The phones at Lexington County’s 911 center started ringing just after 2:30 a.m.
“I'm on the Amtrak and we just had a bad wreck.”
“There's babies on here bleeding out their head; it's a lot of people hurt. Somebody needs to come on.”
The calls last Sunday launched an emergency response that eventually included firefighters, sheriff’s deputies and paramedics in Lexington County as well as doctors and nurses at four area hospitals. For the next three hours, they cared for more than 100 people with injuries ranging from severe organ or brain damage to cuts and bruises.
But at 3 a.m., while most of the Midlands area slept in, the first responders getting dressed and rushing to the scene knew only that two trains had collided and one was a passenger train.
Dispatchers at Lexington County 911 gathered the first bits of information about the crash, asking the stunned train passengers where they were, how many cars were on the train, if other vehicles or structures were involved and how many people were hurt.
“Probably half the train is injured,” one caller says, seemingly irritated with the dispatcher’s questions. “Everybody's injured, sir. Everybody's injured.”
Getting that information was critical not just for sending the right resources to the scene, but ensuring the safety of responders as they arrived, according to Rodney Watson, deputy chief of 911 communications.
Asking those questions “by no means” delays the response, he said. “Maybe by the third question we’ve already dispatched units to the scene.”
‘All hands on deck’
Lexington County sheriff’s deputies arrived first at the crash, about six minutes after the first 911 call, according to Chief Brian Hood of Lexington County EMS. A minute later, the first ambulance arrived, and then the first fire engine a minute after that.
“One of the hardest things to do, as any disciplined first responder, is not to immediately engage the sick and injured,” Hood said. “As strange as that might sound. If you run in and come across the first significantly-injured patient, you’re stuck right there and so many other people may need your care.”
Instead, the 25 paramedics and EMTs began sizing up the scope of the crash, which involved getting the passenger manifest for the Amtrak train, Hood said. From there, they set up a “casualty collection point” on either end of the crash site, and EMS, firefighters and deputies got the passengers to those points.
“It was truly all hands on deck,” Hood said.
The lack of chaos at the scene was surprising, said David Kerr, director of Lexington County Public Safety.
“A lot of people might expect it to be chaotic, but it really wasn’t. It was very structured,” he said. “We were very blessed with the number of ambulatory patients we had that didn’t require serious medical treatment. To have only two souls lost in an incident like this is a blessing.”
Triage and transport
Most of the passengers were what Hood described as “walking wounded.” Even some passengers with “significant fractures” in the upper body could still get to the triage area on their own, Hood said.
First responders used color-coded tags to categorize the extent of each passenger’s injuries, Hood said. He estimated about 85 percent of the passengers wore green tags, which were the lowest priority. Patients with yellow tags were a higher priority but still were “somewhat stable,” Hood said. Those with red tags – there were two after Sunday’s crash – had the most critical injuries.
Victims were taken to one of several area hospitals, with the most severely injured going to Palmetto Health Richland, the only Level I trauma center in the Midlands.
“It becomes a bit of an air traffic controller job,” Hood said of coordinating patient transport. “You’re trying to determine exactly who can take how many.”
Two fatalities were reported early on. Lexington County Coroner Margaret Fisher said early fatality reports were higher.
“I expected it to be complete chaos,” she said. “When I arrived, everything was orderly. The communication between all the agencies was great.”
‘A slower night’ in the ER
Dr. Steve Shelton was an intern at Richland Memorial Hospital in 1991, when an Amtrak train derailed near Camden, killing eight people and injuring more than 70 others in the early hours of Aug. 1.
Shelton is a physician in the emergency division at what is now Palmetto Health Richland, and serves as medical director for emergency preparedness.
“It happened to be a slower night in the emergency department,” Shelton said of Sunday’s crash. “If it had been less than a week earlier, we would’ve had an emergency department packed with people and the hallways lined” with flu patients.
A tent with heaters and lights set up outside the emergency room for flu patients was empty that night, Shelton said. It became a triage area to accept incoming patients from the train wreck.
When the hospital was notified between 3:30 and 4 a.m. that it should expect multiple casualties, Shelton said the ER staff gathered ventilators, IV fluids, stretchers, wheelchairs and other items they might need. There was a trauma surgeon on shift, and Shelton said additional surgeons were made aware that they might be called in. However, they did not have to call in the additional support.
