the city of new orleans amtrak train disaster—one emergency department’s experience

October 1999 367

A t 9:23 PM on March 15, 1999, the 16-car City of NewOrleans train left the Amtrak station in Home-

wood, Ill, on the way to its next scheduled stop inKankakee, Ill. The train was filled with activity as par-ents put small children to bed in the sleeper car.

At 9:47 PM, a semi truck carrying 22 tons of rein-forced steel bars departed from the Birmingham Steelplant in Bourbonnais, Ill. At 9:48 PM, as the semi driverentered a nearby railroad track crossing, he looked upto see an Amtrak passenger train bearing down onhim, literally 6 seconds from impact.

The Amtrak engineer hit his brake and soundedhis whistle, to no avail…a collision was inevitable inthe train cars. Barreling down the railroad tracks at alegal speed of 79 miles per hour, the train, carrying216 passengers, slammed into the flatbed trailer. Thecollision of tons of steel and train cars caused fuelleaks and a fire in the train cars.

Just like the moment when people learned thatJohn F. Kennedy had been assassinated, every em-ployee of Provena St. Mary’s Hospital in Kankakee canrecount with precise clarity exactly where they wereand what they were doing that night when they re-ceived word of the Amtrak collision. The event wouldresult in an unforgettable memory of a disaster of un-fathomable magnitude (Figure 1).

Event historyAt 9:50 PM, the night shift house operations managerheard a Bourbonnais Police Department broadcastover the triage desk scanner confirming the devasta-tion and immediately notified the ED charge nurse.The operations manager continued to monitor reportsover the scanner and informed the ED charge nursethat the Bourbonnais Fire Department was initiating

a 5-11 box alarm (summoning virtually every fire de-partment in the region). The charge nurse initiatedthe department’s disaster fan-out by notifying the EDdirector via his digital pager, entering the ED tele-phone number with a “911” at the end of the page.

Having received a page from the emergency de-partment in this fashion, the director knew “some-thing big” must be happening. He called but couldnot get through to the emergency department be-cause all the phone lines were busy. Fearing theworst, he jumped in his car and headed for the emer-gency department, finally getting through the busytelephone lines with his cell phone. As he learned ofthe magnitude of the event, he advised the chargenurse to initiate the hospital-wide mass casualtyplan. By 10:00 PM, hospital staff were arriving en massand began to prepare for anywhere from 200 to 400potential victims.

By the time the ED director and operations man-ager arrived at 9:58 PM, Chicago media had alreadybegun calling the emergency department. Preparationfor arrival of victims began with the set up of an inci-dent command system. The emergency departmentwas divided into sectors that included command,communications, bed availability, supplies, trafficcontrol, triage, in-house transportation, and registra-tion. Patients were triaged to 8 different treatment

April S. Mickelson, Illinois ENA, is Group Practice Manager, ECHO,Ltd & EXCEL, LLC, Kankakee, Ill. Linda Bruno is Operations Man-ager and Mark E. Schario, Illinois ENA, is Vice President of ClinicalOperations, Provena, St Mary’s Trauma Center, Kankakee, Ill.For reprints, write: April S. Mickelson, RN, BSN, MBA, EMT-P,Group Practice Manager, ECHO, Ltd & EXCEL, LLC, 555 W CourtSt, Suite 410, Kankakee, IL 60901.J Emerg Nurs 1999;25:367-72.Copyright © 1999 by the Emergency Nurses Association.0099-1767/99 $8.00 + 0 18/1/101456

Clinical ArticlesThe City of New Orleans Amtrak train disaster—One emergency department’s experienceAuthors: April S. Mickelson, RN, BSN, MBA, EMT-P, Linda Bruno, RN, PHRN, and Mark E. Schario,MS, RN, CEN, NREMTP, Kankakee, Ill

The emergency departmentwas divided into sectorsthat included command,communications, bedavailability, supplies, trafficcontrol, triage, in-housetransportation, andregistration.

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sectors of the hospital, depending on injury severity. Asector leader was designated to be in charge of eacharea. The 3 main sectors were the emergency depart-ment, the outpatient department, and the birthingcenter; the walking wounded went to the outpatientdepartment or the birthing center, depending on whohad beds. This procedure freed the emergency depart-ment to treat more serious injuries.

