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The tram accident in Gothenburg March 12, 1992 – KAMEDO-report 62

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

This report is entirely in Swedish. Only summary in English.

Summary

On Thursday March 12, 1992 at approximately 08.00 hrs a tram overhead contact wire became disconnected in a street in Gothenburg. A tram set became immobilized in Wavrinsky Place (Wavrinskys plats), obstructing the traffic. No passengers were left in the tram. A police patrol directed the cars past the tram. Due to incorrect application of the brakes the tram started to move uncontrolled along a downhill track. A specific accident cause investigation has been carried out by the Swedish Board of Accident Investigation.
When the police patrol realized what was going to happen, it drove at high speed with siren and blue lights on in front of the tram set. Just before the 56-ton tram set reached the stop at Vasagatan it derailed, crashed into a house and turned into a plough which violently hit people waiting at a tram stop and in cars. Gasoline pouring out of a crashed car was ignited. The fire spread to the tram car and along the tram rail in the street.
The derailment occurred at approximately 09.10 hrs. The first alarm to the centre came from a private person at 09.17 hrs via the emergency number 90 000. The centre transferred the alarm to the police and fire brigade alarm centres which in turn initiated major alarm at 09.18 hrs.
The first ambulance arrived at the scene two minutes after the first alarm and the crew reported that they estimated that approximately 50 people could be dead and maybe some hundreds injured. Specially equipped ambulances, standard ambulances from the region and reserve ambulances were then immediately directed to the accident scene along with other rescue vehicles and police cars. Three hospitals were alerted and two medical teams were sent to the scene.
Within approximately 15 minutes, 18 ambulances, 38 ambulance crew members and 34 firemen had arrived at the accident scene. Those arriving first started immediately to fight fires, give life-saving first-aid and transport victims to the nearest hospital. One doctor who witnessed the accident, and private volunteers initially took part in the care of injured persons. The weather conditions were bad, with a temperature around freezing point. strong wind and rain mixed with snow.
No casualty assembly point was established. No advanced medical treatment was given at the accident site. The load-and-go principle was used instead. Transport times to the three nearest hospitals were 5, 15 and 15 minutes respectively. The task for the doctor in command and the medical teams was mainly to give the patients priorities for transportation and distribution to hospitals.
The patients were distributed to the region's hospitals unevenly, since transportation and distribution were done initially without central command. Twenty-nine patients were sent to the nearest hospital, Sahlgren's (Sahlgrenska sjukhuset). Somewhat later, six ambulances were directed to the East Hospital (Östra sjukhuset) and one to Mölndal Hospital.
In total, 42 persons were affected, of whom 13 died. After approximately 40 minutes, 36 patients had been transported to hospitals. Of these four were dead on arrival. Six dead persons were left at the accident site. Three patients died in hospital during the first 24 hours, but no one died later. Nine patients underwent acute surgery. Thirteen patients with mild injuries were discharged after treatment at the emergency department.
Initially, a brief red alert was initiated at Sahlgren's Hospital. In the afternoon the hospital activities returned to normal. The activities for the hospital psychosocial groups were chiefly care of victims' relatives. The support groups of the fire brigade, police and the tram company took care of the debriefing of their own personnel.
Information to the press was arranged already at the accident scene. At a press conference at the main fire station four hours after the accident, the commands of all participating rescue organizations were represented as well as the medical services and the tram company. At Sahlgren's Hospital and East Hospital, press conferences were held repeatedly. The general public was informed at regular intervals via the local broadcasting service. Among other things information was given by the church and other religious societies on where people could meet. A great number of telephone calls came to hospitals, the fire brigade and the police during the first 24 hours.
Forensic examination of the 13 dead bodies revealed that none of them could have been saved by medical treatment at the accident site. Eleven of them had irreparable injury to vital organs. One person caught in a car died due to bums and one patient with intracranial bleeding was not operable due to his high age.
Examination of the survivors showed that all in need of acute surgery or other active therapy got this. They did not develop any complications such as ARDS (adult respiratory distress syndrome), septicaemia or multiorgan failure. The results after six months are satisfactory even though not all are fully recovered.
In summary, analysis of the medical course shows that the tactics used in this accident, "load-and-go", was efficient. This technique is probably also relevant in other similar situations during daytime on weekdays in densely-populated areas with short transportation time to well equipped emergency hospitals.

Experience and conclusions

Experience and conclusions that can be drawn from this accident are the following:
• The intense violence led to a great number of instant deaths due to irreparable damage of vital organs.
• In situations with high transportation capacity in combination with short distances to hospitals with large resources, it might be wise to consider not using casualty assembly points but instead transporting patients immediately to hospital after basic ABC care. Decision in this matter must be taken early by the rescue leader upon advice from the doctor in command.
• The rapidly given medico-technical rescue care led to patients with curable injuries quickly receiving qualified therapy at hospitals, and therefore survived.
• The tactics used at the accident site and at hospitals meant that lethal complications were avoided.
• Alarm and action plans for police, fire brigade and health care systems in Gothenburg do function well in at least major accidents during weekday office hours. The corresponding preparedness for other times and for less densely populated areas is, for obvious reasons, different. Communication problems do exist within the health care system.
• Psycho-social care of relatives and personnel should be well integrated in health care emergency and disaster preparedness and also in community preparedness.
• Information to the general public and contacts with mass media calls for quick initiatives from the police, fire brigade and health care system in order to be efficient and avoid complications.
• The "all clear" after the accident (no more victims) must reach all parties involved.
• The shortest possible turnout times for medical teams to the accident site should be sought. This means that the medical teams should in principle be able to leave the hospital within 5 minutes of the alert.
• Personnel in specialized ambulances should be trained to direct medical activities at the accident site in major accidents.
• Communications between the accident site and hospitals must be guaranteed so that e g patients may be allocated to the different hospitals in an optimal way. This is of special importance now that the reorganization of the health care system is leading to smaller or no margins and little or no over-capacity.
• Police guided tours of the accident site for mass media representatives is a good way of taking care of the press. It probably also allows the rescue work to go on with little press interference.
• The importance for the rescue commander, accident site commander, police in command and medical doctor in command always to wear properly marked helmets and vests can never be over-emphasized.
• In all major accidents a doctor in command should always be sent to the accident site even if no medical team need to be called out.

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