On a night when a routine trip on Amtrak Train 188 went horribly wrong, the emergency response at a handful of Philadelphia hospitals went laudably right.
Just before 9:30 p.m. May 12, the speeding train derailed on a curved stretch of track at Philadelphia’s Frankford Junction. Eight passengers lost their lives, and hundreds more were injured.
“Anyone who has seen photos of the mangled Amtrak cars has marveled that more people did not die,” wrote Daily News columnist Ronnie Polaneczky. “I think the fatalities might have been even higher if the crash hadn’t occurred so close to Philly’s top-notch medical centers.”
Hospitals credited disaster drills with preparing them for the mass casualty event. But this was no mere drill, and without the know-how and dedication of emergency nurses, physicians and other hospital workers, the outcome could have been significantly different.
"People from key departments who were at home came in to help out, including nurses, doctors, laboratory workers, cafeteria workers, security folks,” said Herbert Cushing, MD, chief medical officer at Temple University Hospital, in a Newsworks.org report. “Everybody that works in the hospital—and makes it work—responded and came to the hospital.”
Preparing for the Patient Influx
Some 54 patients were transported, mostly by police cars, to Temple, a Level I trauma center. While they were on their way, staff worked quickly to clear the already full emergency department by discharging patients ready for release and moving those who needed to stay to inpatient rooms, according to the Daily News.
Mentally, nurses prepared for what lay ahead.
"So your mind immediately starts working," said nurse Pat Crowley. "Mentally, you think, OK, it's a train—so there's a lot of metal, it's moving fast, there's no air bags. So you imagine the kinds of injuries you'll see: You're thinking amputations, lacerations, blunt trauma and, of course, penetrating trauma. You're preparing for the worst before they even come in the door….And then you just do what you always do.”
Less than one month earlier, the emergency department quadrupled its number of ambulance bays from three to 12. The expansion proved a blessing the night of the Amtrak crash.
“You sometimes think there’s a higher being who puts things in place the way they need to be,” Michele Jones, emergency department nurse manager, told the Daily News, “because that space made all the difference for us.”
The timing of the patient influx, which at Einstein Medical Center occurred shortly before a shift change, meant there were plenty of healthcare staff on hand to attend to the nearly two dozen Amtrak passengers treated there.
"People who were at the end of their shift stayed, people that were coming in for their shift at 11 o'clock came in early,” said Mark Kaplan, MD. “So we had a lot of physicians and a lot of nurses."
Broken Bones, Stunned Silence
In addition to Temple and Einstein Medical Center, Episcopal Hospital, Thomas Jefferson University Hospital, Aria Health, Hahnemann Hospital and Penn Presbyterian provided care to victims of the derailment, and all were praised by local officials for their top-notch response.
More than 150 Amtrak passengers were treated that night. Many were stunned.
"We were shouting to each other: Do this! and Do that! But they were silent,” Crowley said. “I can still see them, in a line that went out the door. Some were standing, or leaning against somebody, or in wheelchairs. They were bloody, dirty, no shoes, their suits half-off, covered in soot, like they'd been in a fire. They were so quiet."
According to reports, most passengers had broken ribs, arms or legs. Some injuries were more critical, involving the chest and lungs and requiring ICU care. One patient suffered a massive chest injury and was resuscitated twice, but died in the early morning hours of May 13.
"Philadelphia is, out of any city in this state, they are probably the best prepared by virtue of the volume of trauma patients they get every day," Juliet Geiger, executive director of the Pennsylvania Trauma Systems Foundation, told Newsworks.org.
At Temple—the hospital that treated the most victims—chief trauma resident Lucas Ferrer, MD, worked eight extra hours with Amtrak patients, stretching his shift to 30 straight hours, according to a Philly.com feature. He finally left the hospital May 13 at noon.
"Something like this comes along, and you realize the things you've learned, the things you can do to help other people,” he said, “and it feels really good."