Regional coordination and patient tracking during passenger train derailment response

Pierce/Thurston Co., Washington
December 2017

In December 2017, on a trip inaugurating a new route from Seattle, Washington, to Portland, Oregon a passenger train derailed near the border of Washington’s Pierce and Thurston counties. The Northwest Healthcare Response Network (“the Network”) led a critical role in coordinating the health care system’s response.

Supported in part by the Hospital Preparedness Program (HPP), the Network leads the health care coalition encompassing King, Kitsap, and Pierce counties, and serves the largest concentration of health care organizations in Washington State. The Network has strengthened the region’s health care preparedness and response capabilities since 2005.

Thirteen cars left the track when the train derailed, some spilling into morning rush-hour traffic on Interstate 5 below. The derailment occurred near the border of two counties and two coalitions, requiring cross-jurisdictional coordination between the Network’s coalition partners and the Region 3 Healthcare Coalition.

“Because of where the train derailed, we knew right away that we would need to coordinate with the coalition south of us,” said Onora Lien, Executive Director of the Network. “Thanks to HPP-funded planning efforts, we’ve built relationships with our neighboring coalitions, and we were able to leverage those relationships throughout the response.”

Within an hour of the incident, the Network activated its Healthcare Emergency Coordination Center and Washington’s HPP-funded patient tracking system, WATrac. Led by Washington’s Department of Health, WATrac serves as a statewide, web-based tool for health care bed availability and communications, with a module dedicated to patient tracking. Along with WATrac, the Network uses a detailed Regional Patient Tracking Concept of Operations plan that outlines the roles and responsibilities of coalition partners.

“For many years we have worked with local partners on mass casualty incident plans,” said Lien. “Many of the benefits of this work came to light during the response. Hospitals and EMS across both coalitions implemented their mass casualty incident plans and responded, providing timely distribution of patients and ongoing patient care.”

Patient tracking during large mass-casualty incidents (MCIs) often poses significant challenges, ranging from identifying patients to maintaining confidentiality. Yet in this response, patient tracking was a stellar example of putting the coalition’s practice into action.

Area hospitals used WATrac and coordinated with the Network to document the arrival of injured patients, just as they had planned and exercised with the Network’s guidance.

“Coalition members and health care partners were nothing short of amazing when it came to patient tracking,” said Susan Pelaez, Director of Preparedness and Response at the Network.

According to Lien, having the Network lead coordination among these entities streamlined patient tracking and distribution while minimizing disruption to patient care. During the course of the response, nine hospitals across three counties received 69 patients, ten of which were children; there were three fatalities in all.

Family reunification is another benefit of having a patient tracking system. The Network acted as a liaison between the health care community, the rail line, and the National Transportation Safety Board toward this end.

Working in partnership with area hospitals, the rail line, and local responders, the Network helped to reconcile the passenger ​ manifest with the patient tracking data by the end of day one – a feat that earned praise from county health officials and rail line representatives alike.

“The Network’s response throughout the train derailment incident was impressive,” said Nigel Turner, Division Director, Tacoma-Pierce County Health Department. “The staff demonstrated all the exceptional skills and capabilities of an expert health care coalition.”

This was not the Network’s first time responding to an MCI. In September 2015, a tour bus crashed on Seattle’s Aurora Bridge, killing five students and injuring 71 others. The Network supported the health care system response to that event, too, tracking all injured bus passengers across the seven area hospitals.

Following the bus crash, many of the Network’s drills and planning activities focused on strengthening MCI response capabilities, such as patient tracking and support for family reunification. As a result, the Network was ready to respond to the 2017 derailment.

“It’s almost hard to envision how this response might have unfolded without HPP funding,” Lien remarked. “We’re fortunate to have a community that is committed to quality of patient care and to collaboration, but HPP funding is at the core of what builds our community capacity to respond to these events.”