- Email: [email protected]
The Edison plant disaster
The Edison Plant Disaster by Davette Shea, RN, GlendaCrabbe,RN, Denny Longman,and Barbara Poling
Laughlin, NV - Minutes after a pipeline explosion ripped through the Mohave Generating Plant near Laughlin, Nevada, on June 9, 1985, authorities at a nearby hospital began emergency procedures that sparked Nevada's largest airlift of disaster victims since the MGM Grand Hotel fire in 1980. The Mohave Generating Plant is located in the rapidly growing region of the Colorado River Basin, situated between Bullhead City, Arizona, and Laughlin. It is a steam-generating plant that has round-the-clock coverage, seven days a week. The closest medical facility is located in Bullhead City, Arizona (Bullhead City Community Hospital), which has a four-bed emergency room with 24-hour physician coverage, and a progressive nine-bed intensive care unit. Prehospital resources include: Mercy Ambulance located at Laughlin, Nevada with EMTII capabilities; the Clark County Fire Department; and the Bullhead City Fire Department. Both fire departments offer EMT-II capabilities. The following is a narrative/scenario of the incident on June 9, 1985: Barbara Poling, Communications Specialist Supervisor 1539: Barbara Poling, Communications Specialist Supervisor, was notified by fire department EMS control to place Life Guard I on standby for an explosion at the Southern California Edison Plant at Laughlin, Nevada. Later, details revealed that an explosion had occurred when a 30-inch pipe, with 1,000 degree IF) steam and 600 psi had exploded in a closed area during a shift change. At the time of the standby, the only information that Poling received and relayed to the crew was that there were multiple victims and injuries. After receiving the call and placing the crew on standby, we also received a call from the National Park Service {NPS}, Lake Mead, requesting our assistance in looking for four children who had been missing for approximately four hours. I advised the NPS personnel that we were unavailable due to a previous request from Las Vegas City Fire Department Central Alarm office. I informed them that 18 MARCH/APRIL 1986
.,&M,,.I
the Communications Center dispatchers would call them after the helicopter and crew returned to inquire about whether our services were still needed. 1546: A "go" per Fire Department and Mercy Ambulance to the scene of the explosion. 1550: Life Guard I lifted off the roof en route to the Mohave Generating Plant in Laughlin. Following notification of the fire department that Life Guard I was en route, I notified in-house personnel, nursing supervisory staff and administration. Since multiple victims and injuries were reported which could constitute an internal disaster situation, I began to alert appropriate personnel of the evolving events in Laughlin, even though our facility does not offer burn care and we had no update as to the types or extent of injuries. Denny Longman, Director of Flight Operations/FLIGHT FOR LIFE 1546: At the time we were placed on standby, I verified the location with dispatch personnel and checked fuel and weather conditions. We were in a "ready" situation. 1550: While en route to the plant, I contacted Barbara Poling to confirm that there had been an explosion. My concern then was the nature of the explosion and the danger of an additional explosion that might involve our landing area, or could endanger the crew and/or aircraft. Poling confirmed that there had been an explosion, but ground units at the scene radioed that the area was clear and there was no impending danger of a second explosion at that time. Davette Shea, RN/Flight Nurse: 1546: As we were placed on standby, Ken Riddle, flight medic, and I did a quick check of the aircraft. We anticipated multiple trauma victims with probable burn injuries. We put on an extra pair of antishock trousers, the burn packs and extra, normal saline solu-
tion for irrigation purposes, and Ringers Lactate for IVs. 1550: As Longman checked with Poling concerning hazards at the site, we awaited further medical information. In preparation for the possibility of multiple victims either at the site or at Bullhead City Community Hospital, the closest medical facility, I asked Poling to get administrative approval for fixed-wing support, and to call in the next flight nurse and fright medic to be on duty.
Between 1539 when Life Guard I was placed on standby, and 1508 when we were notified that all victims had been transferred to Bullhead City Hospital, the resources of Laughlin and Bullhead City had responded to the scene, triaged and transported all semi-critical and critical victims to the hospital setting. During this entire afternoon and evening, the only communication problem that arose was when Life Guard I was diverted to the hospital and then redirected to the scene,
Poling: 1600: Bullhead City Community Hospital confirmed that there were numerous injuries, mainly related to high pressure steam burns. I advised them that we also had Aeromedical Services International, the local fixed-wing vendor, available to respond if needed. 1605: We were advised by the officer at the scene not to land on the helipad area due to debris and gravel from the explosion. This was relayed to the flight crew. 1608: Per the Laughlin Fire Department, Life Guard I was diverted to the hospital as all of the patients had been triaged and sent there. 1610: Per the Metro officer at the scene, Life Guard I continued to the scene as there were two remaining critical victims at the plant.
Longman: 1628: After determining that the landing area was clear from the air, I was directed to land on the parking lot betgnd the helipad. I contacted Poling and told her we were landing at that time. We were told that one patient was in a pickup truck and one patient was in the ambulance. Shea: 1628: Upon arrival at the scene, Riddle and I each proceeded to one of the victims. Riddle began to assess and ready the male patient in the pickup truck while I moved to the back of the ambulance for the female patient. Longman got out our transport stretchers and assisted with equipment and burn packs. It was reported that there were two fatalities at the scene. The 30-year-old
/
I
CALIFORNIA
1
'4J t Oce,'m~
L. Pacific
" . . . an explosion had
occurred when a 30-inch pipe, with 1,000 F steam and 600 psi had exploded in a closed area during a shift change."
