Coordination Went Well Despite Minor Snags : Trauma Systems Pass Test After I-5 Accident

It began at 6:45 p.m. Thursday--a major traffic accident, with two people killed and 23 injured, in the barren “no-man’s land” just south of the U.S. Border Patrol checkpoint at San Onofre.

Before it was over, three helicopters and eight ambulances, including a military ambulance from Camp Pendleton, had ferried victims to six hospitals in San Diego and Orange counties.

The accident put trauma systems in both counties to the test. And there were some snags: Gridlocked traffic blocked ambulances trying to reach the accident. An Orange County emergency radio network went into operation a half hour late and could not be heard by a San Clemente hospital. And it took one to two hours to get some critically injured patients to the nearest trauma center.

Despite these problems, the system generally seemed to work well, officials from both counties said Friday.

“Patients were appropriately spread out (to different hospitals),” said Betty O’Rourke, program director of Orange County’s emergency medical services. “Though it was two counties and many agencies, it went fine.”

Gail Cooper, chief of emergency medical services in San Diego County, agreed: “You had two federal agencies, a state agency, two different county agencies and a city--all working together.”

Among those involved were the U.S. Border Patrol, the California Highway Patrol, Orange County’s communications agency, a San Diego County sheriff’s helicopter, an ambulance crew from Camp Pendleton, three private ambulance companies and paramedics from San Clemente.

The medical response was coordinated at the accident scene by Linda Nunez, a veteran flight nurse with Life Flight, UC San Diego Medical Center’s emergency helicopter service. Nunez, initially flown in to treat patients, became a scene commander, evaluating the conditions of the victims and routing the most seriously injured by helicopter to trauma centers in Mission Viejo, La Jolla and San Diego.

“It’s everyone’s nightmare to go to one of these,” Nunez said Friday. “But I was really pleased with the way everyone reacted.”

Marty Bennett, chief flight nurse for Life Flight, was aboard the third helicopter to arrive on the scene, landing a little more than an hour after the accident. By that time, she said, “everything was extremely well-organized.”

The crew was directed to two patients who had been designated for Scripps Memorial Hospital in La Jolla, and they were back in the air in about 20 minutes, she said.

In Orange County, an emergency system called Hospital Emergency Administrative Radio asked all 38 hospitals in the county to “stand by” for accident victims.

But there were several problems with the emergency radio network, said Marcia Thompson, chief of operational support for Orange County Communications, a public safety agency.

San Clemente General Hospital said its reception was fuzzy and eventually gave up on the network altogether, instead communicating with dispatchers by phone.

The traffic accident occurred when a tractor-trailer rig plowed into a van, causing a chain-reaction crash involving several other vans on northbound Interstate 5. At least five of the injured were trapped in their cars, California Highway Patrol Sgt. Bill Starnes said.

Starnes, who is based in Oceanside, said paramedics and private ambulances responded quickly. “But the problem was the motoring public,” he said. “The freeway was at a standstill northbound. There was no way to get paramedics to the scene.”

With traffic stopped dead, some motorists parked in the freeway’s center divider and on the right shoulder, Starnes said. Trying to clear a path for emergency vehicles on the right-hand shoulder, 11 CHP officers got out of their cars and waded through traffic, he said.

“But once we cleared it up, other people would pull over and block it again,” Starnes said. He said it took at least 20 minutes for the first ambulance to get through.

That unit, a Hartson’s ambulance based in Oceanside, arrived shortly after 7 p.m., and its two emergency medical technicians were immediately “overwhelmed,” Hartson’s operations coordinator John Reisdorfer said. “They were inundated with so many patients--so much to do,” he said.

The Life Flight helicopter bearing Nunez, nurse Mike Epperson and a pilot arrived at 7:14 p.m., a Life Flight supervisor said, and the second Life Flight helicopter arrived at 7:53 p.m., landing just behind a helicopter from Orange County.

Life Flight delivered two of the most seriously injured patients to Scripps Memorial Hospital, the La Jolla trauma center that is designated to serve the Oceanside area, at 8:47 p.m.--two hours after the accident, the supervisor said..

Scripps’ director of trauma, Dr. Brent Eastman, called that two-hour period “indeed a long time” for patients to wait to receive treatment. The average time from an accident scene to a San Diego County trauma center is 11 minutes, Eastman said, “But you have to put that in the context of what happened--the congestion, the extrication, the mass of trauma at the scene. Considering that, I think the system was working well.”

Another Life Flight helicopter delivered two injured women to Sharp Memorial Hospital in San Diego at 9:07 p.m. Though the hospital activated its trauma team, the women were not seriously injured, said trauma nurse Joan Anders; one had chest pain and the other had injuries to her limbs, she said. Again, at 9:35 p.m. and at 10:03, three more patients with minor to moderate injuries arrived at Sharp by ambulance, Anders said. One of those remained hospitalized Friday, but the other two were treated and released, she said.

Ambulances brought three patients to Tri-City Hospital in Oceanside at about 8:30 p.m. One of these was hospitalized with a broken leg, and the others were treated and released.