JOURNAL OF EMERGENCY NURSING/Mickelson, Bruno, and Schario

The ED charge nurse completed the departmen-tal disaster fan-out and paged both the project med-ical director and ED medical director, both of whomwere attending a Chicago Bulls game 60 miles away.As they headed for Kankakee, the ED medical direc-tor used his cell phone to alert surrounding traumacenters of the Amtrak disaster, asking them to holdover their PM shifts in case Provena St. Mary’s needed

Figure 1Rescue workers were astounded at the devastation they found at thescene of the collision between the City of New Orleans Amtrak trainand a semi truck in Bourbonnais, Ill, on March 15, 1999. (Photo cour-tesy of the Kankakee Daily Journal.)

Figure 2Rescue workers battle a blaze in a sleeper car in which 11 peoplewere killed. (Courtesy Paul R. Grzelak Photography.)

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to send them victims. He also contacted 2 area emer-gency helicopter transport units and instructed themto respond to the scene.

At 10:05 PM, a disaster response team comprisingan ED physician and trauma nurse specialist (whoalso happened to be a fire chief and paramedic for alocal volunteer department) responded to the scenewith disaster packs containing supplies. The devas-tation at the scene was nothing like either the physi-cian or the trauma nurse specialist had ever seen. Theforce of the collision was so severe that all but 3 of thetrain’s 16 cars derailed. Some broken rail cars were ontheir sides, lying across the tracks. Still other cars hadbeen heaved into ditches like toys. Diesel fuel leakingfrom the engine had ignited the 3 cars near the frontof the train, the site of the most serious injuries and 11deaths. The sight of the victims, the shrill sounds ofsirens and radios, the screams of the injured, and theterror in people’s faces were overwhelming to many ofthe rescue workers (Figure 2).

Meanwhile, the director of Trauma Services forProvena St. Mary’s Hospital had arrived home lateand was settling in with his microwaved supper towatch the late evening news. The Amtrak collisionwas the lead story. The trauma surgeon and his wife,a nurse and one of Provena St. Mary’s Hospital opera-tions managers, rushed to the hospital, knowing theywould be needed to assist with the disaster. The trau-ma surgeon manned the emergency department until5:00 AM the following morning.

Within the next 25 minutes, 30 physicians repre-senting a diverse range of specialties, 50 ED personnel,4 anesthesiologists, and more than 100 hospital staffhad arrived and began making preparations to care forthe injured. No one who was called said he or she couldnot come in. This type of response lent a sense of con-trol to the ongoing chaos. Everyone concentrated ondoing his or her job and only that job as best and as effi-ciently as he or she could. All the staff seemed to thinkabout were the patients who were on their way.

By 11:00 PM, all of the critically injured victimswere en route or already at the emergency depart-ment. As we cared for these patients, a second re-sponse team from the emergency department, con-sisting of a physician and two trauma nurses, headedto the disaster scene to treat “green” patients whohad been transported to a first-aid station set up atBourbonnais Upper Grade Center. At the gradeschool, emergency workers treated victims and re-leased them directly from the school to the local RedCross to be assisted with housing, food, and clothing.Having heard news reports of the disaster, teachersand other personnel from the school left their homesin the middle of the night and reported to their schoolto assist any way they could.

Many stories evolved behind the scenes in theemergency department. Children who were passen-gers on the train and who were separated from theirparents were crying and covered in dirt and soot fromthe fire. Nurses acted as substitute parents, rocking

Figure 3Hospital triage personnel unloaded victims from the ambulancestretchers onto hospital beds, enabling ambulances to return to thescene quickly and decrease EMS personnel traffic in the emergencydepartment. (Photo courtesy of the Kankakee Daily Journal.)


and comforting crying children until families could bereunited. Hospital staff babysat for children who hadbeen discharged from the emergency department butwhose parents were admitted in more serious condi-tion. Pastoral care and social workers counseled bothvictims and staff.

Most of us will never forget the 70-year-old manin the trauma room who begged his nurse to find hiswife. The couple had been eating in the dining carwhen the crash occurred. The rescue team was ableto remove the gentleman easily from the wreckage,but his wife was trapped. After more than an hour oftorturous waiting, she was brought by ambulance tothe emergency department with orthopedic injuries.The nursing staff was so happy to find her that wepushed the couple’s stretchers together so they couldphysically see and touch each other. There was not adry eye in the department.

By 1:30 AM, representatives of Amtrak and theNational Transportation Safety Board and FBI officialsand special investigators had arrived at Provena StMary’s Hospital with a list of passengers to assess thesituation. Accounting for a correct number of passen-gers was difficult, because trains, unlike airlines, arenot required to record passenger lists. Whether all thepassengers on Amtrak’s list were actually on the trainwas still unclear. The search for victims would con-tinue until the next day because of a discrepancy be-tween the list and actual passengers on the train andbecause some of the walking “green” victims hadused cellular telephones to notify relatives to pickthem up from the crash site.