Life Flight(LongBeach)helicopter approachesthe SouthernNevadaMemorial Hospitalhe[ipad.Photoby Scott Henry, LasVegasReview-Journal. AM.]
MARCH/APRIL 1986
19
"The 30-year-old female victim was awake and alert, crying with pain. "
Flight for Life crew loads patients at Bullhead Community Hospital, Bullhead City, Arizona. Photo by Don Polk, Las Vegas Sun.
female victim was awake and alert, crying with pain. She had approximately 65 percent first-, second- and third-degree burns over her head, neck, torso, arms/hands and anterior thighs. The 33year-old male patient had approximately 74 percent first-, secondand third-degree burns over the same areas of his body. Both patients were awake, breathing spontaneously and complaining of pain from their burns. Neither patient had sustained a loss of consciousness. Both patients had been partially stripped of their clothing and wrapped in wet sheets. They were both cold and shivering, and this presented Riddle and I with a challenge in attempting to establish IV lines. Riddle was unable to initiate a line after two tries. I was able to establish a #18 gage in the female patient. Upon loading the patients, I secured an IV line in the male patient's ankle area. We applied humidified oxygen at 10-12 liters to each patient. The secondary exams revealed no obvious deformities other than the burns. We estimated fluid volume to be given according to the burns, rechecked vital signs and decided to administer morphine for pain. In flight, the male patient developed cyanosis, stridor and increased respiratory rate. I nasally intubated the patient without difficulty and assisted his respirations. His respiratory status improved, but I suctioned a moderate amount of frothy blood-tinged secretions with tissue from his airway during flight. Riddle and I continued monitoring both patients' vital signs and respiratory status. We called our report to Southern Nevada Memorial Hospital and were directed to continue fluids, respiratory monitoring and morphine administration.
1635: At this time, ASI fixed-wing was dispatched to Bullhead City to transport two patients. Due to the volume of calls and criticality of the situation, I called in the third communications specialist to assist with anticipated communications endeavors. I was also informed that Life Flight from Long Beach was responding to the hospital. 1647: Upon receiving notification that Long Beach Life Flight was responding, I realized the need for a coordinated communications system for the flight crews. We are the closest flight program and dispatch center available in the Bullhead City area. I contacted Dispatcher Katherine Montgomery in Long Beach and was advised that there were two helicopters and one fixed-wing en route. Radio capabilities and ETAs were discussed, and Montgomery and I developed the necessary dialogue to carry us through the next intense three hours. 1649: I contacted the Laughlin Fire Department to notify them of
the Long Beach helicopter and fixed-wings' ETA. I told them that I would continue to contact them with necessary information in regard to the air ambulances. Longman: 1655: We departed the scene en route to Southern Nevada Memorial Hospital with two critical patients on board. Due to the number of patients and extent of injuries relayed to us at the scene, I anticipated a quick turn around to Bullhead City Community Hospital.
Poling: 1628: As I waited for further information concerning patient condition and disposition, I notified Marcia Hawkins, director of marketing, so that she could assist and direct the numerous calls from the media being received from other geographical areas. 20 MARCH/APRIL 1986 AM.J
Shea: 1655: Due to the extent of the burn injuries, we knew that we would be transferring these patients to the burn care center at Southern Nevada Memorial Hospital. Poling informed me that
Bullhead City Community Hospital had been in contact with Southern Nevada so that everyone was aware of the number and extent of the injuries involved. Southern Nevada has a five-bed burn unit with an intensive care unit capability of 14 beds. Once the victims had been triaged to the Bullhead City Hospital, the physicians at that facility made the decision to air evac the surviving patients to burn care centers. Due to the criticality' pulmonary injuries and distance, air transport was the best decision for the patients' care. The capabilities and respiratory equipment available through the air ambulance services also were major deciding factors in utilizing airlift vs. ground transport. Ground miles are approximately 110 vs. 75 statute miles by air, looking at one-and-a-half hours by ground vs. 35 minutes by air.
"Due to the extent of the burn injuries, we knew that we wouM be transferring these patients to the burn care center at Southern Nevada M e m o r i a l Hospital."
Poling: 1703: Life Guard I had a 29-minute ETA to Southern Nevada Memorial Hospital. I notified the appropriate individuals of the ETA and I was also able to call Bullhead City's hospital with an ETA on the ASI fixed-wing to their location. 1720: Usually" Life Guard I would land on the designated helipad that is located a block away from the emergency room. At this time, Southern Nevada notified me that they were requesting Life Guard I land in the driveway of the hospital adjacent to the emergency room for more rapid deployment of the patients. 1725: Long Beach called to verify ETA to Bullhead City' ETA was relayed to Bullhead City Community Hospital.
Shea: 1730: Upon landing at Southern Nevada, we were met by an excellent team of surgical, burn care and emergency room personnel. A report on each patient was given. Dr. Charles Burke, director of the burn care unit, informed me that all the remaining patients would be coming to Las Vegas. He had spoken with the physician in Bullhead City, and it was agreed they would be transferred by air to Las Vegas. Longman: 1743: We arrived back at Valley Hospital Medical Center to refuel and change medical crews. Poling informed me that additional air ambulance crews were en route to Bullhead City Community Hospital. I talked with Poling concerning her coordination efforts and asked if I could be of assistance. She relayed to me the information that she had available concerning the other aircraft. We had been told all victims would be transferred to Southern Nevada, so I realized that multiple aircraft would be responding to the Las Vegas area. Upon arriving back at Valley Hospital, we were informed that we would not need to return to Bullhead City, as there were enough aircraft there to accomplish the necessary transports. However, three minutes later we were given a "go" to return there to transport the last two patients of the disaster. At 1800, we were en route to Bullhead . . . . Poling: 1745: Metro called to inform us that there were aircraft from Phoenix and Flagstaff (Arizona) also responding to Bullhead City. I gave Shea this information after he landed at Valley Hospital's home base. Glenda Crabbe, RN/Flight Nurse Dispatching the second half of our crew started with an early wake-up call at 1616, requesting that I come in to start my night shift duties a few hours earlier than scheduled. Poling explained that there had been an explosion in Laughlin and that the helicopter was already at Bullhead City Community Hospital, picking up and transporting the last two victims. After taking the two patients to
Life Flight (Long Beach) crew unloadspatient at SouthernNevada Memorial Hospital in Las Vegas. Photoby Scott Henry, Las Vegas Review-Journal.
