It sounded like an explosion. And it rocked the Lodi Health Urgent Care Clinic. The first lifesavers on scene of the fatal multi-vehicle crash at Vine Street and Ham Lane last month weren’t even dispatched.
But registered nurse Yolanda Watt looked out the window of the hospital’s emergency care center and saw people scrambling. She thought perhaps a white van had struck a child, but wasn’t sure.
She quickly dialed 911, grabbed blankets and gloves, and bolted out the door along with nurse practitioner Michelle Martin.
A Lodi police dispatcher picked up the first 911 call at 5:21 p.m. The person on the other end was reporting a reckless driver.
Then came another call. Breathlessly, the caller said there had been a multi-vehicle accident.
A horrible one.
There were people lying on the lawn. On the sidewalk. In the street.
Smoke swirled through the air. Debris was everywhere. A crowd of bystanders began growing.
“I just assessed the scene at first. When I looked around ... it was a bad scene,” Martin recalled. She and Watt were the first emergency personnel on scene.
The vehicles were so twisted and tangled that the hospital employees couldn’t discern makes or models. It looked like a war zone, according to Watt.
“I saw this man leaning over cradling a child’s head,” she said, adding that the child was in the street, crying. “There was a another little boy on the lawn. He was moaning and crying, and had injuries as well.”
Martin went to them first, checking to see whose condition was worst.
She tried to open the airway of 6-year-old Jose Luis Miranda, who was laying on the grass.
Watt saw Stephanie Miranda, 4, bleeding from the head. She began pumping her little chest, but it was too late.
“I tried to help her,” she said. “She had no pulse.”
As Watt looked up, she could see emergency lights, flashing red and blue, coming closer.
She saw police blocking off the street, controlling traffic.
She heard the sirens coming, signaling to traffic that more emergency crews were on their way.
It was a scene of chaos and carnage. But Watt and others would now bring a certain order to it, a rapid but measured response. Dozens of medical and safety workers converged at the corner of Ham and Vine, each playing a role in a life-and-death drama. They relied on their experience, training and skills. Later, some would say it was an incident, a challenge, unlike any they had confronted before.
The incident commander
Fire Battalion Chief George Juelch was the first of those dispatched to arrive on scene. Before any other emergency crews arrived, he quickly evaluated the scene, which included at least five, maybe six, vehicles and 11 patients. He assessed each before paramedics and firefighters got there so that he would be able to direct aid to the ones who needed it most.
“This call is one of those where we have everything except a fire. We had ejected victims, multiple victims, lots of children, multiple vehicles, traffic control issues,” he recalled. “As the incident commander, that complicates things.”
As soon as Juelch arrived, he knew it was a multi-casualty incident, or MCI for short.
With some bodies up to 50 feet from any vehicle, it was unclear at first where each patient had been riding. He noticed three victims already on the grass area; two were being attended to by bystanders and medical personnel from nearby office buildings.
Juelch started making assignments using an MCI kit, calling for more firefighters, who arrived on the scene and started a triage area.
The battalion chief opened the kit, which contains color-coded tarps on which to place patients based on the severity of their injuries. He also pulled out a a flow chart of positions and vests that first responders wear, whether they work for the fire department or the ambulance company.
Titles on vests include “treatment unit leader,” who designates which treatments patients receive on-scene, and “transportation unit leader,” who helps designate who is going to which hospital, according to Lodi Fire Engineer Tim Ortegel.
“The key part when you get on a scene like this is being able to communicate with the right person,” he said.
In an MCI, multiple patients have to be dispersed among hospitals to avoid pressure on just one emergency room. First responders coordinate through the county EMS dispatch system where to send each of the patients based on their injuries.
Slicing through metal
At the scene, bystanders were trying to help, to support lifesavers, according to Watt.
Soon, an American Medical Response ambulance pulled up. Five more would follow from various locations throughout the county.
AMR’s on-scene medical group supervisor immediately began consulting via the MedNet radio system with the mobile intensive care nurse at San Joaquin General Hospital, which serves as the county’s control center.
The intensive care nurse there used an Internet-linked computer system known as EMResource that connects all of the hospitals in the area, including the trauma centers of San Joaquin General Hospital, UC Davis Medical Center, Kaiser Medical Center South Sacramento, Doctors Medical Center in Modesto and Memorial Medical Center, also in Modesto.
These centers have trauma surgeons and operating teams available within 15 minutes and can provide a higher level of care, according to Dan Burch, the county’s EMS administrator.
“I tried to sort out who was OK. I motioned to paramedics, there’s one here, there’s one there,” Watt recalled. “One of the paramedics came by and said, ‘Just continue what you’re doing.’”