By 3:30 AM, the last patient had arrived in theemergency department. We heard reports from thescene and on the news that 6 of the train’s passengercars had been uprighted and set back on the tracks.By 4:00 AM, 90% of the patients had been treated, andthe emergency department returned to its “typical”state.

In a 5-hour span, our emergency department hadtreated 74 patients (normally, our average 24-hourcensus). Surprisingly, we did not treat severe multipletrauma patients, as one might expect with this typeof collision. One burn patient was airlifted to anotherfacility; most of the other patients with serious in-juries had sustained blunt trauma, broken bones,smoke inhalation, or minor burns. All the passengerswho died had been in the sleeper car that was en-gulfed in flames. Miraculously, some of the passen-gers in that car escaped. Approximately 50 patientswere transported to a second hospital in the area.

Strategies used by staff• The ED charge nurse took control of the ED disas-

ter fan-out. Instead of having each staff member onthe fan-out call the next person, ED staff membersdivided the fan-out and made all the calls.

• ED staff, trauma surgeons, and neurosurgeons re-ported directly to the emergency department. Allother staff members reported to a personnel pooland were called to patient care areas as needed.

• Housekeeping staff went to all patient care areasand moved all empty beds and stretchers to theemergency department.

Figure 4Survivors, rescue workers, and hospital staff will long remember oneof the deadliest transportation disasters in US history. (Courtesy PaulR. Grzelak Photography.)

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• A request that all visitors who had parked on the EDentrance ramp move their cars was made over thepublic address system. Kankakee City Police stagedthemselves at both ends of the ramp and allowed onlyemergency vehicles to have access to the ED ramp.

• As ambulances arrived, a nurse and a physicianmet each ambulance and literally moved each pa-tient from the ambulance stretcher to a hospitalstretcher on the ED ramp (Figure 3).

• Ambulance supplies and linen were staged at theED entrance. This tactic enabled ambulances toquickly unload patients, grab needed supplies, andbe back en route to the disaster scene within min-utes. By using this method for patient unloading,ambulance personnel traffic was diverted from theemergency department, decreasing the number ofemergency personnel crowding the department.

• The director of Materials Management broughtsupplies from the central supply area to the com-mand center, located adjacent to the emergencydepartment at the triage desk (triage was beingperformed outside on the ED ambulance ramp). He

brought bandages, tape, syringes, sterile saline so-lution, and extra blankets for the blanket warmer.

• The Dietary Department and Human ResourcesDepartment supplied food and drinks for staff andpatients.

• Patient care units were able to adjust room assign-ments to keep family members together. They alsoreported bed status rapidly and kept the updatescoming into the incident command center.

Disaster planWho could have known that our disaster trainingwould be put to use for an event of such magnitude?In the future, few of us will question the necessity orpurpose of yearly required disaster drills. Two yearsago, Kankakee County staged a mock train wreck andhad since initiated some changes in the countywidedisaster plan on the basis of problems discovered inits critique. As we prepare for and implement disas-ter drills, a feeling of the “same old routine” seems toexist. We can only plan and practice so much for theunknown. The City of New Orleans disaster has put

Table 1Problems identified during the disaster response and corrective actions required

Problems identified Corrective action

Not all physicians were notified. Switchboard did nothave phone numbers for 2 recently added answer-ing services.

There was no reference phone list for each depart-ment to use to access other departments during thedisaster.

Incident command location is too far from the emer-gency department, which hinders communicationwith staff.

Patient location was hard to track.

Communication was inadequate between incident com-mand and all support functions. Phones were tied up,not available in areas where staff were located, ornot appropriate for the communication needed.

Reporting of bed status to the county emergency op-erations center was inconsistent.

The hospital media representative needs to be locatedaway from the incident command center because ofthe chance of a confidentiality breach.

A back-up occurred in the radiology department.

Update notification listing in switchboard to include 2 newestanswering services. Brief physician services staff to ensurepatient registration is alerted when such services are added.

Implement “Quick Reaction Response” guide for staff that willinclude both phone numbers and response actions.

Move the incident command center to the ED waiting room.

Previous efforts to correct this continuous problem have notworked as well as planned. At the next drill/incident, staffmembers such as clerical staff from other hospital units will beposted at each department’s exits or entrances to track pa-tients as they leave the unit to go to ancillary departments.

