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Safety Recommendation Details

Safety Recommendation H-09-005
Details
Synopsis: On January 6, 2008, about 3:15 p.m. mountain standard time, a 2007 Motor Coach Industries 56-passenger motorcoach with a driver and 52 passengers on board departed Telluride, Colorado, en route to Phoenix, Arizona, as part of a 17-motorcoach charter. The motorcoach passengers were returning from a 3-day ski trip. The normal route from Telluride to Phoenix along Colorado State Route 145 was closed due to snow, and the lead driver planned an alternate route that included U.S. Route 163/191 through Utah. About 8:02 p.m., the motorcoach was traveling southbound, descending a 5.6-percent grade leading to a curve to the left, 1,800 feet north of milepost 29 on U.S. Route 163. The weather was cloudy, and the roadway was dry at the time of the accident. After entering the curve, the motorcoach departed the right side of the roadway at a shallow angle, striking the guardrail with the right-rear wheel and lower coach body about 61 feet before the end of the guardrail. The motorcoach traveled approximately 350 feet along the foreslope (portion of roadside sloping away from the roadway), with the right tires off the roadway. The back tires lost traction as the foreslope transitioned into the drainage ditch.
Recommendation: TO THE FEDERAL INTERAGENCY COMMITTEE ON EMERGENCY MEDICAL SERVICES: Evaluate the system of emergency care response to large-scale transportationrelated rural accidents and, once that evaluation is completed, develop guidelines for emergency medical service response and provide those guidelines to the States.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Action
Mode: Highway
Location: Mexican Hat, UT, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: HWY08MH012
Accident Reports: Motorcoach Rollover
Report #: HAR-09-01
Accident Date: 1/6/2008
Issue Date: 5/29/2009
Date Closed: 6/19/2012
Addressee(s) and Addressee Status: Federal Interagency Committee on Emergency Medical Services (Closed - Acceptable Action)
Keyword(s):

Safety Recommendation History
From: NTSB
To: Federal Interagency Committee on Emergency Medical Services
Date: 6/19/2012
Response: The NTSB is encouraged by FICEMS’ continued collaboration with the National Association of State EMS Officials, the Federal Highway Administration, the American Association of State Highway and Transportation Officials, and the state of Utah to address this recommendation. We note that the EMS Incident Response and Readiness Assessment tool and scorecard and a proof-of-concept version of the Model Inventory of Emergency Care Elements were developed and subsequently distributed to the states on March 15, 2012. As your committee’s actions satisfy this recommendation, Safety Recommendation H-09-5 is classified CLOSED—ACCEPTABLE ACTION.

