biggest county in Utah at 7,725 square miles, its population only measures 14,413, an average of 1.8 residents per square mile. Larson compared that to Washington, DC, which is 61.4 square miles with a population of 599,000, or 9,300 residents per square mile.

The Accident

On January 6, 2008, 17 tour buses traveled through San Juan County, Utah, on their way to Phoenix, Arizona, from a ski holiday in Telluride, Colorado. Normally, the convoy would have traveled through Colorado, but Lizard Pass on State Route 145 was closed due to snow, and the buses were diverted through San Juan County on Highway 191. It is believed, Larson said, that instead of making a necessary turn to stay on Highway 191, five of the busses kept driving straight and inadvertently ended up on Highway 163, which is a very narrow, winding road, without a shoulder. The fourth bus failed to negotiate a turn and rolled down a 41-foot embankment. The crash site was 10 miles north of Mexican Hat, 22 miles south of Bluff, and 80 miles from Monticello.

At the time of the crash, approximately 8:00 p.m., it was already dark, very cold, and raining. Larson played an audio clip of the 9-1-1 call made by one of the victims to EMS, shortly after the crash. Given the lack of cell phone coverage in that area, it is unknown how that call was connected. From the recording, workshop participants heard that the connection was poor and was ultimately lost before the dispatcher could obtain any information other than that there had been a crash. Another 9-1-1 call was successfully completed around 8:30 p.m. by a passerby.

The Response

The first ambulance was paged at 8:30 p.m., and four ambulances were en route by 8:45 p.m. The EMS team alerted the local hospital and the emergency manager, who sent the mass casualty trailer to the scene. The San Juan County EMS is voluntary, but has a fulltime interfacility transport vehicle that just happened to be in the area, about 20 minutes away. Both of the personnel on the transport were ALS certified.

The first ambulance on the scene arrived at 9:01 p.m. to what Larson described as a messy, surreal scene of strewn skis, poles, jackets, and suitcases. The bus had gone through a barbed wire fence and made a full 360 degree roll down the embankment, losing its roof in the process (Figure 2-1).

Forty-three EMTs responded, which Larson noted as fortunate rather than routine: normally only half that number are available to respond. Two highway patrol officers responded, both of whom had some EMT experi-



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