Elks Lodge Building COLLAPSE

It was about 30 minutes past shift change on June 26 for the crews of Golden Valley EMS when the call came over the statewide ambulance/hospital radio frequency for a building collapse with 50 victims.

     We knew something major was happening when they didn't call us on our direct line to dispatch, and we knew it was a signal to activate the hospital's emergency disaster plan. Several surrounding agencies also heard the transmission and prepared for our request for mutual aid.

     Our first truck was en route when the second truck's crew called the hospital supervisor to activate the disaster plan, contact dispatch to call all immediately surrounding agencies for mutual aid, and put additional backboards on the truck. As the second truck went en route, the first truck arrived on scene, did a scene size-up and contacted dispatch to request that the larger cities in the area send more mutual aid. At that time, we didn't know how many patients we had, how many were trapped or that the county's presiding commissioner was one of the victims who had managed to escape. It was the presiding commissioner who contacted our local emergency management director to have FEMA's MO Task Force One activated after declaring the collapse a disaster.

     On arrival of our second truck, we quickly established a triage/treatment area approximately 50–75 yards from the collapse, away from the anticipated operation zone. Then, with the assistance of police officers, we set up a temporary perimeter and searched for walking wounded in the crowd of about 500 that had quickly formed.

     While this was going on, the fire department was able to rescue two men from the building with a ladder truck and brought them to the "green" treatment area. Another man was removed from the building and classified as a yellow, placed in a spinal package, then transported to the hospital. A total of five men were seen almost immediately in the treatment area; four had been in the building and one in front of the building in a car that was partially buried under bricks and rubble. Two men refused transport; three were transported by our third truck manned by off-duty personnel who had been called in.

     With additional ambulances starting to arrive, we quickly determined our entrance/exit routes off the square. A short time later, two firefighters were brought to the treatment area with minor injuries (not directly related to the rescue effort) and also transported to the local hospital. We learned the next day that 14 people with minor injuries escaped from the building quickly, left the immediate area and went to the ED by private vehicle.

     After the initial rush, we met with the incident commander and learned that, of the 50 original patients, all but 10 had escaped. Nine were located close together, and one had been on the third floor by himself. The nine who were close together had access to a cell phone and had been able to give a partial report of their conditions, but the 10th man had not been heard from.

     The incident commander called for a sector commanders' meeting before any more rescue efforts were attempted, since the building was still shifting and we all needed to know the course of action that was being planned. At the command meeting, each area of action was assigned a specific radio frequency, with the command trailer being able to monitor and communicate with each section and relay pertinent information. Commanders were identified for each sector and the basic rescue operation plan was passed on. After the commanders' meeting, we went back to our respective sectors to communicate with our workers.

     When we returned to our treatment/triage area, it was evident that the EMS response was quickly becoming overwhelming. We released four helicopters and 22 ground units to return to their respective service areas within the first two hours. As we released ambulances back to service, we asked our surrounding agencies to mutual-aid our service for the remainder of the night. Knowing that we would not be transporting, we had stripped two of our ambulances of equipment early and had them moved out of the way so transport vehicles could be lined up and ready as the victims were brought out. Three ambulances were kept ready at the hospital and nine stayed at the scene throughout the night while heavy rescue efforts were underway. Three helicopters were also stationed two blocks from the scene. Two more ambulances responded with their fire service and then converted to fire service.

     Throughout the night, Task Force One worked on shoring up the building and extricating victims. As patients were removed from the building, they were quickly moved to a safe area, evaluated and immobilized and a transport decision was made. They were then moved to an ambulance and transported to the hospital or helicopter, after which the ambulances were released to their service. By the time the last living victim was extricated, only five ambulances remained on scene.

     After the last man we had been communicating with was extricated, another command meeting was held. With the information from Task Force One about what they had seen in the building, and the fact that we didn't know where in the building the last victim was, we determined we should move from rescue phase to recovery.

     We then released all ambulances except our own, restocked the equipment we had stripped off earlier, reorganized all the extra EMS equipment still on scene, and moved our truck to another location where heavy equipment could get into the building. Mid-afternoon, the body of the only fatality was removed and the coroner determined he had died at the time of the collapse due to head trauma.

Why the response worked

Incident command
     In our service area, the incident command system is already structured to each area of command and responsibility. The only thing that has to be determined is who the sector commanders will be at each incident.

Communication
     This started with the dispatchers using the statewide frequency to dispatch everyone and continued with our request for additional services to respond. With the incident command structure, communication within and between each sector of operations was left to sector commanders, who needed to learn about all operations by listening and asking questions.