From: Federal Interagency Committee on Emergency Medical Services
To: NTSB
Date: 1/31/2012
Response: -From Alexander G. Garza, MD, MPH, Chair, Federal Interagency Committee on EMS, Assistant Secretary for Health Affairs and Chief Medical Officer, U.S. Department of Homeland Security: I am pleased to submit the enclosed final report describing the completed work that the Federal Interagency Committee on Emergency Medical Services (FICEMS) has produced in addressing recommendation H-09-5 - Mexican Hat Bush Crash. This response is based on the strategy we provided to you on August 4, 2010. We appreciate the NTSB's recognition of the essential role of our Nation's 9-1-1 and EMS systems in reducing motor vehicle morbidity and mortality and the opportunity to respond to this recommendation. The FICEMS requests that recommendation H-09-5 receive a "Closed - Exceeds Recommended Action" rating. The completed response includes the enclosed attachments as well as those transmitted to you on August 9, 2011. Background NTBS's Recommendation H-09-5 includes two separate but related processes: evaluation and guideline development which are both being addressed by the Federal Interagency Committee on EMS (FICEMS). This final report summarizes the work sponsored and endorsed by FICEMS in response to the recommendation. Initial Evaluation by Institute of Medicine Workshop As requested by FICEMS, the National Highway Traffic Safety Administration (NHTSA) entered into a cooperative agreement with the Institute of Medicine (10M) for their Forum on Medical and Public Health Preparedness for Catastrophic Events (the Forum) to host a workshop on evaluating the system of emergency care response to large-scale transportation related rural crashes. The Forum's workshop summary report, Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary, is attached to this report. As detailed in the workshop summary report, the Forum convened the workshop on August 3rd - 4th 2010 in Washington D.C. The objectives of the workshop were: • Review the findings from the NTSB report of the 2008 Mexican Hat incident and discuss near- and long-term opportunities to improve response capabilities in rural settings. • Explore existing standards, guidance and innovative models and approaches in place for state and local jurisdictions. • Examine integrated systems approaches to improve the capability of the EMS systems to respond to large-scale rural incidents. • Discuss opportunities to improve integration and coordination with public health systems to address challenges to national public health security, particularly in rural settings. Evaluation and Tool Development by the National Association of State EMS Officials Input from the 10M Forum workshop helped inform the National Association of State EMS Officials (NASEMSO) Highway Incident and Transportation Systems (HITS) Committee and their Highway Mass Casualty Readiness Project Steering Committee (Steering Committee), as they worked to define an assessment and evaluation process for today's system of emergency medical response to highway incidents, with particular emphasis on risks related to mass casualty incidents (e.g. crashes involving large buses or motorcoaches). As requested by FICEMS, NHTSA entered into a cooperative agreement with NASEMSO which included a specific tasking to NASEMSO in response to the NTSB Mexican Hat recommendations. Through its HITS Committee, NASEMSO undertook the Highway Mass Casualty Readiness and Response project. The project steering committee included representation from the NASEMSO Rural EMS Committee, the American Association of State Highway and Transportation Officials (AASHTO), and the Federal Highway Administration (FHWA), as well as representatives from the State of Utah EMS office and the local EMS responders from Mexican Hat, and others. The project has resulted in two important tools that are further described below. At its July meeting, the FICEMS received a report from NASEMSO and endorsed the following completed products: The EMS Incident Response and Readiness Assessment (EIRRA) Tool and initial EIRRA scorecard (attached to this report). EIRRA is comprised of seven categories (eight when used at the statewide or regional level) of resources or activities essential to optimal emergency medical dispatch, emergency medical services (EMS) system, and emergency care/hospital response in the wake of a highway-based mass casualty incident (MCI). State and local EMS agencies can use this EIRRA Tool to assess their level of multidisciplinary system integration and response - Capability for MCI’s on highways. This assessment, when completed at the local, regional, or state level, will provide a basis for critical programmatic decisions and point to activities that can contribute to safety as well as benchmark activity levels, allowing comparison of local to local, state to state, and aggregate information. This EIRRA tool generated enough interest in the states and prompted 28 states to voluntarily complete the initial self-assessment. This initial EIRRA "scorecard" is attached. The Model Inventory of Emergency Care Elements (MIECE) demonstrates the feasibility and utility of an emergency care inventory that displays resource availability and system capacity by segment of interstates and US highways. This model inventory includes measureable characteristics of the emergency care system, such as ground EMS agencies, rescue services that provide vehicle extrication, helicopter emergency medical services, hospitals and designated trauma centers, to name just a few. MIECE's matrix of data elements is modeled after the U.S. Department of Transportation's Model Inventory of Roadway Elements (MIRE), which is also a geographically organized resource inventory using defined characteristics intended to contribute to risk assessment, system improvement, and retrospective analysis. By measuring and scoring these EMS characteristics along segments of our nation's roadways, a visual representation of the EMS system's capabilities could be displayed. At this stage of the project, MIECE is limited to a "proof of concept" to determine if the model inventory is feasible and worth further development. It does not entail the complete development of all elements and underlying collection mechanisms in an emergency care inventory; rather it represents a proof of concept for what could emerge as a full scale project in the future. Development of Guidelines for Emergency Medical Service Response by NASEMSO The National Association of State EMS Officials, as part of their cooperative agreement with NHTSA, developed a set of guidelines for States and localities to use and disseminate that would: 1. Evaluate EMS system readiness; 2. Prepare to quantify resources on a geographic basis; and 3. Engage and educate partners. The guidelines rely on EIRRA and MIECE to evaluate EMS system capabilities and allow States to apply that knowledge to improve readiness in targeted areas. Dissemination of Guidelines to the States Following FICEMS approval of the Guidelines for Emergency Medical Services Response and submission of the Final H-09-05 Report to NTSB, NASEMSO will disseminate the Guidelines and accompanying EIRRA and MIECE Tools to the States and Territories for application in their respective states.

From: NTSB
To: Federal Interagency Committee on Emergency Medical Services
Date: 1/12/2012
Response: The NTSB is encouraged by FICEMS’ continued collaboration with the National Association of State EMS Officials, the Federal Highway Administration, the American Association of State Highway and Transportation Officials, and the state of Utah to address the intent of this recommendation. We note that draft versions of an EMS Incident Response and Readiness Assessment tool and scorecard, as well as a Model Inventory of Emergency Care Elements, have been developed and are now ready to be finalized and distributed to the states. The NTSB would appreciate receiving periodic updates on these efforts as they continue. Pending receipt of this information and completion of the recommended actions, Safety Recommendation H-09-5 is classified OPEN—ACCEPTABLE RESPONSE.