Somebody yelled out, “There’s a pregnant woman on the other side of the pick-up.”
Luis Miranda’s wife Viviana Rodriguez, 31, was still seatbelted into the passenger seat. She was removed by EMTs, taken to the triage area for assessment, then loaded into an ambulance by a paramedic.
On-scene personnel classified patients as “immediate,” “delayed” or “minor,” with immediate patients sub-classified as “adult” or “pediatric.”
They decided to send Rodriguez to San Joaquin General based on her condition, but she went into cardiac arrest on-scene and was instead taken a block east to Lodi Memorial. Neither she nor her unborn child survived.
The of the jaws of life could be heard slicing through metal to extricate Ryan Christopher Morales, 28, the driver of the GMC Yukon suspected of causing the accident. He, too, was loaded into a ground ambulance.
Help from above
Juelch called for an air ambulance through the Lodi Police Department dispatch. He directed the air ambulance en route from its base at the Stockton Metropolitan Airport to land at Lodi Memorial Hospital’s helipad, so that he did not have to take an entire fire crew away from the scene to secure the landing zone.
It scooped up Jose Miranda and took him to UC Davis Medical Center, as his condition was deemed more serious than his 9-year-old brother, Eden.
Jose Miranda, however, died during surgery. Eden, who was taken to the same hospital by ground ambulance, was released Tuesday.
A second air ambulance was considered, but not used due to factors such as the time and distance, Burch said.
Ken Slater was the first police officer on scene.
After immediately radioing dispatchers for more officers, Slater called on the volunteer Police Partners unit to conduct traffic control, as well as the Major Accident Investigation Team.
Meanwhile, a firefighter placed a yellow blanket atop the lifeless body of the pick-up truck’s driver and the children’s father, Luis Miranda, 30, who was partially ejected out the vehicle’s rear window. He was dead when emergency crews arrived. The blankets are carried on fire engines, but are also used to carry people and items.
Martin can’t recall how long they were at the scene as time rushed past.
“You just went from person to person, doing what we could,” Martin said.
Stephanie Miranda and her 12-year-old brother, Irvin, died at the scene after being carried to the makeshift triage area on the lawn in front of Lodi Middle School.
A third vehicle, driven by Antonio Vasquez Romero of Lodi, was involved in the accident. First responders opted to send Romero and his three children, ages 8, 13 and 17, to St. Joseph’s Medical Center in Stockton, where they were treated for minor injuries and released.
Others were treated by paramedics on scene.
Calm in a time of chaos
Juelch had to call in six off-duty firefighters and a Woodbridge Fire Department crew to help cover the city, as the day’s entire shift of 13 personnel was on scene of the accident.
Every single piece of Lodi Fire apparatus was at the crash site that evening. He is proud of how everyone handled the incident.
“Everyone’s pretty confident we did the right thing. We’ve gotten a lot of positive feedback,” he said.
Because one vehicle was leaking fuel and there were concerns about it starting a fire, one crew remained on scene until around midnight when MAIT completed its initial investigation.
Despite the chaos of such a scene, Lodi Police Lt. Chris Jacobson said everyone remained calm and focused on the job at hand.
“It was quiet, then dozens of calls came through. We were inundated,” he said. “It was a very difficult situation. We were just flooded by calls because everyone thinks they are the first person to report it.”
The department’s four full-time dispatchers not only took dozens of 911 calls from Lodi residents, but kept in regular radio contact with first responders on scene.
Martin, the nurse practitioner who was at Urgent Care, also works in the hospital’s emergency room.
Still, she had never seen an accident as bad as the one the night of Oct. 22.
“We don’t typically get trauma that we’re first on the scene for,” Martin said. “It’s tough. It’s probably the worst I’ve had to deal with in my 23 years.”
Watt used to work in the emergency room, so like Martin, she has emergency training.
“You do what you’re trained to do at the time without thinking about it,” Watt said. “Afterward, when the adrenaline wears out, then you crash. Oh my gosh, all your best efforts and you weren’t able to save that person. It hits you — especially if you have children or a family.”
In the end, she relied on her faith and prayed about the scene after she went home that Tuesday evening.
“My heart goes out to all the families, the Mirandas and everyone else,” Watt said. “It’s the worst that I’ve ever come upon a scene. All this blood, and people hurt, injured and crying out for help. It’s a different mindset.”/News-Sentinel Staff Writer Todd Allen Wilson contributed to this report.
Contact reporter Jennifer Bonnett at firstname.lastname@example.org.