Southern Nevada Memorial Hospital, the helicopter returned and was restocked by myself and Janice Childers, one of our flight medics who had relieved Medic Ken Riddle. At 1800, Life Guard I started out again . . . .
Shea: During the flight, I contacted Las Vegas approach control and informed them that several helicopters, carrying critical patients from Bullhead Arizona, would be coming into the city with pilots who were not famih'ar with the area. Approach control agreed to render assistance with the necessary radar vectors and to direct pilots to Southern Nevada Memorial Hospital. En route, I contacted the Department of Public Safety's helicopter pilot who was out of Flagstaff, the first helicopter out of Bullhead City with the first of what would be the next 11 patients to be transported to Southern Nevada. At that time, they were informed of our dispatch frequency' as well as the Las Vegas aircraft frequency, and that approach control would assist them in locating the hospital. I also contacted the Air Force helicopter pilots, et al. Crabbe: 1840: Arriving at Bullhead City, our usual landing pad was already occupied. In addition, there were four other helicopters scattered about the hospital's parking lot, making it look like a helicopter convention! The helicopter crew from Survival Flight was just departing with their patient, who was taken to Maricopa County Hospital in Phoenix. When Janice and I walked into the emergency room, the scene could have been described as "organized" chaos, but we rapidly assessed the situation knowing everything was well under control. The entire emergency room area, rooms and hallways were filled with patients on stretchers. There were multiple personnel AM.J
MARCH/APRIL 1986
21
involved in the stabilizing of these patients when we arrived, i.e., physicians, nurses, prehospital personnel, and a variety of flight suits were visible. Entering the hospital, I became involved in triage work, since I was knowledgeable about flight times and receiving ability of Southern Nevada Memorial Hospital and its available resources. We extended our normal ground times to assist in coordinating the departure and arrival times of aircraft to Southern Nevada Memorial Hospital in order not to inundate the facility with an overwhelming volume of patients at one time. Childers and I were directed to our two designated patients and began to prepare them for transport. The patients had been well stabilized with IVs, oxygenation and appropriate dressings for their burns. The records and reports were copied and put into envelopes, enabling us to transport in a very short time. A well-organized report was received on each patient, and each patient had been attended by an assigned nurse and physician, thus avoiding repetitive care and information.
"The entire emergency room area, rooms a n d halllways, were filled with people on stretchers."
Shea: 1840: While the flight nurse and flight medic were inside preparing the patients and assisting with triage, I was contacting all of the pilots and informing them of radio contact frequencies and directions to Southern Nevada. The Bullhead City Fire Department did an excellent job of coordinating the air ~rews' landing and air traffic control at the scene of the hospital. The potential for a disaster to occur was certainly real, but due to the professional response and management of the Bullhead City Fire Department, the entire mission was flawless. Crabbe: 1934: Both of our male patients had received various degrees of first- and second-degree burns. In flight, we maintained their IV fluids and observed each patient for any change in vital signs or respiratory status. Poling: 1810: Continuing with my routine duties, I checked with the National Park Service personnel about the status of the four missing children. They advised me that they had been located and were in good condition. 1826: I notified Southern Nevada Memorial Hospital that I would have communications contact and frequency capabilities with all the inbound aircraft, and that I would keep them up-to-date and advised as to patient conditions and aircraft ETAs. 1830: Montgomery called from Long Beach and advised us of a 30minute ETA, with one helicopter carrying two patients and one helicopter carrying one patient. I informed them that the helicopter from the Department of Public Safety was inbound and carrying two patients. 1845: ASI, our fixed-wing support and backup, arrived at Scenic Airlines carrying two male patients. Flight nurse Nancy Dunbar and pilots Dan Scroggins and Ira Eichenfleld assisted with transferring the patients to American Ambulance and their paramedic crew members, Patti Young and Mike Gunner. Nancy Dunbar accompanied the patients along with the paramedics to Southern Nevada Memorial Hospital. They were the third and fourth victims of the disaster to arrive. 1900: I received the first contact with the Department of Public Safety's helicopter, 31AZ. The pilot informed me that he was seven minutes from Las Vegas and was requesting landing information. I also received a simultaneous call from Life Flight I who had a 15minute ETA. 1902: I notified Dr. Charles Zumpft, director of emergency services at Southern Nevada and the physician coordinating patients being received, of the ETAs of the two aircraft. He questioned the 22
MARCH/APRIL 1986
AMJ
Soulhern Nevada Memorial Hospitalmedical team members receive patients. Photo by Scott Henry, Las Vegas Review-Journal.
