Disaster Response to Mendon, Missouri Train Derailment

On June 27, 2022, the north central Missouri rural community of Mendon, Missouri, population 161, suddenly became the site of an unexpected railroad disaster when Amtrak passenger train 4 known as the Southwest Chief struck a dump truck loaded with rock at a railroad crossing. The train was carrying 270 passengers and 12 crew members in transit from Los Angeles, California to Chicago, Illinois. The 2 non-passenger locomotives and all 8 passenger cars derailed when the train traveling at 87 mph struck a dump truck. According to a preliminary report from NTSB, 7 railcars came to a rest on their sides and the dump truck came to rest in a ditch northeast of the rail crossing adjacent to the road. According to the Missouri State Highway Patrol twitter page, approximately 150 persons were transported from the scene to 10 area hospitals. Sadly, 3 passengers and the dump truck driver died. Multiple ground and air ambulance services were utilized for patient transport. School buses were used to transport individuals to the local high school for assessment, reunification, and further evacuation if indicated.

According to several published statements this rural community and its health partners did a tremendous job in handling this complex disaster response demonstrating that readiness at all levels pays enormous dividends. The nearest level I trauma center was approximately 90 miles away in Columbia, Missouri. The coordination of care from the scene was involved.  Seventeen (17) patients were treated at Pershing Memorial Hospital, a 25-bed critical access hospital in Brookfield, Missouri approximately 25 miles away. Thirty-six (36) patients were cared for at Moberly Regional Medical Center, a 99-bed community hospital 50 miles away. Twenty-eight (28) patients were received at Boone Hospital, a 392-bed facility and 16 individuals were received by University Hospital, level I trauma center, both located in Columbia, Missouri 90 miles away. University Health Hospital, level I trauma center in Kansas City, Missouri 100 miles away received 1 transport and 1 walk-in from the incident.  There were several interfacility transfers including 4 from Moberly Regional Medical Center to University Hospital and 6 from Pershing Memorial Hospital (3 to University Hospital, 2 to Northeast Regional Hospital in Kirksville, Missouri, 66 miles away, and 1 to Children’s Mercy Hospital in Kansas City, Missouri 100 miles distance).

Railway accidents while not completely rare are not nearly the most frequently occurring transportation accident. By far, motor vehicle accidents are the leading cause accounting for approximately 94% of the total. However, according to data published by the Federal Railroad Administration Office of Safety Analysis, in 2022 there was a total of 3,276 total railroad accidents resulting in 231 deaths. Of these accidents, 552 derailments occurred. Derailments have the potential to cause severe injury from high impact velocity and passengers being thrown within passenger compartment. Several passenger accounts of the Mendon train crash describe witnessing individuals being thrown across the passenger cars.

As coincidence would have it, travelers aboard the train included a Kansas City Fire Department Battalion Chief and Firefighter Joseph Disciacca traveling to Chicago for training. This proved to be fortunate as they used their training, extracting victims from the train wreck and providing immediate care. The Battalion Chief even recounted using a crowbar to etch in the side of the train the number of remaining victims that needed to be rescued.  Boy Scouts returning from Philmont Scout Ranch in New Mexico also rendered first aid and helped pull victims out of the overturned train. Response efforts were bolstered by volunteer firefighters, school officials, community members, The Salvation Army, and the Red Cross.  

Important to the advancement of Disaster Medicine is sharing disaster experiences which allows others to better prepare for future disasters. Jennifer Sutherlin, MPH, BSN, MARC HCC Coordinator and Missouri Region A Readiness and Response Coordinator and Steven Hoeger, Director Corporate Emergency Management and Compliance, University Health, Kansas City generously offered many valuable insights. They were attending their Health Care Coalition Leadership meeting when they were contacted by another hospital in the region and notified of the derailment disaster. A State Medical and Command team threat assessment call ensued to address the regional impact, followed by a phone conference with Health Care Coalition partners to include hospitals, EMS, and public health entities to communicate disaster information and for integrated regional preparation. In the following days, State meetings proved to be extremely beneficial in exchanging information and updating interested parties. Multi-agency coordination included Health Care Coalition Coordinators, Department of Health and Senior Services, Missouri State Emergency Management Agency (SEMA), AMTRAK and NTSB officials, and the Department of Mental Health.

Multiple requests for patient contact and various types of patient information were made by the National Transportation Safety Board (NTSB), Amtrak, and a third-party contractor. All efforts were made to allow patient desired communication while ensuring appropriate patient privacy rights under The Health Insurance and Portability Accountability Act (HIPAA). Family members had already been reunited and therefore disclosures necessary for reunification were no longer applicable. Consultation with hospital legal and compliance professionals provided valuable guidance in affirming the proper procedures for releasing information and facilitating important information exchange sought by the patient. Disaster exercises should include plans for proper exchange of patient information for immediate disaster care and reunification efforts.

This disaster proved to be the largest aeromedical response in the state of Missouri with approximately 26 helicopter transports taking place that day.  The high number of patient transfers reinforced the need for accurate patient tracking. All passengers, not just the injured, need to be accounted for.  The transportation agency may be obligated to ensure uninjured passengers can continue to their travel destination. Provisions must be made for supplying delayed travelers with overnight accommodations and nutrition. Survivors separated from their personal belongings will require arrangements for basic supplies, medications, and needed medical equipment.

This train derailment disaster revealed that the power of prearranged planning and collaboration between regional health care partners at all levels improves disaster response profoundly. In addition, response to disasters occurring in rural communities can be exemplary when integrated with the overall community disaster response strategy.

I wish to gratefully acknowledge the contributions from the following individuals in assisting with information for this article:

• Steve Hoeger, NRP/CHEP
  University Health Corporate Director Emergency Management
• Jennifer Sutherlin, MPH, BSN
  MARC HCC Coordinator/Missouri Region A Readiness and Response Coordinator
  MARC Emergency Services Health and Medical Program Manager

References

1. NTSB investigates Missouri Amtrak crash; locals say they warned of danger - Learn More
2. NTSB says Amtrak train was traveling 87 mph at time of collision on Monday - Learn More
3. 4 killed, as many as 150 injured in Amtrak train hits dump truck, derails in Missouri - Learn More
4. Grade Crossing Collision Between Amtrak Passenger Train and Dump Truck - Learn More
5. MSHP General HQ - Learn More
6. Rapid Response: First-person account of train derailment response complications - Learn More
7. ‘They’ve come to help in droves.’ Missouri school gathering spot for Amtrak passengers - Learn More
8. Mendon, Missouri, community helps Amtrak train passengers after derailment - Learn More
9. NTSB investigates Missouri Amtrak crash; locals say they warned of danger - Learn More
10. 'The entire world was on its side:' KC firefighter talks about surviving Amtrak train derailment - Learn More