Kristopher T. Kimmell, MD
Neurosurgical Resident, University of Rochester Medical Center
Millions of viewers were glued to the news when an Amtrak train en route from Washington, D.C. to New York City derailed outside Philadelphia on May 12, 2015. There were 238 passengers and five crew members on the train. As a result of the derailment, there were over 200 casualties and eight fatalities. Many passengers had critical injuries, including severe neurologic injuries requiring neurosurgical care. Because many were unrestrained and were thrown in the rolling train, a number of the injuries involved vertebrae and the spinal cord.
Dr. Erol Veznedaroglu, a neurosurgeon and the director of the Drexel of Neurosciences Institute and chair of the Department of Neurosurgery at the Drexel University College of Medicine, was on-call and received a number of the victims at Hahnemann University Hospital. Some of the patients required immediate surgery for their injuries. All told, his hospital cared for about 20 of the patients from the derailment.
Mass casualty situations, such as the train derailment, can bring out the best or worst in a hospital and its personnel. Fortunately, in the case of the Amtrak derailment, Dr. Veznedaroglu and his colleagues were well prepared. The hospital’s communication system ensured that all providers were in the loop and the various teams involved (EMS, emergency department, trauma surgery and surgical specialists) provided coordinated and timely care.
One important lesson Dr. Veznedaroglu learned from this experience is the psychological aftermath for the victims. Many of the patients under his care were more mentally distraught with flashback symptoms and post-traumatic stress disorder than they were with physical injuries.
Neurosurgeons are uniquely qualified to care for a wide variety of traumatic injuries: from skull fractures and traumatic brain injuries to spinal fractures and even peripheral nerve injuries. As critical members of trauma teams, neurosurgeons must always be at the ready in the unusual event of a mass casualty situation. As we have previously talked about on Neurosurgery Blog, timely transport of injured patients to high volume trauma centers provides patient’s the best possibility for recovery from traumatic injuries. With more and more people living in urban areas, and the resultant increased regionalization of trauma care, neurosurgeons are advocating for patients both for injury prevention as well as creating responsive and coordinated care teams to be ready at any time when disaster strikes.