Officials don't yet know why the crash occurred, but are conducting a full investigation, New Jersey Gov. Chris Christie told media later in the day.
At the hospital less than a mile away from the train station, Roberson ran to the emergency department and called out a “code triage external,” meaning a major disaster has occurred outside the facility. The staff opened an incident command center and mobilized emergency medical services to the crash site. They counted the number of doctors and nurses on hand and how many they could call in, and made sure gauze, crutches, wheelchairs and other supplies were at the ready. Beds were counted, and staff moved patients with minor injuries to open up more. Then they waited.
“We don't know what it's going to look like, so it's always best to prepare for the worst,” Roberson said.
About a half hour to 45 minutes later, the first patient arrived. From then on, the emergency department worked like “a well-oiled machine,” as patients rolled in and the ER staff did what they're trained to do, Roberson said. In total, 25 train crash victims were treated at her hospital. Only two remained at the hospital Friday afternoon.
The Hoboken University Medical Center constantly prepares for disasters like the Hoboken train crash. The staff runs drills for emergency preparedness once a month for situations ranging from mass casualties to active shooters to electricity issues, Roberson said. Because of the medical center's proximity to train stations and tunnels, it has conducted several drills specific to train derailments.
“Hospitals regularly drill and practice what goes on in the scenario of a disaster,” said Dr. Andrew Bern, a spokesman for the American College of Emergency Physicians. Emergency physicians even have disaster medicine training as part of their residency programs, he said.
The basics of responding to a disaster are typically the same, though the response can be tweaked according to a specific situation, experts say.
Hospitals usually take an “all-hazards approach,” meaning they don't train for a plane or train crash, specifically. “We train for mass casualty events,” said Dr. Gina Piazza, a member of ACEP's high-threat task force. The goal in disaster situations is to make sure hospital staff are never overwhelmed, she said.
While disaster response is generally the same for most situations, like tornadoes, hurricanes and floods, some situations are handled differently. For instance, when dealing with a “dirty bomb,” the hospital must protect individuals from radiation exposure, Bern said.
Most hospitals perform a “hazard vulnerability analysis” to determine what unique disasters they may have to deal with. For the Hoboken hospitals near the crash site, it's expected that they would prepare for train-related incidents, especially given how commonplace train accidents are, Bern said.
A total of 1,912 train accidents occurred in 2015, up from 1,870 in 2014, according to the Federal Railroad Administration's Office of Safety Analysis. In 2015 alone, there were 1,348 derailments, the office reported.
The hospitals would “speak to their pre-hospital care providers, their EMS, their fire units, and talk to them about the fact there are these major rail lines…What would happen if these derail?” Bern explained. “It would be a rare and unusual situation for hospital not to be thinking about these things.”
For Jersey City Medical Center, which was 3 miles away from the train station and received 66 crash victims, the Hoboken train wreck felt eerily similar to a drill the staff practiced in fall 2015. Jersey City is the regional trauma level II center. In that scenario, the hospital staff, along with New Jersey Transit, the Port Authority, the state Office of Emergency Management and local police and fire departments practiced responding to two trains crashing inside a tunnel, said Mark Rabson, the medical center's director of public affairs and director of EMS.
They set up triage areas and additional zones where emergency medical services and other hospital employees conducted onsite evaluations of the injured, so that every patient was seen by a paramedic, nurse or physician before they even reached a hospital.
Practice turned into reality Thursday, and the Jersey City team responded in the same way. Shortly after receiving a notification from the EMS dispatch center, the hospital staff reported to their stations to await further instruction. Jersey City, which is a regional level II trauma center, set up a command center at the hospital so they would know the injuries of the patients being transported. The hospital called in about 20 additional physicians and specialty doctors, such as oral and facial physicians, plastic surgeons, orthopedic doctors and others.
Along with an on-site triage center where patients, depending on their injuries, were evaluated and put on ambulances or public transit buses, the hospital turned a local Target store into a staging area to keep from overwhelming the emergency department with ambulances and other trucks.
“It was hectic (but) expected because we had prepared for it … on previous mass casualty drills,” Rabson said.
As of Friday morning, 11 of the 13 patients admitted at Jersey City were in stable condition while two remained in the intensive-care unit, he said.
In the next county over about 40 minutes away, Hackensack University Medical Center received 13 walk-ins with aches, pains and minor bruises, and one with more severe injuries. All have been discharged, said Dr. Joseph Feldman, the hospital's chairman of emergency services. Christ Hospital, an affiliate of the Hoboken University Medical Center, received one patient, who has been transferred, a spokesman said.
Part of disaster preparedness means helping the hospital staff recovery after disaster situations, experts said. Staff may need “psychological first aid” because there are behavioral health concerns associated with dealing with high-stress scenarios, said Dr. Oscar Alleyne, senior adviser for public health programs at the National Association of County and City Health Officials in Washington.
After most of the injured patients had left Hoboken University Medical Center on Thursday, the staff had a debriefing. "That's really important,” Roberson said. “Especially in disasters—it's a very emotional time.” Hospital staff talk about what went well, what could improve, and give “kudos” to everyone who went above and beyond. Everybody gets a chance to speak, she said. After that, it's time to get set for the next patient.