Passenger Train Derailment in a Remote Area of Montana Leaves 3 Dead and Scores Injured: Liberty Medical Center in Chester Coordinates Triage and Treatment in a Regional Response

What Happened

The tracks that carry trains east and west in north-central Montana run perpendicular to Highway 2. They usually pass without incident, carrying passengers and cargo to far-off destinations without the people in the area paying much attention. On September 25, 2021, at approximately 3:55 p.m., a westbound Amtrak passenger train carrying 141 travelers and 17 crew derailed west of Joplin, Montana. The cause of the derailment is still unclear. What is known is that two locomotives were pulling a 10-car train when 8 cars went off the tracks. There were 3 fatalities and numerous injuries, both serious and minor. At the same time, this remote stretch of highway was full of party guests on their way to a wedding in Chester, who witnessed the chaos and immediately jumped in to assist.

Initial Triage

Those who were first on scene, many in their wedding attire, included emergency responders from the area and nurses from the closest hospital, Liberty Medical Center, a Critical Access Hospital (CAH) in Chester. Liberty Medical Center's chief financial officer, Shari Dolan, was the administrator on call who also took on the role of incident commander. Triage began on scene immediately, and as soon as officials were aware that it was a passenger train derailment, the call went out for emergency medical services (EMS). Ambulances began arriving from surrounding communities such as Conrad, Fort Benton, Havre, Big Sandy, and Shelby. Logan Health, a trauma center in the region, deployed a fixed-wing plane to stage at Shelby in case someone needed that level of transport across the mountains. Benefis Health System in Great Falls, Montana, the receiving triage hospital for Liberty Medical Center, prepared to receive critical patients. This type of regional response and collaboration is one strength that Dolan highlighted as assisting with the massive response necessary.

Planning is Key

Planning for a disaster is key, Dolan stressed. Liberty Medical Center had a disaster coordinator and a trauma activation plan. Despite training with tabletop exercises that dealt mostly with farming emergencies, such as anhydrous ammonia spills, and never having practiced a train derailment, resources quickly came together. She pointed out that as a small community, the whole community looks out for, helps, and supports one another.

She said one of the first goals was to get nurses into the hospital. She and three other individuals spent the rest of the day on the phone calling in staff, coordinating resources, and removing barriers. She pointed out that nearly everyone contacted responded and went to work to assist the passengers. One nurse who was on a trip three hours away rushed back to help, and another student nurse employee came back from college to assist.

The effort required coordination, and the hospital's planning included having all staff report to a certain area and then be assigned out from there. This kept the emergency room clear and allowed for staff to be placed in the most needed areas in an efficient manner. Another process that assisted in contacting staff was a communication application that the hospital had implemented called Remind.

Immediately after the derailment, community members started arriving to do what they could. The senior center in town was opened to receive train passengers. When that quickly filled up, community members shifted to take in people at the school. Liberty Medical Center sent staff up to the shelter areas, along with EMS to triage passengers who might seem okay but were actually in shock or injured, in order to get them hospital assistance. Over 50 community members brought food, blankets, and assistance. In addition, the local pharmacist opened the pharmacy to provide medications that might be needed and assist with maintenance medications that passengers might have lost in the accident or had to leave behind, filling as many replacement prescriptions as possible.

Mobile Passengers and Multiple Patient Locations

Dolan pointed out that one of the barriers to accounting for all passengers was that many people were in shock or mobile despite being wounded. As triage occurred, many of the wounded got into private cars and were taken to area healthcare facilities. In addition, as they were adults and not required to remain in the shelter areas, people could come and go as they pleased. People moving around in the community caused some confusion and difficulty. Some attempted to calm their nerves by visiting the local tavern, which made it hard to ensure that every passenger was accounted for. Confusion about the number of passengers aboard the train was further complicated by the accident's remote location, which prevented Amtrak representatives' timely delivery of the passenger manifest.

Often Overlooked Resources

Hospital resources that Dolan said were important but might be overlooked included housekeepers who came in to turn rooms and maintenance staff who retrieved needed supplies from the warehouse. Dietary staff were needed to prepare food as well. Many of these staff also sat with some of the long-term swing bed patients in the hospital that might be confused or overwhelmed with what was happening. These individuals read to patients and kept them occupied with puzzles, among other things. Dolan emphasized thinking about how a facility will take care of the patients they already have during an emergency. Dolan said, “I don't ever remember planning for that in any of our tabletops.”

By 10:30 p.m. that evening, all of the train passengers had been located. The patients had been treated; the most critically injured had been transferred to larger trauma facilities; and those passengers who could still travel had been put on another train, airplane, or other modes of travel if they were feeling up to it. Arrangements were made for those who needed to stay in the area. For example, community members in Chester found a quiet place to stay for the wife of one of the persons who died in the accident; a staff member from the hospital stayed with her all night.

Amidst all the chaos, the community still managed to hold that wedding. Dolan commented that the community had tried to keep the couple focused on their special day while still dealing with the emergency — a bright spot on a difficult day.

Communication Can Always Be Better

One of the recurring themes that Dolan repeatedly cited, including during the debriefing of the event, is that communication can always be better. After the incident, a meeting was held with all of the participating healthcare entities and emergency responders, at which they were able to get feedback on what went right and acknowledge what might have gone better.

Some of the feedback from the larger facilities is that they did not know how many patients to expect or were sometimes waiting for patients that didn't end up coming or were already there. Despite having a triage board, it wasn't always clear if the patients that the tertiary facilities had were all that were coming.

Dolan noted that Liberty Medical Center is a small organization and that presented complications for ensuring communications with other healthcare organizations or responding agencies during the emergency.

Person(s) Interviewed

Shari Dolan, Chief Financial Officer
Liberty Medical Center