Purchase an adequate number of radios using the current, ap-proved facility management frequency. Assign radios to allmajor support areas.

The patient registration supervisor or designee will report to theemergency operations center with a laptop computer usingMeditech software.

The media representative for the hospital will be located in ad-ministration or another location away from the emergencydepartment.

This problem was identified after only an hour into the evolutionof the disaster. As soon as the problem was apparent, a trau-ma surgeon and an ED physician gathered all 30 physicians inthe department, ascertained which radiographs had beendone, then prioritized all remaining computed tomographyscans and radiographs.


disaster drills into a new perspective for every personinvolved in health care at Provena St Mary’s Hospital.When it is the “real thing,” everyone knows that he orshe must get it right the first time—there are no sec-ond chances. A real disaster is baptism by fire beyondone’s comprehension.

The day afterThe following day, nursing students from OlivetNazarene University and Kankakee Community Col-lege arrived at the hospital with their clinical instruc-tors on an unscheduled clinical day to provide assis-tance in any way they could. The nursing studentsmopped floors, rocked children who were victims ofthe crash, folded linen, served meals, and did whateverthey could to support the hospital staff. Not only wasthis assistance welcomed by weary hospital employ-ees, but it also provided invaluable training for nursingstudents who would most likely never see health caredelivered on this scale at any time in their training.

At 2:37 PM on March 16, the emergency depart-ment received a handwritten note via fax from St An-thony Hospital’s emergency department in Oklahoma


City, the site of the bombing of the Alfred E. MuirFederal Building in 1996. The fax read as follows:

Hello St Mary’s ER Dept.

We, here at St Anthony ER in OKC, just wanted youto know our thoughts are with you and your patients.We know you are all probably overwhelmed, but yourskill and compassion will get you through. Just wantedyou to know we in OKC are thinking of you and hopethings start to settle down some for you soon.

Your friends in OKC @ St Anthony Hospital ER Dept.

The timing of this fax was extraordinary. Becauseof their experience, the staff at St Anthony’s emer-gency department knew how long the disorder lasts ina large-scale disaster situation. Their fax arrived afterthe majority of our patients had been assessed, treat-ed, and moved to critical care or elsewhere. The factthat the letter was handwritten was very touching.The letter hit us right at the time when everyone need-ed some reassurance or a pat on the back. Copies ofthe letter were made and distributed to all hospitaldepartments.

Lessons learnedDespite improvements in communication technologyduring the past several years, the inability to instantlyaccess individuals during the disaster was evident, in-cluding communication from the scene of the collisionto the hospital and internal communications withinthe hospital. Technologies used included high-bandand low-band FM radios and cellular and newer Nextelradios. Our planning for emergency situations shouldinclude increasing the number of portable radios avail-able for disaster situations. It appears that this issuecontinues to surface in every major incident.

Several problems in the hospital’s disaster planwere identified during the Amtrak disaster. During thehospital critique, problems and corrective actionswere identified and a plan for implementing correctiveactions into our disaster plan was developed (Table 1).

SummaryThe disaster plan of Provena St Mary’s Hospital wasput to the test with the crash of the City of New Or-leans Amtrak train. The lives of many persons werechanged that night, including hospital employees,emergency rescue personnel, the victims and theirfamilies, Amtrak employees and supervisors, and theentire community at large. A great deal of communityspirit and teamwork was witnessed during this tragicevent that put all of our abilities to the test (Table 2).

Table 2City of New Orleans Amtrak disaster statistics

No. of agencies responding to scene 65No. of communities that sent ambulances 45No. of fire department tankers at scene 15No. of communities that sent fire engines 14No. of rescue crews 23Total No. of fatalities 11Age range of victims (y) 8 to 76Location of all fatalities Sleeper

car No. 5No. of Birmingham Steel workers at scene 30No. of patients treated at PSMH 77No. of patients admitted as inpatient status 27No. of patients transferred for tertiary care 1No. of contacts to PSMH marketing depart- 150

ment from 10 PM on 3/15/99 through 10 PM

on 3/17/99No. of calls from media within first hour of 25

crashNo. of contacts to PSMH marketing depart- 350

ment from 3/15/99 through 3/22/99No. of press conferences held 3No. of patients remaining hospitalized as 2

of 4/5/99No. of months the National Transportation 12

Safety Board estimates it will require to complete its investigation

PSMH, Provena St Mary’s Hospital.

the city of new orleans amtrak train disaster—one emergency department’s experience

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