‘They were coming in ones and twos’
The first few patients trickled in on ambulances.
“They were coming in ones and twos,” Shelton said. “The big surge came a little bit later when the two disaster buses arrived almost simultaneously, carrying roughly 20 patients each.”
Palmetto Health’s three campuses treated 62 patients.
Shelton said a majority of the injuries at the Richland campus were cuts, scrapes, bumps and bruises.
“There were a couple of critical-injury patients who had solid organ injuries and brain injuries,” he said.
The first wave of patients came right before a shift change. Shelton said that effectively doubled the amount of staff in the ER because those scheduled to leave stayed later and those coming on duty came in earlier.
“It’s organized chaos,” he said of the ER. “You start getting an influx of folks and it looks chaotic. I think it was handled very well.”
‘Like it was an everyday thing’
Eight miles away at Lexington Medical Center, a mass-casualty bus arrived around 4:30 a.m. with 18 crash survivors.
Nine more were brought in by ambulance, according to Joshua Angle, a captain with the hospital’s public safety department and the facility’s emergency preparedness coordinator.
“It’s an event that, for the public, seems very large,” Angle said. “But we (treated) this like any major car accident. This staff handled it like it was an everyday thing.”
With the first notification of an incident, the hospital mobilized a triage area, nursing staff and necessary supplies, all of which were waiting when the patients came in, Angle said. Translators were on hand for non-English speaking patients, and the hospital’s medical social services department assisted with discharge of patients, which included organizing clothing and other items the passengers needed.
By 6:30 a.m., the hospital had scaled back its response and resumed normal operation, Angle said.
Training and previous incidents helped
Angle attributed the hospital’s smooth handling of crash victims to regular drills and exercises.
Twice a year, the hospital conducts a “full-functioning community event” that simulates a mass-casualty incident, usually involving an explosion or incident at a fair or a large traffic accident, Angle said. To keep participants on their toes, supervisors throw in “injects,” such as a power outage.
Similar exercises at Palmetto Health helped prepare staff for the influx in patients after last weekend’s train crash, but so did other major incidents they’ve handled in recent months.
“We had a chance to do this on a smaller scale three times this past year,” Shelton said, noting the July car attack at a Columbia cemetery that injured 12 people, the September shooting in the Vista that injured eight and October’s truck accident at Fort Jackson that killed two soldiers and injured six others.
“You don’t see that often,” Shelton said of the large number of patients. “This is the first time we’ve had this large of an event in the time I can remember since the other train accident in Camden. It’s rare for an individual in a health care facility to experience this more than once in their career.”
Not ‘if’ but ‘when’
Fisher said she spoke after the crash with a National Transportation Safety Board investigator.
“He said he had been investigating train accidents for 15 years, and this was the worst one he'd ever seen in the fact that two trains collided,” she said. “Considering that, (he said) you should have a lot more casualties, a lot more injuries.”
The crash happened at night, when most passengers were sleeping or in their seats and not up and moving around, which helped reduce the number of deaths and the extent of injuries, Fisher said.
Also working in favor of emergency workers were the low number of serious injuries, the crash’s proximity to both the S.C. Emergency Management Division headquarters and Pine Ridge Middle School, where the Red Cross opened a shelter, officials said.
“You’ve got 147 people out there involved in that, and within three hours they’re either in a hospital or in a shelter, it’s just incredible,” Lexington County Fire Service Chief Brad Cox said. “You talk about the perfect storm – everything just came together and worked so well.”
County agencies will pore through their response to the train wreck to figure out what can be done better and how they can help other agencies be ready for such an event. Hood said preparing for a mass-casualty incident is not a matter of “if” but “when.”
“It’s gonna be your turn at some point,” he said. “The question is, will you be prepared to answer the call?”
Victims of the Amtrak train crash Sunday were taken to four area hospitals.
▪ Palmetto Health Richland: 48 patients
▪ Palmetto Baptist Parkridge: 10 patients
▪ Palmetto Health Baptist: 4 patients
▪ Lexington Medical Center: 27