criticality of the patients on board the aircrafts. I checked with 31 AZ and Life Flight I and it was determined that the patient on board Life Flight I was the most critical. Dr. Zumpft then directed the Life Flight Helicopter to land in the driveway to enable rapid patient access, and directed the Department of Public Safety's helicopter to land on the helipad at the hospital. He said we would have appropriate personnel at both locations to receive the patients. 1 9 0 5 : 3 1 AZ landed with two patients at Southern Nevada's helipad. 1918:31 AZ requested information about where to relocate and wait for his medic. He was directed to the alternate helipad available at Valley Hospital, and he arrived at Valley at 1931. 1925: Life Flight I landed at Southern Nevada Memorial Hospital with one critical patient on board. 1939: Life Flight II had a 12-minute ETA to Southern Nevada Memorial Hospital with two patients on board. 1944: Life Guard I called with a 20-minute ETA to Southern Nevada with two patients on board. 1950: Life Flight I was en route to Bullhead City to refuel, pick up equipment and return to Long Beach. 1952: Life Flight II requested information on landing at Southern Nevada. I was told at that time the Air Force helicopter had landed on the helipad at the hospital and Life Flight II was directed to land on Southern's driveway. 1956: Life Guard I called requesting landing instructions. Advised Life Guard I to land in the parking area in front of Southern Nevada's emergency room. 2003: Life Flight II requested information on landing at Valley Hospital Medical Center to refuel their aircraft. They had been informed of rooftop refueling capabilities at our hospital and that they were welcome to utilize our helipad. Life Flight II arrived at Valley Hospital.
2011: Life Guard I landed at Southern Nevada Memorial Hospital with the last of the two patients of the airlift. 2023: Montgomery` in Long Beach, was notified of the location of the Life Flight helicopters. 2021: Life Flight II departed from Valley Hospital Medical Center en route to Long Beach via Bullhead City. Life Guard I retuned to home base. ha a matter of three hours and 23 minutes from receipt of the call to response to the scene, all 13 critical victims had been airlifted to appropriate burn care facilities. This major effort could not have been possible without the cooperation and professional response of the agencies, hospitals and personnel involved. The highest compliments go to the following individuals and agencies: •. the air traffic controllers at McCarren International Airport, Las Vegas •. the physicians and staffof Bullhead City Community Hospital, Bullhead Cityl Arizona .. personnel/paramedics/firefighters of Bullhead City Fire Department, Bulkhead City, Arizona .. personnel/dispatchers/paramedics of American and Mercy Ambulance, Laughlin, Nevada .. officers/dispatchers of the Metropolitan Police Department, Las Vegas, Nevada •. personnel/paramedics/firefighters of Clark County Fire Department, Clark County, Nevada .. Dr. Charles Zumpft and emergency room staff; Dr. Charles Burke and burn care staff, surgical staff and ancillary services of Southern Nevada Memorial Hospital •.. employees and medical assistance crew of Southern California Edison Plant, Laughlin, Nevada O n - D u t y F l i g h t Crews • . . Life Guard I, Las Vegas - Denny Longman/Pilot, Davette Shea/Flight Nurse, Glenda Crabbe/Flight Nurse, Janice Childers/ Flight Nurse, Ken Riddle/Fright Medic, Barbara Poling/Communications Specialist, Nancy Pasnik/Communicafions Specialist and Don Bartholomew, Communications Specialist. • • • Air Evac, Phoenix - G a r y Lobman/Pilot, Thomas Evans/Flight Nurse, Gary Rust/Fright Medic •. • Life Flight I, Long Beach - Jim Nauman/Pilot, Efren Vargas/ Flight Nurse . . . Life Flight II, Long Beach - Dan Aguilar/Pilot, John Hood/ Flight Nurse, Katherine Montgomery/Dispatcher •.. Aeromedical Services International {fixed-wing), Las Vegas Dan Scroggins/Pilot, Ira Eichenfield/Pilot, Nancy Dunbar/Flight Nurse • . . Arizona Department of Public Safety - J i m Knapp/Pilot, Mikel Longman]Medic . . . 4460th Helicopter Squadron, Auxiliary Field, Indian Springs, Nevada - Capt• Robert F. Clegg/Pilot, 1st Lt. Kelley E. Anderson and Staff Sgt. Charles D. Lee, III • . . Survival Flight
PROFESSIONALS CHOOSE
pI o MzD, HOME OF THE PRO MED PACKS t h e s t a n d a r d o f t h e EMS i n d u s t r y Manikin Parts & Repair
pP,O MED 737 No. 1200 W., OREM, UT 84057 INSIDE UTAH 1-800-662-1585 TOLL FREE 1-800-453-1264 1-801-226-3633 P.O. Box 21395 Salt Lake City, Utah 84121
BASHAW MEDICAL, INC PRESENTS A M U L T I P U R P O S E VEST FOR: MEDIVAC PERSONNEL, PARAMEDICS, EMTs FEATURES: WATERPROOF CORDURA POCKETS IV CATHETER POCKET LIGHTWEIGHT
Patient Sumary:
WASHABLE
T w o patients were DOA at the scene
6 COLORS
Four patients expired at Southern Nevada Memorial Hospital O n e patient expired in Phoenix, Arizona T w o patients were transferred to Southern California from Southern Nevada Memorial Hospital O n e patient was transferred to Salt Lake City, Utah from Southern Nevada Memorial Hospital F i v e patients survived and were discharged from Southern Nevada Memorial Hospital in addition to the other patients that had been transferred to other facilities.
FOR MORE I N F O R M A T I O N CALL OR WRITE: BASHAW MEDICAL, INC. 4909-B MOBILE HWY, PENSACOLA, FL 32506
904-455-7017 AM.]
