway arrived to find something much worse: a chain-reaction accident involving two tractor-trailer trucks, one straight truck and two vans. Seven of the 13 people involved in the accident had been killed; an eighth victim would later die in a hospital. Three other people were injured.
The incident proved the benefits of training, a smoothly functioning incident management system and close cooperation among numerous mutual aid agencies. It was the second-worst motor vehicle accident in Wisconsin history; nine people were killed in a 1937 crash in Manitowoc County. Two accidents in 1940, one in Mani-towoc and another in Richland County, also each claimed eight lives.
How It Happened
The morning of Feb. 12, 1997, found Washington County, WI, highway crews plowing the snow nature had left behind. At 5:53 A.M., the Slinger Fire Department and Dick's Ambulance Service were paged to a reported single-car rollover accident with one person trapped on Highway 41, just north of Slinger. Within minutes, the command vehicle left the station with Captain Daryl Otte, Lieutenant Greg Bayer and Firefighter/EMT Rod Hansen. Road conditions forced the driver to use four-wheel-drive on the way to the scene.
Upon arrival, the three firefighters were surprised by what they found. Instead of a single car, the accident involved two tractor-trailers, one straight truck and two vans and covered a stretch of highway at least 250 yards long. Otte assumed command and split Bayer to left scene command and Hansen to right scene command.
Bayer checked the straight truck, one van and a tractor-trailer truck 250 yards up the highway. The only person in the van was the driver, who was unhurt. The driver of the straight truck, its only occupant, complained of a sore knee but refused assistance. The driver of the tractor-trailer was pinned in his vehicle. He complained of shoulder pain but was alert and oriented. Bayer was in constant radio communication with command, which asked the Allenton Volunteer Fire Department to respond and extricate and care for that driver. When Allenton units arrived, they relieved Bayer and assumed north scene command. Bayer then returned to the main scene.
In the meantime, Hansen found the driver of the other tractor-trailer sitting inside the truck. He complained of a laceration to his head. Hansen then inspected the van. Inside the van one patient was alert and oriented. Hansen asked how many people were in the van. Nine, the patient replied.
Hansen grabbed a flashlight, looked inside and said, "Oh my God!" Eight people were pinned in an area measuring about two feet by four feet. At least three were obviously deceased. Hansen requested additional ambulances and the Flight-for-Life helicopter. Command called for first responders from the St. Lawrence Fire Department and ambulances from the Hartford Rescue Squad, Richfield Fire Department, West Bend Fire Department and Jackson Fire Department, along with Flight-for-Life and an engine company and a command vehicle from Jackson.
Hansen ran up to the first-in Engine Company and requested any available emergency medical technicians (EMTs). The Slinger Fire Department does not run a rescue service but has firefighters who are trained as EMTs. The fire department frequently trains with Dick's Ambulance Service, a private operator that holds the village's 911 contract. Firefighter/ EMT Brad Schaefer was assigned to patient care with Hansen. They both went inside the van to treat the highest-priority patients. Chief Robert Schaefer was the officer on the engine company/ hydraulic rescue tool truck. He immediately established a hoseline for fire protection and an extrication crew, of which he took charge.
The extrication crew worked side by side with the firefighter/EMTs inside the van. Dick's Ambulance Service personnel were also on scene and assisted in care of the patients inside the van. Triage inside the van was difficult due to the limited space. The injured victims were removed and taken to a secondary triage area next to the van to be reassessed and prioritized. Command assigned Firefighter/EMT Chuck Dodge, from the second-in Slinger engine company, to assist with the overall scene from the EMS side. Dodge asked the St. Lawrence Fire Department to assist with setting up triage and blocking the view of the accident scene from passing motorists and media. Dodge also maintained records of the destination and status of all the transported patients.
Firefighter Rick Hanke assumed fire protection operations and foamed the area due to the large amount of diesel fuel on the ground. The area was then diked and all the contamination was cleaned up and maintained in hazmat barrels for pickup by a hazmat agency. He also established crews to spread drying agent and salt to the icy roadway. This assignment freed the chief to handle the extrication operation.
Initial Operations
The initial goal was to take the roof off the van to gain access to the people inside. It was believed that four of the people inside the van were still alive but the entanglement made it impossible to be certain. As the operation proceeded, the condition of the highest-priority patient began to decline, so priorities were changed to try to reach him sooner. Because of the damage to the driver's door, a second entry point had to be made. The chief had the extrication crew open the side panel of the van with an air chisel to expose the support beams. The crew then cut points behind the B post and, because of the location of side windows, cut the C post in front of the D post, and cut the side-support posts of the van. The side of the van could then be folded down, opening the entire side of the van.
