Following a school bus crash, fire and Emergency Medical Service (EMS) personnel will arrive on scene and immediately begin to size up the situation. Hazardous conditions — including fire, spilled fuel, fallen electrical lines and vehicular traffic — will need to be dealt with before anyone in the emergency response team approaches the school bus. Students that are not injured or have only sustained minor injuries will be escorted out of the bus. These individuals need to be taken to a single location a safe distance from the bus. This will assist in maintaining accountability and allow EMS personnel to provide each passenger with the proper medical care. Rescue workers will then quickly determine the number of occupants left inside the bus and how many are seriously injured or trapped. By knowing the number of occupants and assessing the scope of their injuries, additional resources can be requested. More extrication equipment, ambulances, medical transport helicopters and personnel may be needed. The influx of bystanders, parents being contacted via cell phone and the media represent other challenges that rescue personnel face. All of these people want to help and are concerned about the students’ safety, but they can easily disrupt rescue efforts and put themselves in danger. Law enforcement officers will play a key role in managing the increased vehicular traffic and providing security at the scene. Rescue operations
As emergency response personnel have learned from their training, a rescue involves three main steps: stabilizing the vehicle, gaining access, then extricating and treating the vehicle’s occupants. A bus positioned on its side, roof or down an embankment is in a precarious position and will need to be stabilized appropriately — cribbing and horizontal shoring will prevent further movement. Once stabilized, rescuers will gain access inside the bus through the doors, windows, sidewalls, floor or the roof using power and hydraulic tools. The techniques they use will depend on the structural condition of the bus, the amount of damage and location of the damage. If possible, the rescuers will use the front door as their entry point and the rear door as their exit. Any damage to those doors will dictate whether window removal or a more technical extrication is necessary. After gaining access into the vehicle, the emergency crew will have its first opportunity to see which passengers are trapped and who is injured. Occupants will then be triaged (a process for sorting injured people into groups based on their need for, or likely benefit from, immediate medical treatment). Life-threatening injuries will be treated first — the occupants will be immobilized on backboards with cervical collars to prevent further injury. If disentanglement procedures are necessary, rescuers will protect the patient and any surrounding occupants from broken glass, sharp steel edges or collapsing structures. Rescuers will also use established entry and exit points to take passengers out of the bus; as they are removed, they will be transferred to awaiting EMS crews for treatment and transport to local hospitals. Preplanning
Although we hope to never be involved in a school bus crash, it is imperative that school districts take steps to ensure that the necessary precautions are in place. The following are several suggestions to engender effective preparation.