MARCH/APRIL 1986
23
Laughlin, NV - Minutes after a pipeline explosion ripped through the Mohave Generating Plant near Laughlin, Nevada, on June 9, 1985, authorities at a nearby hospital began emergency procedures that sparked Nevada's largest airlift of disaster victims since the MGM Grand Hotel fire in 1980. The Mohave Generating Plant is located in the rapidly growing region of the Colorado River Basin, situated between Bullhead City, Arizona, and Laughlin. It is a steam-generating plant that has round-the-clock coverage, seven days a week. The closest medical facility is located in Bullhead City, Arizona (Bullhead City Community Hospital), which has a four-bed emergency room with 24-hour physician coverage, and a progressive nine-bed intensive care unit. Prehospital resources include: Mercy Ambulance located at Laughlin, Nevada with EMTII capabilities; the Clark County Fire Department; and the Bullhead City Fire Department. Both fire departments offer EMT-II capabilities. The following is a narrative/scenario of the incident on June 9, 1985: Barbara Poling, Communications Specialist Supervisor 1539: Barbara Poling, Communications Specialist Supervisor, was notified by fire department EMS control to place Life Guard I on standby for an explosion at the Southern California Edison Plant at Laughlin, Nevada. Later, details revealed that an explosion had occurred when a 30-inch pipe, with 1,000 degree IF) steam and 600 psi had exploded in a closed area during a shift change. At the time of the standby, the only information that Poling received and relayed to the crew was that there were multiple victims and injuries. After receiving the call and placing the crew on standby, we also received a call from the National Park Service {NPS}, Lake Mead, requesting our assistance in looking for four children who had been missing for approximately four hours. I advised the NPS personnel that we were unavailable due to a previous request from Las Vegas City Fire Department Central Alarm office. I informed them that 18 MARCH/APRIL 1986
.,&M,,.I
the Communications Center dispatchers would call them after the helicopter and crew returned to inquire about whether our services were still needed. 1546: A "go" per Fire Department and Mercy Ambulance to the scene of the explosion. 1550: Life Guard I lifted off the roof en route to the Mohave Generating Plant in Laughlin. Following notification of the fire department that Life Guard I was en route, I notified in-house personnel, nursing supervisory staff and administration. Since multiple victims and injuries were reported which could constitute an internal disaster situation, I began to alert appropriate personnel of the evolving events in Laughlin, even though our facility does not offer burn care and we had no update as to the types or extent of injuries. Denny Longman, Director of Flight Operations/FLIGHT FOR LIFE 1546: At the time we were placed on standby, I verified the location with dispatch personnel and checked fuel and weather conditions. We were in a "ready" situation. 1550: While en route to the plant, I contacted Barbara Poling to confirm that there had been an explosion. My concern then was the nature of the explosion and the danger of an additional explosion that might involve our landing area, or could endanger the crew and/or aircraft. Poling confirmed that there had been an explosion, but ground units at the scene radioed that the area was clear and there was no impending danger of a second explosion at that time. Davette Shea, RN/Flight Nurse: 1546: As we were placed on standby, Ken Riddle, flight medic, and I did a quick check of the aircraft. We anticipated multiple trauma victims with probable burn injuries. We put on an extra pair of antishock trousers, the burn packs and extra, normal saline solu-
tion for irrigation purposes, and Ringers Lactate for IVs. 1550: As Longman checked with Poling concerning hazards at the site, we awaited further medical information. In preparation for the possibility of multiple victims either at the site or at Bullhead City Community Hospital, the closest medical facility, I asked Poling to get administrative approval for fixed-wing support, and to call in the next flight nurse and fright medic to be on duty.
Between 1539 when Life Guard I was placed on standby, and 1508 when we were notified that all victims had been transferred to Bullhead City Hospital, the resources of Laughlin and Bullhead City had responded to the scene, triaged and transported all semi-critical and critical victims to the hospital setting. During this entire afternoon and evening, the only communication problem that arose was when Life Guard I was diverted to the hospital and then redirected to the scene,
Poling: 1600: Bullhead City Community Hospital confirmed that there were numerous injuries, mainly related to high pressure steam burns. I advised them that we also had Aeromedical Services International, the local fixed-wing vendor, available to respond if needed. 1605: We were advised by the officer at the scene not to land on the helipad area due to debris and gravel from the explosion. This was relayed to the flight crew. 1608: Per the Laughlin Fire Department, Life Guard I was diverted to the hospital as all of the patients had been triaged and sent there. 1610: Per the Metro officer at the scene, Life Guard I continued to the scene as there were two remaining critical victims at the plant.
Longman: 1628: After determining that the landing area was clear from the air, I was directed to land on the parking lot betgnd the helipad. I contacted Poling and told her we were landing at that time. We were told that one patient was in a pickup truck and one patient was in the ambulance. Shea: 1628: Upon arrival at the scene, Riddle and I each proceeded to one of the victims. Riddle began to assess and ready the male patient in the pickup truck while I moved to the back of the ambulance for the female patient. Longman got out our transport stretchers and assisted with equipment and burn packs. It was reported that there were two fatalities at the scene. The 30-year-old
/
I
CALIFORNIA
1
'4J t Oce,'m~
L. Pacific
" . . . an explosion had
occurred when a 30-inch pipe, with 1,000 F steam and 600 psi had exploded in a closed area during a shift change."
Life Flight(LongBeach)helicopter approachesthe SouthernNevadaMemorial Hospitalhe[ipad.Photoby Scott Henry, LasVegasReview-Journal. AM.]
