ensure that those patients are transported to appropriate facilities for minor treatment and not sent to Trauma Centers or hospitals in close proximity to the event. To facilitate communication with police vehicles a police supervisor will be requested and should be assigned to the Transportation Group to allow for direct communications with police units.[1]
The Philadelphia OEM included similar language in its draft updated citywide mass casualty plan. Meanwhile, the PPD directive 3.14 states, "Police personnel assigned to radio patrol cars will, whenever possible, without detriment to the person, handle hospital cases to ensure availability of emergency patrol wagons for other assignments." Hospital cases are injured or medically ill individuals. The directive further specifies that hospital cases with "a serious penetrating wound or a blunt trauma to the body will be transported to the nearest accredited trauma center."[2] However, it later specifies that "persons suffering from blunt trauma or a violent injury to the body (e.g., closed trauma to the head or chest as may result from a motor vehicle accident or a fall)" should be transported by fire department paramedics. There is no PPD policy regarding transportation of injured victims in an MCI or describing the command-level participation with PFD regarding patient transport. Of note, Philadelphia OEM has not finalized its after-action report following this accident.
It is noteworthy that the current PFD policy specifies police will not transport patients in an MCI without being asked to do so by an assigned incident supervisor from the PFD, but the PPD has no corresponding policy. In addition, the PPD routinely transports injured patients from the scene before EMS arrives. However, the current PFD policy and updated draft OEM policy quoted above, which were developed following this accident, may not optimize the use of PPD resources. Specifically, they require police officers to change their routine and delay transporting hospital cases in the event of an MCI, thus restricting their ability to provide more rapid transport to many patients than they would otherwise have received.
While the response to the MCI resulting from the derailment of train 188 used the structure of the National Incident Management System, the individual agency response plans had not been customized to address daily operations that allow police officers to independently transport injured patients to hospitals. As a result, transport of the injured was not coordinated after the derailment. As noted above, the Philadelphia OEM has developed an updated citywide mass casualty plan, but, as of the date of this report, it remains a draft, just as it was on the day of the accident. The previous plan, from May 2011, includes several systems that are no longer in use in Philadelphia, including the facilities and resources emergency database. The 2011 plan, which remains in effect, states that responsibility for patient transport belongs to the PFD and that "patient transport from the incident scene to hospital will be provided by ambulances, helicopters, buses, and other available resources." The NTSB concludes that current Philadelphia Police Department, Philadelphia Fire Department, and Philadelphia Office of Emergency Management policies regarding transport of patients in an MCI were not, and still are not, integrated.
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