Physician Response Team Mobilizes for Tour Bus Crash

Joeseph A. Bart, DO, was writing emails the afternoon of Aug. 22 when he got the call about the tour bus crash on the Thruway. It was a mass casualty incident, he was told, and there were fatalities.

“This was an ‘all-call,’” Bart explains. “Anybody who is available goes.” A few minutes later he was on the road headed toward the site of the tragic tour bus accident that claimed the lives of five passengers and injured dozens.

Bart, an associate professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences at UB and a physician with UBMD Emergency Medicine, leads the Physician Response team, an innovative program that is a partnership between UBMD Emergency Medicine and AMR, the local ambulance company. The partnership, which began in 2022, is a network of volunteer emergency medicine physicians throughout Western New York who make themselves available to respond to high-severity 911 calls and mass-casualty incidents 24 hours a day.

Once on-site at a mass-casualty event, these physicians assist on-scene EMS providers with decision-making and patient care of critically injured, ill or complicated patients.

On Aug. 22, UBMD Emergency Medicine sent six of its physicians, who are also faculty members in the Jacobs School, to the scene in Pembroke; AMR also sent physicians.

Among those who arrived early on the scene, providing intense triage, were Bart, EMS operations director, and Kevin McGee, DO, both members of the Department of Emergency Medicine at the Jacobs School. Assisting with the on-site response were Johanna C. Innes, MD; Marta Plonka, MD '20; and John McNamara, DO, also faculty members in the Department of Emergency Medicine, as well as Greg May, an emergency medicine fellow.

The first order of business was to link up with whoever was serving as incident command at the site to determine patient counts and triage them. Many patients were seriously injured, while others could walk on their own but had contusions and bruises.

“Our job is to bring to the scene our clinical acumen and ability to evaluate patients in order to understand and make treatment decisions,” Bart says. “There were more than 50 patients and there was no emergency department in the area that could take all those patients at once.”

After determining which hospitals could take patients, the physicians had to figure out how to get them there.

“If you have one helicopter and a few ambulances, and you’re pulling patients from the bus, who goes in the helicopter and who goes in the ambulances?” says Bart. “Emergency medicine physicians make decisions 100 times per shift. We bring that resource to the field.”

According to Bart, the purpose of having physicians on-site is to support the volunteers doing their jobs, to provide reassurance that they are doing the right things and to make sure the best patient care decisions are being made.

“The Physician Response Team is a support resource for EMS and other responders — not just in challenging environments, but every day on EMS calls,” says Innes. “We do hands-on support with direct operations and patient care, but our expanded role on more complex scenes can integrate critical logistics, triage and transport decisions as well. We're there to help on-site agencies and responders operate at their best.”

Once patients started arriving at area hospitals, they were cared for and treated by physicians from the UB Department of Emergency Medicine, the Department of Surgery and UBMD Emergency Medicine and UBMD Surgery. Many patients were taken to Erie County Medical Center, the area’s level 1 trauma center. Others were taken to Buffalo General Medical Center, Millard Fillmore Suburban Hospital and Oishei Children’s Hospital.

Jennifer L. Pugh, MD '09, of UBMD Emergency Medicine and the Jacobs School led the ECMC Emergency Department response, along with many colleagues from emergency medicine, UBMD Surgery and the Department of Surgery. Jeffrey J. Brewer, MD '05, clinical associate professor, led the surgery team. UB surgery residents also responded, with several coming to ECMC from other sites to help out; even some who weren’t on shift came in to help.

“This was an all-hands-on-deck situation,” Bart explains, “so the emergency department also brought in many medical students, anyone who was in clinical rotation at the time in the hospital. In that scenario, we were going to utilize anybody who could do something helpful. They’re not playing critical roles, but they can check vital signs, tag or retag patients, establish IV access, provide documentation, anything within their capabilities.”

Brian I. Ludwig, DO, led the response at Buffalo General Medical Center and Michael A. Filice did so at Suburban Hospital; both are faculty in emergency medicine and physicians with UBMD Emergency Medicine. Jeremy J. Killion, MD '05, in the Department of Pediatrics and with UBMD Pediatrics led the response at Oishei Children’s Hospital.

The Physician Response program, which is integrated into AMR’s ground medical transport operations, is supported by UBMD Emergency Medicine and the EMS fellowship at the Jacobs School. The team is comprised of UBMD EMS medical directors, EMS fellows, Emergency Medicine residents and regional EMS medical directors who work on a 24/7, on-call schedule to complement existing staffing within partner emergency departments.