EMS 'should be commended' for response to Amtrak train derailment, says MU trauma director

The University of Missouri Health Care trauma director lauded the work of the emergency medical services community in central Missouri on Monday for its response to a fatal train derailment in Chariton County.

Dr. Jeffrey Coughenour, who also heads the central region of the Missouri EMS System, said he was "extremely proud" of the coordinated effort.

"There are a lot of folks out there that did really, really great work today and should be commended for it," Coughenour said during a media briefing Monday night.

More:The Amtrak train derailment in Mendon, Missouri, killed three. Here's what else we know.

At least four people died and dozens were injured after an Amtrak train traveling from Los Angeles to Chicago with approximately 275 passengers struck a dump truck and derailed in a rural north-central Missouri town on Monday afternoon.

Several cars of Amtrak’s Southwest Chief train came off the tracks after colliding with the truck at 12:42 p.m. in Mendon, just under 100 miles northwest of Columbia.

First responders began arriving on scene within about 20 minutes of the collision, the Missouri State Highway Patrol reported.

At least three train passengers died, and the truck driver also perished, the highway patrol confirmed Tuesday.

Approximately 150 people with injuries were transported to various hospitals around the state, many of whom who were brought to Columbia for treatment.

MU Health Care reported caring for 18 patients from the train derailment as of noon Tuesday, including several who were life-flighted to University Hospital.

Two patients required immediate surgery, and one died at the hospital, Coughenour said Monday.

More:3 killed and more injured when Amtrak train hits truck, derails in Mendon

All patients treated by MU Health Care were adults, and most injuries seen were minor to moderate, he said.

"I imagine it's possible that there may be a few others trickling in throughout the night that are currently receiving care at some of the hospitals closest to the incident," he said Monday night. "I would imagine most of the patients will probably have a relatively short length of stay, and to me, that's in the order of one or two days. But I think there are a few that will probably potentially be here five to seven, just as an initial estimate."

Boone Hospital Center, meanwhile, reported receiving 28 patients by Monday night, all arriving by ground with minor to moderate injuries.

Agencies involved in the response included sheriff's offices in Chariton, Linn, Macon and Randolph counties; Brookfield and Macon police departments; Missouri Highway Patrol; Missouri Department of Conservation; Missouri State Park Rangers; Missouri State Fire Marshals; and State Emergency Management Agency, the highway patrol reported.

Ambulances from Chariton, Linn, Randolph, Livingston, Macon, Howard, Carroll and Caldwell counties as well as medical helicopters from multiple service providers responded to the scene, the patrol said.

"Anytime that you are part of a rural EMS service like Chariton County, like Linn County, like Randolph County, you certainly don't get a call maybe but once in a career that you potentially have hundreds of patients," Coughenour said during a conference call with media eight hours after the incident. "The folks that were on the scene, as best we can tell from the events this afternoon, they did a remarkable job providing initial care, getting the patients sent out to all of the hospitals that were close to the incident."

More:See passengers standing in the derailed Amtrak train car in Missouri

Screening passengers for severity of injuries is a tough task on such a large scale, Coughenour said.

"It's hard when you have potentially 200 people that you need to screen, and statistically there's only about 10% of that entire population that is seriously injured," he said. "So you're trying to find 20 patients potentially out of 200."

The response effort relied on mutual aid agreements such as what are in place through the State Emergency Management Agency and the Missouri Ambulance Association, Coughenour said.

Passengers who weren't taken to a hospital from the crash scene were relocated to nearby Northwestern High School in Mendon, where EMS personnel from Cole County responded to a SEMA mutual aid request and helped facilitate a triage center.

"Some of the ambulances from Jeff City, from St. Joe, from here in Columbia that were able to respond and assist up there, that's part of a set mutual aid agreement," he said. "We were able to deploy some emergency physicians from the MU system up to Moberly and one of our EMS coordinators actually up to the scene in case they needed extra physician support."

Coughenour talked on the phone several times Monday with the Kansas City regional EMS medical director, whom he communicates with at least once a month, he said. One patient was transported by helicopter to University Health in Kansas City.

More:Photos show aftermath of passenger train derailment in Missouri

It's normal procedure for hospitals "to coordinate and understand where the patients are going and to make sure that we are prepared, and at the same time not burden the incident commanders and the folks that were there on the scene, to have all the resources available that they would need for the patient load," he said.

It's too early to identify ways Monday's emergency response could have been improved, but the situation will be reviewed, Coughenour said.

"It's always a challenge when your hospital is almost always full, to all of a sudden find room for who knows how many patients," Coughenour said. "That's certainly a challenge in the hospital. We'll look at is there a way with either ground or air assets that things could have maybe been triaged a little better, but from what I can tell at the moment, there was a remarkable job done."