From: Federal Interagency Committee on Emergency Medical Services
To: NTSB
Date: 8/9/2011
Response: CC# 201100317: - From Alexander G. Garza, MD, MPH, Chair, Federal Interagency Committee on EMS and Assistant Secretary for Health Affairs and Chief Medical Officer, U.S. Department of Homeland Security: I am pleased to submit the enclosed report describing the excellent progress that FICEMS has made in addressing recommendation H-09-S - Mexican Hat Bus Crash, This response is based on the strategy we provided to you on August 4, 2010. We appreciate the NTSB's recognition of the essential role of our Nation's 9-1-1 and EMS systems in reducing motor vehicle morbidity and mortality and the opportunity to respond to this recommendation. The FICEMS requests that recommendation H-09-5 receive an "Open - Acceptable Action" rating.

From: NTSB
To: Federal Interagency Committee on Emergency Medical Services
Date: 12/29/2010
Response: The NTSB is encouraged that FICEMS continues to work on implementing the committee-approved strategies for addressing these recommendations. The NTSB notes that NHTSA has entered into a contract with Booz Allen Hamilton to provide technical support in developing a plan to enhance accident notification and emergency response along high-risk rural roads and cooperative agreements with the Institute of Medicine and the National Association of State EMS Officials to evaluate EMS system response and response to rural mass casualty incidents through deliberation sessions at public forums. FICEMS continues to monitor these efforts. The NTSB would appreciate receiving periodic updates on these efforts as they continue. Pending receipt of this information and completion of the recommended actions, Safety Recommendations H-09-4 and -5 are classified OPEN—ACCEPTABLE RESPONSE.

From: Federal Interagency Committee on Emergency Medical Services
To: NTSB
Date: 8/4/2010
Response: MC# 2100277 - From David L. Strickland, Chair of the Federal Interagency Committee on Emergency Medical Services, Administrator of the National Highway Traffic Safety Administration: As Chairman of the Federal Interagency Committee on Emergency Medical Services (FICEMS), I am pleased to submit this brief report describing the progress that FICEMS has made in addressing the National Transportation Safety Board's (NTSB) recommendations H-09-4 and H-09-5 relating to the Mexican Hat bus crash. We appreciate the NTSB' s recognition of the essential role of our Nation's 9-1-1 and EMS systems in reducing motor vehicle morbidity and mortality and are working diligently to address the NTSB's recommendations. In March, I sent you a letter outlining the FICEMS' strategies to address these two important recommendations. Since then we have continued to make excellent progress. The National Highway Traffic Safety Administration (NHTSA) has entered into a contract with Booz Allen Hamilton to provide technical support for the development of a plan that can be used by the States and public safety answering points to enhance accident notification and emergency response along high-risk rural roads. I anticipate that this final plan will be presented to FICEMS in December. NHTSA has also entered into cooperative agreements with the Institute of Medicine (10M) and the National Association of State EMS Officials (NASEMSO). The 10M's Forum on Medical and Public Health Preparedness for Catastrophic Events (the Forum) hosted a workshop on August 3 to August 4 in Washington, DC to evaluate the EMS system response to rural mass casualty incidents (MCls). This meeting was immediately followed by a meeting of NASEMSO's Highway Incidents and Transportation Systems (HITS) committee on August 5 to August 6 in Washington, DC to continue the development of guidelines for EMS system response to rural MCls. I am particularly pleased that the 10M and NASEMSO have coordinated their meetings to provide an opportunity for the HITS committee to be informed by a public deliberation of subject matter experts. I anticipate that proceedings from the 10M workshop will be available to FICEMS in the winter of2010 and NASEMSO's HITS committee will present their work to FICEMS in June 2011. The FICEMS Preparedness Committee and 9-1-l/Medical Communication Ad-Hoc Committee provide ongoing direction and oversight for these projects and keep the FICEMS apprised on progress toward addressing the NTSB's recommendations. I will continue to provide periodic project updates to the NTSB as FICEMS' work progresses. I would be pleased to respond to your questions, or you may have your staff contact Drew Dawson, Chair of the FICEMS Technical Working Group at NHTSA's Office of Emergency Medical Services. Drew can be reached at (202) 366-9966 or by e-mail at drew.dawson@dot.gov.