MARCH/APRIL 1986
19
"The 30-year-old female victim was awake and alert, crying with pain. "
Flight for Life crew loads patients at Bullhead Community Hospital, Bullhead City, Arizona. Photo by Don Polk, Las Vegas Sun.
female victim was awake and alert, crying with pain. She had approximately 65 percent first-, second- and third-degree burns over her head, neck, torso, arms/hands and anterior thighs. The 33year-old male patient had approximately 74 percent first-, secondand third-degree burns over the same areas of his body. Both patients were awake, breathing spontaneously and complaining of pain from their burns. Neither patient had sustained a loss of consciousness. Both patients had been partially stripped of their clothing and wrapped in wet sheets. They were both cold and shivering, and this presented Riddle and I with a challenge in attempting to establish IV lines. Riddle was unable to initiate a line after two tries. I was able to establish a #18 gage in the female patient. Upon loading the patients, I secured an IV line in the male patient's ankle area. We applied humidified oxygen at 10-12 liters to each patient. The secondary exams revealed no obvious deformities other than the burns. We estimated fluid volume to be given according to the burns, rechecked vital signs and decided to administer morphine for pain. In flight, the male patient developed cyanosis, stridor and increased respiratory rate. I nasally intubated the patient without difficulty and assisted his respirations. His respiratory status improved, but I suctioned a moderate amount of frothy blood-tinged secretions with tissue from his airway during flight. Riddle and I continued monitoring both patients' vital signs and respiratory status. We called our report to Southern Nevada Memorial Hospital and were directed to continue fluids, respiratory monitoring and morphine administration.
1635: At this time, ASI fixed-wing was dispatched to Bullhead City to transport two patients. Due to the volume of calls and criticality of the situation, I called in the third communications specialist to assist with anticipated communications endeavors. I was also informed that Life Flight from Long Beach was responding to the hospital. 1647: Upon receiving notification that Long Beach Life Flight was responding, I realized the need for a coordinated communications system for the flight crews. We are the closest flight program and dispatch center available in the Bullhead City area. I contacted Dispatcher Katherine Montgomery in Long Beach and was advised that there were two helicopters and one fixed-wing en route. Radio capabilities and ETAs were discussed, and Montgomery and I developed the necessary dialogue to carry us through the next intense three hours. 1649: I contacted the Laughlin Fire Department to notify them of
the Long Beach helicopter and fixed-wings' ETA. I told them that I would continue to contact them with necessary information in regard to the air ambulances. Longman: 1655: We departed the scene en route to Southern Nevada Memorial Hospital with two critical patients on board. Due to the number of patients and extent of injuries relayed to us at the scene, I anticipated a quick turn around to Bullhead City Community Hospital.
Poling: 1628: As I waited for further information concerning patient condition and disposition, I notified Marcia Hawkins, director of marketing, so that she could assist and direct the numerous calls from the media being received from other geographical areas. 20 MARCH/APRIL 1986 AM.J
Shea: 1655: Due to the extent of the burn injuries, we knew that we would be transferring these patients to the burn care center at Southern Nevada Memorial Hospital. Poling informed me that
Bullhead City Community Hospital had been in contact with Southern Nevada so that everyone was aware of the number and extent of the injuries involved. Southern Nevada has a five-bed burn unit with an intensive care unit capability of 14 beds. Once the victims had been triaged to the Bullhead City Hospital, the physicians at that facility made the decision to air evac the surviving patients to burn care centers. Due to the criticality' pulmonary injuries and distance, air transport was the best decision for the patients' care. The capabilities and respiratory equipment available through the air ambulance services also were major deciding factors in utilizing airlift vs. ground transport. Ground miles are approximately 110 vs. 75 statute miles by air, looking at one-and-a-half hours by ground vs. 35 minutes by air.
"Due to the extent of the burn injuries, we knew that we wouM be transferring these patients to the burn care center at Southern Nevada M e m o r i a l Hospital."
Poling: 1703: Life Guard I had a 29-minute ETA to Southern Nevada Memorial Hospital. I notified the appropriate individuals of the ETA and I was also able to call Bullhead City's hospital with an ETA on the ASI fixed-wing to their location. 1720: Usually" Life Guard I would land on the designated helipad that is located a block away from the emergency room. At this time, Southern Nevada notified me that they were requesting Life Guard I land in the driveway of the hospital adjacent to the emergency room for more rapid deployment of the patients. 1725: Long Beach called to verify ETA to Bullhead City' ETA was relayed to Bullhead City Community Hospital.
Shea: 1730: Upon landing at Southern Nevada, we were met by an excellent team of surgical, burn care and emergency room personnel. A report on each patient was given. Dr. Charles Burke, director of the burn care unit, informed me that all the remaining patients would be coming to Las Vegas. He had spoken with the physician in Bullhead City, and it was agreed they would be transferred by air to Las Vegas. Longman: 1743: We arrived back at Valley Hospital Medical Center to refuel and change medical crews. Poling informed me that additional air ambulance crews were en route to Bullhead City Community Hospital. I talked with Poling concerning her coordination efforts and asked if I could be of assistance. She relayed to me the information that she had available concerning the other aircraft. We had been told all victims would be transferred to Southern Nevada, so I realized that multiple aircraft would be responding to the Las Vegas area. Upon arriving back at Valley Hospital, we were informed that we would not need to return to Bullhead City, as there were enough aircraft there to accomplish the necessary transports. However, three minutes later we were given a "go" to return there to transport the last two patients of the disaster. At 1800, we were en route to Bullhead . . . . Poling: 1745: Metro called to inform us that there were aircraft from Phoenix and Flagstaff (Arizona) also responding to Bullhead City. I gave Shea this information after he landed at Valley Hospital's home base. Glenda Crabbe, RN/Flight Nurse Dispatching the second half of our crew started with an early wake-up call at 1616, requesting that I come in to start my night shift duties a few hours earlier than scheduled. Poling explained that there had been an explosion in Laughlin and that the helicopter was already at Bullhead City Community Hospital, picking up and transporting the last two victims. After taking the two patients to
Life Flight (Long Beach) crew unloadspatient at SouthernNevada Memorial Hospital in Las Vegas. Photoby Scott Henry, Las Vegas Review-Journal.
