Following its investigation of the Mexican Hat incident, the NTSB recommended that FICEMS address the need for funding to enhance the communication capabilities of rural areas and conduct a systematic review of EMS response to large rural accidents. The NTSB made recommendations to the Utah Bureau of EMS and Preparedness, calling for the development of a contingency plan for large rural accidents that are complicated by severe weather. Recommendations were also made to the Federal Highway Administration, the National Association of State EMS Officials, and the American Association of State Highway and Transportation Officials to develop a risk assessment process to identify those stretches of rural roads most vulnerable to accidents in order to focus communication enhancements and response plan development.

Hart emphasized that the challenge of vast open spaces goes beyond how long it takes for emergency vehicles and responders to reach the site. Physical distance can be a significant barrier to transporting emergent patients quickly and effectively after first responders have arrived. From the accident scene in Mexican Hat, the closest medical facility with a trauma unit was 117 miles away in Moab, Utah. Five of the victims were treated at this level IV trauma center. The closest level I trauma unit was 190 miles away in Flagstaff, Arizona, and two individuals were treated there. Twenty-five accident victims were treated 75 miles away in Monticello, Utah, in a facility without a trauma center; 10 were treated as far as 230 miles away at a level II trauma unit in Grand Junction, Colorado, and three were treated 360 miles away in Salt Lake City, Utah, at a level I trauma unit.

There are a variety of exacerbating circumstances that affect rural incidents, including lack of communications, bad weather, lack of roads (of particular concern for railroad or aviation crashes), and impact on the larger community (e.g., a crash resulting in a pipeline leak or other hazmat situation). Hart emphasized the importance of state and local governments considering potential aggravating circumstances when developing response plans.

In the future, he said, we can expect to see more tour buses on rural roads as people set out on more ski trips and other expeditions to see our beautiful country “up close and personal.”


Linda Larson, EMS director for San Juan County, Utah, provided a local EMS perspective of the 2008 Mexican Hat incident. Currently an emergency medical technician (EMT)-intermediate with advanced life support (ALS) certification, Larson has been an EMS in Utah for 10 years, and was an incident commander at the scene. Though San Juan County is the

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