From: NTSB
To: Federal Interagency Committee on Emergency Medical Services
Date: 7/20/2010
Response: Thank you for your March 17, 2010 letter; the September 14 and December 18, 2009, letters from Dr. Kevin Yeskey, Past-Chairman, Federal Interagency Committee on Emergency Medical Services (FICEMS); and the December 19, 2009, e-mail from Ms. Laurie Flaherty, Program Analyst, Office of Emergency Medical Services, following a meeting the same day between our staffs regarding Safety Recommendations H-09-4 and -5, stated below. The National Transportation Safety Board (NTSB) issued these recommendations to FICEMS on May 29, 2009, as a result of the NTSB’s investigation of a motorcoach rollover accident that occurred near Mexican Hat, Utah, on January 6, 2008. The NTSB is pleased that FICEMS has approved strategies for addressing these recommendations and that both the development and implementation of these plans reflect its interagency commitment and collaboration. The NTSB would appreciate receiving periodic updates on these efforts as they continue. Pending receipt of such updates and completion of the recommended actions, Safety Recommendations H 09-4 and -5 are classified "OPEN -- ACCEPTABLE RESPONSE. Thank you for your cooperation.

From: Federal Interagency Committee on Emergency Medical Services
To: NTSB
Date: 3/17/2010
Response: Letter Mail Controlled 3/25/2010 3:30:28 PM MC# 2100111 - From David L. Strickland, Chair, Federal Interagency Committee on Emergency Medical Services, Administrator of the National Highway Traffic Safety Administration: The Federal Interagency Committee on Emergency Medical Services (FICEMS) appreciates the National Transportation Safety Board's (NTSB) recognition of the essential role of our nation's 9-1-1 and Emergency Medical Services (EMS) systems in reducing motor vehicle morbidity and mortality. The Mexican Hat bus crash report aptly describes many of the challenges of accessing and delivering EMS in rural areas. The FICEMS is pleased that NTSB Member Sumwalt provided an overview of the Mexican Hat bus crash during our June 2009 meeting. In addition to the FICEMS' review of the entire report, several of our subcommittees formulated detailed plans to address the NTSB recommendations. These subcommittee reports were deliberated and approved during the January 20,2010 FICEMS meeting. We are pleased to provide the enclosed FICEMS-approved strategies for addressing the two NTSB recommendations (H-09-4 and H-09-5). Both the development and implementation of these plans reflect our significant interagency commitment and collaboration. We request that both recommendations receive an "Open-Acceptable Action" status. We will provide periodic project updates to the NTSB. If you have any questions concerning these FICEMS reports, please contact Drew Dawson at the NHTSA Office of EMS which provides administrative support to FICEMS.

From: Federal Interagency Committee on Emergency Medical Services
To: NTSB
Date: 12/17/2009
Response: Letter Mail Controlled 12/30/2009 8:37:16 AM MC# 2090727 - From Laurie Flaherty, FICEMS: [Forwarding a copy of the FICEMS Technical Working Group draft tasking plan.]

From: Federal Interagency Committee on Emergency Medical Services
To: NTSB
Date: 9/14/2009
Response: Letter Mail Controlled 9/22/2009 4:08:45 PM MC# 2090598 - From Kevin Yeskey, M.D., Chair, Federal Interagency Committee on Emergency Medical Services, Director, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response: The Federal Interagency Committee on Emergency Medical Services (FICEMS) appreciates the National Transportation Safety Board's (NTSB) recognition of the emergency medical s e ~ c essy stem as an essential component of reducing morbidity and mortality from motor vehicle crashes and other transportation-related emergencies. As aptly described in the Mexican Hat bus crash report, there are difficult challenges in both access to and delivery of EMS in rural areas. The FICEMS takes the NTSB recommendations very seriously and has initiated steps to fully explore solutions. The FICEMS is carefully reviewing the facts of the Mexican Hat Crash and is scheduled to consider a proposed response to the NTSB recommendations at its next meeting in December 2009. In the interim, the FICEMS offers the following information for consideration by the Board. The FICEMS Preparedness Committee has done extensive review of programs addressing emergency care response to large rural crashes and will soon present a recommended response to FICEMS. The Preparedness Committee staff has established initial communications with the NASEMSO HITS committee and with the TSAG. The NHTSA OEMs will add a task to the NASEMSO cooperative agreement for the operation of the HITS committee and request their collaboration in drafting recommendations for FICEMS consideration. The recommendation will also draw on information from the Federal Emergency Management Agency and From the Rural EMS & Trauma Technical Assistance Center. The National EMS Information System and the future National EMS Assessment may provide useful information. We appreciate the NTSB's recognition of the challenging issues of EMS notification, response, and communication in rural and frontier areas such as Mexican Hat, Utah. The FICEMS acknowledges these issues and, in cooperation with FICEMS member agencies, NASEMSO and other organizations, will develop more detailed responses to the recommendations made by the NTSB.