Southern Nevada Memorial Hospital, the helicopter returned and was restocked by myself and Janice Childers, one of our flight medics who had relieved Medic Ken Riddle. At 1800, Life Guard I started out again . . . .
Shea: During the flight, I contacted Las Vegas approach control and informed them that several helicopters, carrying critical patients from Bullhead Arizona, would be coming into the city with pilots who were not famih'ar with the area. Approach control agreed to render assistance with the necessary radar vectors and to direct pilots to Southern Nevada Memorial Hospital. En route, I contacted the Department of Public Safety's helicopter pilot who was out of Flagstaff, the first helicopter out of Bullhead City with the first of what would be the next 11 patients to be transported to Southern Nevada. At that time, they were informed of our dispatch frequency' as well as the Las Vegas aircraft frequency, and that approach control would assist them in locating the hospital. I also contacted the Air Force helicopter pilots, et al. Crabbe: 1840: Arriving at Bullhead City, our usual landing pad was already occupied. In addition, there were four other helicopters scattered about the hospital's parking lot, making it look like a helicopter convention! The helicopter crew from Survival Flight was just departing with their patient, who was taken to Maricopa County Hospital in Phoenix. When Janice and I walked into the emergency room, the scene could have been described as "organized" chaos, but we rapidly assessed the situation knowing everything was well under control. The entire emergency room area, rooms and hallways were filled with patients on stretchers. There were multiple personnel AM.J
MARCH/APRIL 1986
21
involved in the stabilizing of these patients when we arrived, i.e., physicians, nurses, prehospital personnel, and a variety of flight suits were visible. Entering the hospital, I became involved in triage work, since I was knowledgeable about flight times and receiving ability of Southern Nevada Memorial Hospital and its available resources. We extended our normal ground times to assist in coordinating the departure and arrival times of aircraft to Southern Nevada Memorial Hospital in order not to inundate the facility with an overwhelming volume of patients at one time. Childers and I were directed to our two designated patients and began to prepare them for transport. The patients had been well stabilized with IVs, oxygenation and appropriate dressings for their burns. The records and reports were copied and put into envelopes, enabling us to transport in a very short time. A well-organized report was received on each patient, and each patient had been attended by an assigned nurse and physician, thus avoiding repetitive care and information.
"The entire emergency room area, rooms a n d halllways, were filled with people on stretchers."
Shea: 1840: While the flight nurse and flight medic were inside preparing the patients and assisting with triage, I was contacting all of the pilots and informing them of radio contact frequencies and directions to Southern Nevada. The Bullhead City Fire Department did an excellent job of coordinating the air ~rews' landing and air traffic control at the scene of the hospital. The potential for a disaster to occur was certainly real, but due to the professional response and management of the Bullhead City Fire Department, the entire mission was flawless. Crabbe: 1934: Both of our male patients had received various degrees of first- and second-degree burns. In flight, we maintained their IV fluids and observed each patient for any change in vital signs or respiratory status. Poling: 1810: Continuing with my routine duties, I checked with the National Park Service personnel about the status of the four missing children. They advised me that they had been located and were in good condition. 1826: I notified Southern Nevada Memorial Hospital that I would have communications contact and frequency capabilities with all the inbound aircraft, and that I would keep them up-to-date and advised as to patient conditions and aircraft ETAs. 1830: Montgomery called from Long Beach and advised us of a 30minute ETA, with one helicopter carrying two patients and one helicopter carrying one patient. I informed them that the helicopter from the Department of Public Safety was inbound and carrying two patients. 1845: ASI, our fixed-wing support and backup, arrived at Scenic Airlines carrying two male patients. Flight nurse Nancy Dunbar and pilots Dan Scroggins and Ira Eichenfleld assisted with transferring the patients to American Ambulance and their paramedic crew members, Patti Young and Mike Gunner. Nancy Dunbar accompanied the patients along with the paramedics to Southern Nevada Memorial Hospital. They were the third and fourth victims of the disaster to arrive. 1900: I received the first contact with the Department of Public Safety's helicopter, 31AZ. The pilot informed me that he was seven minutes from Las Vegas and was requesting landing information. I also received a simultaneous call from Life Flight I who had a 15minute ETA. 1902: I notified Dr. Charles Zumpft, director of emergency services at Southern Nevada and the physician coordinating patients being received, of the ETAs of the two aircraft. He questioned the 22
MARCH/APRIL 1986
AMJ
Soulhern Nevada Memorial Hospitalmedical team members receive patients. Photo by Scott Henry, Las Vegas Review-Journal.