Each area used its expertise
     Fire and Task Force One handled rescue operations, with Task Force One doing confined-space rescue. EMS handled patient and bystander care, and the police handled traffic and crowd control.

Community support
     Local restaurants provided free burgers, pizza, doughnuts and sandwiches. The American Red Cross provided food and drinks throughout the night and the next day. Stores brought ice and drinks, and churches provided volunteers to serve the rescuers. Construction workers brought their saws and cut cribbing for the rescuers. Medically trained citizens came to ask if they could help. A cell phone company provided batteries and chargers to help maintain communications with victims and families. A lumber yard was opened, and the wood needed for supporting the remaining structure was provided for free. The Rotary club was opened for the families of the trapped men, and social workers remained by their side. In short, the community worked together for the better good.

Planning
     At the onset, the EMS sector commanders planned for how we would triage/treat/transport patients and set up equipment, then provided that information to our ambulance crews and medical volunteers so everyone in our sector knew the plan.

Flexibility
     During the rescue operation, a second operations sector was set up on the north side of the building, and the command center informed us that patients would be brought there, meaning we had to suddenly make a change. But rather than move all of our equipment and triage/treatment centers, we split our operations and established a second triage/treatment/transport area. We moved four ambulances to that side of the building and re-established our exit routes, which was relayed to law enforcement so they knew what to expect. Later, all of the victims were extricated from the south side of the building without a single piece of equipment having to be relocated.

What we learned

Preparation is key
     In our area, we usually try to have two disaster drills a year, but when the real emergency hit, we quickly realized we weren't as prepared as we thought. Since the incident, we've requested a mass-casualty trailer with all the supplies needed for 25 patients. If there are more than 25 patients, we can acquire equipment from ambulances as they stage.

Keep your people in their work areas
     This is probably the hardest lesson. In our profession, we're called to help. Unfortunately, that caused some congestion at the staging area as ambulance crews left their trucks to come to the scene. In our command system, this is where we dropped the ball. We established a staging area, but didn't delegate someone to command it. If we had, they could have kept the crews from leaving the staging area. (Ambulance crews up for transport never left their trucks—only those waiting.)

Delegate
     This is the whole basis of NIMS and incident command, but it doesn't always get carried out. As sector leaders, we are responsible for documentation, our crews' actions, patient care, staging and equipment acquisition. One person can't do it all when there's a large operation. With the number of volunteers available at most large incidents, use more people if necessary. There is nothing wrong with having one person to monitor your ambulances/equipment, another the radio, one to document the names of volunteers, and at least one to document patient contact names, which we did and were thankful for the volunteers who helped us.

Communicate
     As well as communicating on the scene, stay in contact with your hospitals. The one complaint from the ED after the incident was that they would have liked to be updated about every 15–30 minutes by one person only. They told us they received calls from two or three people on the scene with conflicting information. You also need to know how many patients the ED can take and plan for transports to alternate hospitals. One breakdown for us was not having enough radios to go around. We improvised with small handheld family radios to talk to each other on scene and to the command truck, but it only left us with face-to-face communications with other operating sectors.

Plan for relief
     By the time the rescue and recovery efforts were over, the incident had lasted 21 hours. One of our staff members had been on duty for 33 hours and another for 20 hours before being relieved. Don't let people work that long. Make them shift out and take a nap or call people back, but try not to use your crews for the next shift. You'll need them then, not now.

Summary
     Of the 50 patients we anticipated, we evaluated 14 victims, two firefighters and two people in the crowd who developed anxiety-related symptoms in reaction to the incident. Forty-eight people escaped the building in various ways, with the most amazing being when rubble created a hole in the wall that led to a stairwell where people were able to get out. We transported 11 patients to the local hospital, four were flown to trauma centers in Kansas City, and four refused to be transported. Of those four, one later went to the ED, where he was diagnosed as having an AMI and was flown to a cardiac center in Kansas City.

Rick Casey, EMT-P, has 20+ years of experience as a paramedic and currently works for Golden Valley EMS in Clinton, MO.

Joseph Christy, AAS, NREMT-P, ASN, works as a paramedic/RN for Golden Valley EMS in Clinton, MO.

David Ellis, EMT-P, works as a paramedic for Golden Valley EMS in Clinton, MO. Jacob Wade, NREMT-P, works as a paramedic for Golden Valley EMS in Clinton, MO.