EMS crews that had been standing by with long boards removed the patients (some deceased victims had to be removed to reach patients) and took them to the triage area. All the deceased were covered and the patients were treated. The extrication crew continued to remove the roof until the second-highest-priority patient was accessible. He was the farthest one inside the van toward the blocked passenger side of the van. He was removed and patient care was given to the Flight-for-Life nurse and doctor. The last patient was then removed.
Three obviously deceased patients remained inside the van. The Sheriff's Department took photos and measurements of the remaining victims. The greatest care was taken to cover the bodies and the scene to protect the dignity of the patients and victims. When the Sheriff's Department had completed its duties, the three remaining victims were extricated.
The crews directly involved with patient care and extrication were immediately sent back to the firehouse in the equipment truck, contaminating only one vehicle. At the firehouse one area was set up as a decontamination area. The first crew in removed all turnout gear, disassembled it and sent it out for cleaning. All tools and equipment that had been near the scene were brought back to the decon area, cleaned and disinfected before being put back in service.
Because of the severity of the damage to the tractor-trailer that was 250 yards away, it took rescuers 40 minutes to extricate the driver. He was transported with pain to his shoulder and minor cuts and bruises. The driver of the straight truck refused transport and signed a release form on scene. The driver of the first van was unhurt and required no care. His van stalled as he drove through the debris left by the second tractor-trailer but sustained no damage. The driver of the second tractor-trailer had a laceration to his head and was transported to a hospital.
One patient from the second van was flown by Flight-for-Life to a trauma center with broken extremities, facial fractures, and internal injuries. He passed away eight days later. Another patient from that van was transported to a hospital, where he was assessed with broken extremities and later transferred by land to the trauma center. He was alert and oriented throughout the incident. Of nine patients inside the van, he was the only survivor.
Incident Command
The incident was managed smoothly. The Slinger Fire Depart-ment had trained throughout the previous year on incident command, and the entire department and some members of neighboring departments went through incident command classes. The Slinger department then set up meetings with all mutual aid departments to explain its policies and procedures, and to gain an understanding of each mutual aid department's policies and procedures. The departments have worked together many times at fires, setting up the structures of the incident command system. Also, many types of incidents were practiced from water movements to multiple-victim accidents.
What Can Be Learned
Establish a list of resources available to your department. At this scene, numerous basic life support (BLS) and advanced life support (ALS) ambulances, helicopters, hydraulic rescue tools, dump trucks, construction equipment and towing companies were used. Make arrangements before incidents occur and before assistance is needed.
A close ongoing relationship must be established with commonly used resources as well as other possible resources. The Slinger Fire Department, for example, includes Dick's Ambulance Service in all decisions involved in setting up standard operating guidelines for vehicle accidents and in all vehicle accident training. The fire department also trains with other departments throughout the year. This helps the departments' personnel know each other personally and know each other's actions and abilities. All departments agreed they would rather be called to a scene and not required to work than to be called too late.
The extrication crew learned not to work with blinders on. Normally extrication practice involves removing doors and roofs, and even making a third "door" into a two-door vehicle. The crew found another way into the vehicle by air chiseling the side panel of the van to expose the side supports, cutting the supports and folding down the side of the van.
Protect the dignity of patients and victims. Each media agency was trying to get an edge over the others. Law enforcement officers needed help keeping them away. Attempts were made throughout the incident to cover the patients/victims and protect the bad parts of the scene from the media. Firefighters had to keep pulling the media away from areas where they should not have been. The Slinger Fire Department received numerous letters from people from all over the state telling them how nice of a job they did protecting the victims' dignity. Something so humane sticks in the minds of the customers (taxpayers) and gives your department a better image.
Hold a critical incident stress debriefing (CISD) session following a major incident. All of the members benefitted from the time spent talking about the incident with their peers. Many questions were brought forward and answered. One firefighter/EMT was relieved to learn what had happened to the patients/ victims after they were removed from the vehicle. He was relieved to know that each patient/victim was double- and triple-checked for the possibility of life after leaving his care.
Stress debriefing should also involve firefighters who were not on the scene. The fire department becomes a second family to its members. All the members are affected by any incident, even if they are not directly involved. The members needed a conclusion to their duties. They needed to know others were going through the same feelings they were, and that they were there for each other. All of the agencies involved in the incident were invited to the debriefing, including members from the Washington County Sheriff's Department, the Slinger Police Department, Flight-For-Life, Dick's Ambulance and mutual aid fire departments.
Always expect the worst. The call was paged as a single-car/single-person-trapped accident. When firefighters arrived on scene, 13 patients confronted them. It surprised everyone when all the extra help was requested. Otte requested enough ambulances or helicopters to treat everyone and notified the hospital, which in turn held over its third shift.
Brad Schaefer is a firefighter/EMT with the Slinger, WI, Fire Department and a paid-on-call firefighter with the North Shore Fire Department.