criticality of the patients on board the aircrafts. I checked with 31 AZ and Life Flight I and it was determined that the patient on board Life Flight I was the most critical. Dr. Zumpft then directed the Life Flight Helicopter to land in the driveway to enable rapid patient access, and directed the Department of Public Safety's helicopter to land on the helipad at the hospital. He said we would have appropriate personnel at both locations to receive the patients. 1 9 0 5 : 3 1 AZ landed with two patients at Southern Nevada's helipad. 1918:31 AZ requested information about where to relocate and wait for his medic. He was directed to the alternate helipad available at Valley Hospital, and he arrived at Valley at 1931. 1925: Life Flight I landed at Southern Nevada Memorial Hospital with one critical patient on board. 1939: Life Flight II had a 12-minute ETA to Southern Nevada Memorial Hospital with two patients on board. 1944: Life Guard I called with a 20-minute ETA to Southern Nevada with two patients on board. 1950: Life Flight I was en route to Bullhead City to refuel, pick up equipment and return to Long Beach. 1952: Life Flight II requested information on landing at Southern Nevada. I was told at that time the Air Force helicopter had landed on the helipad at the hospital and Life Flight II was directed to land on Southern's driveway. 1956: Life Guard I called requesting landing instructions. Advised Life Guard I to land in the parking area in front of Southern Nevada's emergency room. 2003: Life Flight II requested information on landing at Valley Hospital Medical Center to refuel their aircraft. They had been informed of rooftop refueling capabilities at our hospital and that they were welcome to utilize our helipad. Life Flight II arrived at Valley Hospital.
2011: Life Guard I landed at Southern Nevada Memorial Hospital with the last of the two patients of the airlift. 2023: Montgomery` in Long Beach, was notified of the location of the Life Flight helicopters. 2021: Life Flight II departed from Valley Hospital Medical Center en route to Long Beach via Bullhead City. Life Guard I retuned to home base. ha a matter of three hours and 23 minutes from receipt of the call to response to the scene, all 13 critical victims had been airlifted to appropriate burn care facilities. This major effort could not have been possible without the cooperation and professional response of the agencies, hospitals and personnel involved. The highest compliments go to the following individuals and agencies: •. the air traffic controllers at McCarren International Airport, Las Vegas •. the physicians and staffof Bullhead City Community Hospital, Bullhead Cityl Arizona .. personnel/paramedics/firefighters of Bullhead City Fire Department, Bulkhead City, Arizona .. personnel/dispatchers/paramedics of American and Mercy Ambulance, Laughlin, Nevada .. officers/dispatchers of the Metropolitan Police Department, Las Vegas, Nevada •. personnel/paramedics/firefighters of Clark County Fire Department, Clark County, Nevada .. Dr. Charles Zumpft and emergency room staff; Dr. Charles Burke and burn care staff, surgical staff and ancillary services of Southern Nevada Memorial Hospital •.. employees and medical assistance crew of Southern California Edison Plant, Laughlin, Nevada O n - D u t y F l i g h t Crews • . . Life Guard I, Las Vegas - Denny Longman/Pilot, Davette Shea/Flight Nurse, Glenda Crabbe/Flight Nurse, Janice Childers/ Flight Nurse, Ken Riddle/Fright Medic, Barbara Poling/Communications Specialist, Nancy Pasnik/Communicafions Specialist and Don Bartholomew, Communications Specialist. • • • Air Evac, Phoenix - G a r y Lobman/Pilot, Thomas Evans/Flight Nurse, Gary Rust/Fright Medic •. • Life Flight I, Long Beach - Jim Nauman/Pilot, Efren Vargas/ Flight Nurse . . . Life Flight II, Long Beach - Dan Aguilar/Pilot, John Hood/ Flight Nurse, Katherine Montgomery/Dispatcher •.. Aeromedical Services International {fixed-wing), Las Vegas Dan Scroggins/Pilot, Ira Eichenfield/Pilot, Nancy Dunbar/Flight Nurse • . . Arizona Department of Public Safety - J i m Knapp/Pilot, Mikel Longman]Medic . . . 4460th Helicopter Squadron, Auxiliary Field, Indian Springs, Nevada - Capt• Robert F. Clegg/Pilot, 1st Lt. Kelley E. Anderson and Staff Sgt. Charles D. Lee, III • . . Survival Flight
PROFESSIONALS CHOOSE
pI o MzD, HOME OF THE PRO MED PACKS t h e s t a n d a r d o f t h e EMS i n d u s t r y Manikin Parts & Repair
pP,O MED 737 No. 1200 W., OREM, UT 84057 INSIDE UTAH 1-800-662-1585 TOLL FREE 1-800-453-1264 1-801-226-3633 P.O. Box 21395 Salt Lake City, Utah 84121
BASHAW MEDICAL, INC PRESENTS A M U L T I P U R P O S E VEST FOR: MEDIVAC PERSONNEL, PARAMEDICS, EMTs FEATURES: WATERPROOF CORDURA POCKETS IV CATHETER POCKET LIGHTWEIGHT
Patient Sumary:
WASHABLE
T w o patients were DOA at the scene
6 COLORS
Four patients expired at Southern Nevada Memorial Hospital O n e patient expired in Phoenix, Arizona T w o patients were transferred to Southern California from Southern Nevada Memorial Hospital O n e patient was transferred to Salt Lake City, Utah from Southern Nevada Memorial Hospital F i v e patients survived and were discharged from Southern Nevada Memorial Hospital in addition to the other patients that had been transferred to other facilities.
FOR MORE I N F O R M A T I O N CALL OR WRITE: BASHAW MEDICAL, INC. 4909-B MOBILE HWY, PENSACOLA, FL 32506
904-455-7017 AM.]
MARCH/APRIL 1986
23