West, Texas Explosion - Washington State Hospital Association

West, Texas
Explosion – A
Healthcare Coalition
April 17, 2013
7:29 PM: Firefighters respond to a fire at the West Fertilizer Company
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.
The Event
7:53 PM: “There has been an explosion…..many people down…”
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
• Flaming debris causes scattered fires over a half mile
• 350 of 700 homes in West are significantly impacted.
• 142 homes completely destroyed by blast wave,
secondary negative pressure effect, or fire.
The Event
The Event
Immediate response led by the local EMS & nursing home medical director
who had been supervising evacuation of nursing home patients
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.
The Response
7:59 PM: “All Call” issued by 911 dispatchers
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
The Response
The Response
• 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.
Medical Response
Medical Response
opening of
additional triage
Hillcrest Triage Change
Media Response
Media response was immediate, intrusive, and relentless.
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.
The Response
Search and Rescue hampered by darkness and hazardous conditions.
The Response
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, WacoMcLennan County Public Health District, &
DSHS Region 7.
Regional Response
• Central Texas RAC RMOC stood up their
mortuary trailer through for deployment if
• 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.
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
• Ambulance Strike Teams
• RN Strike Teams
• Mobile Medical Units (MMU).
• These are State assets.
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.
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).
State Response
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.
The Aftermath
The Aftermath
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
• Leaders,
• Communications,
• Capacity (Hospital, ER, ICU, OR)
• Special Situations (biologic/
chemical agents)
• Controlled setting and responders
• Carefully preplanned and
• Significant experience due to previous
Presidential preparations.
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
• Demand for information/data by State/Federal Regulatory and Law
Enforcement Agencies
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
Lessons Learned
• 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
Lessons Learned
• Providers want to participate in the action
• plan for spontaneous responders and unrequested
• 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
Lessons Learned
Media & Public Communications
• Identify trusted spokespersons and knowledge experts
• Proactively schedule and publicize media updates
• 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
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
• We showed the nation that a small semi-rural
community can perform as well as a large
urban center.
Contact Information:
Christine Reeves, Executive Director
Heart of Texas Regional Advisory Council (HOTRAC)
[email protected]
(254) 202-8740

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