On Wednesday, April 17, 2013, at approximately 7:50 pm, an ammonium nitrate explosion occurred at the West Fertilizer Company in West, Texas, while firefighters and emergency medical service personnel were responding to a fire at that facility. Joseph E. Palfini, RN, of the Southwest Texas Regional Advisory Council based in San Antonio, Texas, recalled the incident during a recent presentation at the annual National Disaster Life Support meeting.1 As task force leader of the newly developed Texas Emergency Medical Task Force (EMTF) mobile medical unit, he received the official request for support of a no-notice incident in West a short time later that Wednesday evening. This incident marked the team's first deployment outside of exercise and planned events.
Mr. Palfini recounted the challenges and successes they experienced in responding to this large-scale disaster. The devastation that occurred in this rural central Texas community (estimated population 2807 in the 2010 census) was overwhelming. Several fire and emergency medical service (EMS) personnel were among the 15 reported deaths; approximately 160 persons were injured and hundreds more were displaced by the widespread destruction of homes and businesses. The local health care infrastructure was severely disrupted. The initial clinical challenges demanded expertise in acute trauma and blast injuries, including ear injuries from barotrauma (many casualties), abdominal injuries (2 casualties), and acute asthma exacerbations. Also common were acute anxiety and other mental health exacerbations.
Workforce protection rapidly became an important focus of this deployment. Many responders and volunteers presented with fatigue and illnesses related to the long work hours from challenging work/rest cycles. The loss of primary care capability in the local area quickly affected the deployed team, as many residents needed assistance with refilling medications that were lost or unavailable in newly restricted areas.
The EMTF model the unit followed was developed after the 2008 hurricane season in Texas (hurricanes Dolly, Gustav, and Ike). Successful field-testing of innovations in modular disaster medical and public health assistance teams (ie, Texas Medical Assessment Team)Reference Swienton2 led to the formation of the Texas Disaster Medical System (TDMS), a state-based organization comprising leading university health centers, regional and state agencies, and public/private entities in partnership with the Texas Department of State Health Services and the Department of Emergency Management. The resulting modular standardized EMTF units have a statewide regionally-based response capability. The EMTF model exemplifies interagency coordination and collaboration, which uses the Hospital Preparedness Program (HPP) and associated Regional Advisory Councils (RAC) to link together many vital assets.
