1. West, Texas Explosion – A Healthcare Coalition Response

2. April 17, 2013 7:29 PM: Firefighters respond to a fire at the West Fertilizer Company

3. The Event Responders include volunteer firefighters from West and Abbott as well as an experienced Dallas Fire Department Captain living in West. Students from EMT training class at West EMS building assist in notifying and evacuating nearby residents. West Haven Nursing Home patients are relocated to west wing of building which is furthest from the fire. Efforts concentrate on fire fighting, cooling Ammonium Nitrate, and Anhydrous Ammonia storage containers. Responders split to begin evacuation of surrounding homes and apartment complex.

4. The Event 7:53 PM: “There has been an explosion…..many people down…”

5. The Event Explosion is felt more than 30 miles away and registers as a 2.1 magnitude earthquake. Blast crater is 10 feet deep and 100 feet wide. Immediate 5 block radius affected by tremendous blast wave. Flaming debris causes scattered fires over a half mile radius. 350 of 700 homes in West are significantly impacted. 142 homes completely destroyed by blast wave, secondary negative pressure effect, or fire.

6. The Event

7. Immediate response led by the local EMS & nursing home medical director who had been supervising evacuation of nursing home patients

8. The Event First “No Notice Event” in Texas in more than a decade. Texas A&M bonfire collapse – 1999 Texas City explosion – 1947 14 people killed in blast. 12 First Responders Over 300 people injured. Including 128 nursing home residents.

9. The Response 7:59 PM: “All Call” issued by 911 dispatchers

10. The Response Responders from McLennan and surrounding Counties arrive almost simultaneously at approximately 8:15 PM. Limited radio and cell phone capability at the scene. 2 different staging areas established without coordination. Football field (1/4 mile from blast site). Community Center (1mile). 7 medical transport helicopters deployed to scene from across Central and North Texas. All HOTRAC facilities were readied to accept patients as needed.

11. The Response

12. No official notification to hospitals. Anecdotal phone reports from EMS and DPS personnel to RAC staff and Level II Trauma Program Director. “Code Alert” issued at 8:28 PM. “Code Green” issued at 8:40 PM. First patients arrived at Lead Trauma Center via State Highway Patrol unit and private vehicles at 8:40 PM.

13. Medical Response

14. Walking wounded necessitated opening of additional triage areas

15. Hillcrest Triage Change

16. Media Response Media response was immediate, intrusive, and relentless.

17. Regional Response Receiving Hospitals Hillcrest Baptist Medical Center 123 patients treated (28 admitted, 5 ICU) Providence Health Center 87 patients treated (21 admitted) Hill Regional Hospital 42 patients treated Scott & White Memorial Hospital 3 patients treated (2 ICU) John Peter Smith (JPS) 3 patients treated Parkland 2 patients treated McLane Children's 2 patients treated (1 PICU) Every patient that made it to a staging/triage area at the scene survived.

18. The Response Search and Rescue hampered by darkness and hazardous conditions.

19. The Response

20. Regional Response Heart of Texas Regional Advisory Council (HOTRAC) was activated to coordinate regional response resources and data collection. The Regional Medical Operations Center (RMOC) was stood up at 8:15pm. The RMOC was staffed by HOTRAC, Waco- McLennan County Public Health District, & DSHS Region 7.

21. Regional Response Central Texas RAC RMOC stood up their mortuary trailer through for deployment if needed. Baylor Scott & White – Temple (Level I) stood up Command Center for support. Washington County EMS provided an unit to support the ATF investigation. Once aware of the explosion, surrounding RACs (North Central Texas, Central Texas, Brazos Valley, East Texas, & Capital Area, Southwest Texas), prepared to provide additional assistance as needed.

22. Emergency Medical Task Force EMTF was developed to support local and regional responses to disaster events. There are 8 EMTF Regions in the State. This system is made of up several components: Ambulance Strike Teams RN Strike Teams AMBUS Mobile Medical Units (MMU). These are State assets.

24. State Response Deployed 4 AMBUSs, 2 were demobilized upon arrival at scene since nearly all patients had been transported. One AMBUS remained on-site for another day in case additional needs arose as the area was assessed for damage and casualties. One Type 2 Mobile Medical Unit (MMU) was deployed with staff. It treated citizens that had not gone to the hospitals and some responders until demobilization two days later.

26. State Response Two mortuary trailers were deployed with a mortuary team; the team and trailers were demobilized two days later. Disaster Portable Mortuary Unit (DPMU) and members were deployed and demobilized two days later. Two Medical Incident Support Team (MIST) members were deployed to assist at Disaster District Committee (DDC).

27. State Response

28. The Aftermath Estimates of up to 60 missing people persisted for more than 36 hours. All suspected missing were either located or were never in area of the blast or the City of West.

29. Before

30. The Aftermath

32. Planning & Preparedness Routine National Incident Management System (NIMS) mass casualty drills Planning for the “Unthinkable” Mock incidents coordinated with RAC, EMS, Local/State Law Enforcement, Fire Departments, and Community with defined: Leaders, Communications, Capacity (Hospital, ER, ICU, OR) Special Situations (biologic/ chemical agents) Controlled setting and responders Carefully preplanned and communicated Significant experience due to previous Presidential preparations.

33. Unanticipated Events Loss of first responders leading to lack of coordination at scene Limited communication from scene No reliable estimate of expected casualties Anecdotal estimates from responders and victims proved to be significantly overstated Partial failure of emergency notification system Large number of victims transported by POV Large number of elderly and demented patients with limited information/identification Demand for information/data by State/Federal Regulatory and Law Enforcement Agencies

34. Lessons Learned Planning and Preparation Practice Incident Command structure Drill regularly Drill a wide variety of scenarios Regional planning and practice is invaluable Coordination Communication Relationships Foster relationships with State and Federal Emergency Response agencies and officials

35. Lessons Learned Communications Test and refine mass notification systems working with McLennan County Medical Society on systems to allocate providers among facilities new product purchased and training in progress Test radio communications systems regularly build redundancy When systems break down you may have to rely on personal communications with first responders or regional emergency preparedness personnel made possible by relationships developed during planning and training

36. Lessons Learned Response Providers want to participate in the action plan for spontaneous responders and unrequested resources Impossible to overestimate the importance/difficulty of patient identification/registration/tracking family inquiries/notification radiology, lab, medications, procedures Case Management and Social Work resources were invaluable for disposition and placement

37. Lessons Learned Media & Public Communications Identify trusted spokespersons and knowledge experts Proactively schedule and publicize media updates regularly Utilize social media early and often Understand your organization’s stance on: Patient/Staff interviews Scope of information willing to release Prepare a shell for talking points that can be tailored to the situation Concurrent legal counsel was valuable

38. Regional Lessons Learned RMOC operating guidelines need revision. Regional mass casualty trigger not effective. Lack of use of electronic resources for response efforts. Despite some communication difficulties, the EMS, Fire and medical communities in our RAC performed tremendously. – PAY IT FORWARD!!!!!! We showed the nation that a small semi-rural community can perform as well as a large urban center.

39. Questions? Christine Reeves, Executive Director Heart of Texas Regional Advisory Council (HOTRAC) creeves@hotrac.org (254) 202-8740 Contact Information: