An Amtrak train struck a dump truck on June 27, 2022, derailing and scattering its aluminum-colored cars into the lush green terrain, killing four people and injuring nearly 150 more. Multiple EMS agencies worked together, including the crews from 28 ambulances, 19 fire trucks, and 17 helicopters. These first responders quickly began triaging, prioritizing those with life-threatening injuries and transporting them to hospitals near the small town of Mendon, Missouri. Medics applied tourniquets to mangled limbs, placed tranexamic acid (TXA) coated hemostatic dressings, and gained access with intraosseous (IO) devices when venous access was difficult. Next, medics worked to clear the hot zone. More stable patients were transported to a nearby school that was converted into a casualty collection point. Empty for the summer, the school provided relief from the heat and a safe place for further assessment and treatment of patients. Meanwhile, as the most critical patients arrived by helicopter at the nearest trauma center, where the emergency department team transfused blood in a 1:1:1 ratio of platelets to plasma to packed red blood cells (pRBC).

How did these lifesaving interventions arrive in a small town in Missouri? They were best practices adapted from military medicine by the civilian sector. Although military and civilian health care systems usually operate separately in the United States, the crossover of academia and research has proven valuable to both systems. Emergency physicians (EPs) are particularly valuable in the military for their expertise in trauma but also for their breadth of knowledge ranging from infectious diseases to environmental exposures and even psychiatric conditions.¹ In the civilian sector, emergency medicine has benefited from the military’s advances in mass casualty response, trauma care,

Dr. Fontenette

resuscitation, and pain control. Roderick Fontenette, MD, FACEP, a retired Lieutenant Colonel from the air force, has seen the growing collaboration between the civilian and military sectors occur during his career. “It’s a beneficial relationship for both sides—working in civilian hospitals, we keep up our clinical skills while stateside and in return, we bring with us new and proven critical care techniques from the battlefield.” Joshua Stilley, MD, FACEP, Chief of Division of EMS at the University of Missouri as well as the medical director for Chariton County Ambulance, whose district this crash occurred in adds, “Other than those invaluable techniques, one of the best things we’ve learned in prehospital medicine from the military is the staged approach to triage—extracting patients from the low-resources setting of the disaster and moving them to casualty collection points where we can better assess their needs.”