First-In Actions will dictate outcomes of large vehicle events

Initial Operations at Large Vehicle/School Bus Events

Initial Operations at School Bus Events  are, like those at any other event, are critical to the successful mitigation of the event. We know the actions of the first-due units can make or break any situation; and large profile events will magnify that point. When dealing with an event involving a school bus, mass transit bus, or commercial over the road bus, we have to  remember the physical resources needed may easily overwhelm existing services and carry the potential for surge capacity impact on existing health care systems.

In general, school bus incidents should be treated as multi-patient events or mass casualty incidents. It may be appropriate to consider these events in the same way we look at a target hazard location; sending multiple units and dispatching special call equipment on the initial assignment. Sufficient resources should be sent on the initial assignment based on a jurisdictions Hazard Assessment, rather than waiting for first arriving units. While this may seem contrary to conventional response plans, these events hold high potential for rapid deterioration, need for personnel rotation, additional specialized tools and equipment; and of course, an effective Emergency Incident Rehabilitation program.

Size-up should work in concert with established per-incident plans based on a hazard assessment and include 360-degree assessments on the horizontal and vertical. Bus and large vehicle incidents frequently involve other vehicles. The injury-fatality-rescue ratio will depend on the size of the other vehicle involved. You may wish to consider the other vehicle as a separate event with an entirely separate response and resources.

Triage has to be completed both on the bus/large vehicle and in the crowd. Keep in mind that those able to self-rescue will do so and will scatter into the crowd. Some may even self-refer to area hospitals or home. Accountability for all passengers will be difficult. Although we're accustomed to the priorities of triage and treatment, it must be understood that the first people out of the vehicle may not be the most critically injured...removal of walking wounded or non-injured persons should be done to reduce exposure to further injury and create space to assess and treat others. This also includes removal of deceased.

Keep in mind that there may be persons with special needs on the vehicle. Once these people are removed, they cannot be left unattended.