While hospital and emergency response officials praised the actions of paramedics, firefighters, police officers, and emergency room staffers in responding to Monday's school bus crash that left five children dead, there was general agreement that the horrific accident left many emotionally scarred.
"I've never seen a more upset group of ambulance workers," said one emergency room staffer, who asked to remain anonymous.
The scene inside the mangled bus "was pretty bad," Chattanooga Fire Chief Chris Adams said. "It was something you shouldn't ever see."
The first word of the accident came in about 3:20 p.m. — a bus crash with schoolchildren in it. But firefighters were not concerned.
"We have those from time to time, so everybody is not real ramped up when that comes in," Adams said Tuesday.
But that changed as soon as the first units reached the crash site on Talley Road and supervisors began hearing their radio conversations.
"You could hear it in their voices," Adams said.
At the offices of Hamilton County Emergency Medical Services, which dispatches ambulances countywide, the first indication the situation might be serious was a report that the bus was on its side.
"That kind of ratchets it up a notch," said Ken Wilkerson, director of emergency medical services.
The normal response is to send two ambulances and a supervisor, Wilkerson said. Then the first units arrived at Talley Road and declared a mass casualty event, and the metro area's emergency teams kicked into gear.
Adams and Wilkerson rushed to join Chattanooga police Chief Fred Fletcher in an improvised command post a short distance from the wreckage.
"There were patients on backboards to the right, children who looked fine were a little farther up," Adams said. "It was very heartbreaking, very chaotic at first."
Firefighters and EMTs began working to rescue children from the wreckage of the bus, which was twisted around a large tree.
"It was a very confined space,"Adams said. "The way the bench seats are made, they crumpled up and made a pinch point, and it was difficult to move tools."
"We realized the importance and urgency of the situation. It started hitting home when you heard parents asking about their kids," he said. "It was emotional for me personally, knowing what our firefighters were doing inside that bus."
"You had a totally collapsed interior with children trapped in the bus," Wilkerson said. "We had both paramedics and firefighters inside the bus providing patient care while [firefighters] were removing parts of the bus to gain access — seats, walls, ceiling panels, anything."
Firefighters used saws and the Jaws of Life machinery to push apart and cut through metal.
One child was pinned for two hours inside the wreckage. The victim "was alert and talkative the whole time, and the firefighters really bonded," Adams said.
But firefighters never learned the child's name or the extent of his or her injuries.
"One bad thing about the fire service is that we don't know the outcome of how those patients even do," Adams said. "We're hopeful we'll get information later on."
Fortunately, there were no fuel leaks and therefore no threat of a fire. A risk of sparks "would have changed everything about the tools we could have used," Adams said.
In all, Hamilton County EMS sent 12 ambulances, and four private ambulance services added another 10, Wilkerson estimated.
At Erlanger, security guards rushed to the lobby of T.C. Thompson Children's Hospital emergency room and asked reporters to leave to create a safe space for parents. Large blue curtains were draped across the sides of the portal outside the emergency room, to prevent bystanders from watching as children were carried inside, many on stretchers.
There were occasional outbursts of tears or anger as family members arrived.
For hospital personnel, a major headache was identifying their young patients, so they could connect them with their parents.
"They were all young children and they had no IDs with them when they arrived, and none of their parents were present," Dr. Darvey Koller, medical director for the emergency room at Children's Hospital, said in a press conference Tuesday evening. "They were all wearing uniforms and many were scared or too dazed to talk to us. Many were unable to spell their names, they didn't know their birthdates, and they didn't know their parents' names. Several said 'Mama' when asked what their mother's name was."
Hospital staffers took photos of the children and then relayed them to school teachers at Woodmore Elementary School to establish their identity and contact their parents.
Erlanger officials praised the rapid response to the accident, both inside and outside the hospital. "People dropped what they were doing and immediately went into action to help," Erlanger Chief Operating Officer Rob Brooks said.
Children's Hospital surgeon Dr. Lisa Smith thanked EMS workers and other first responders on the scene who "encountered horrific scenes and did an incredible job keeping the kids warm and safe."
She noted that at one point, she looked up and saw dozens of her former professors at the UT College of Medicine in Chattanooga, as well as other staffers from throughout the hospital "all lined up wanting to help."
Koller noted that many of the 19 children who were treated and released suffered from cuts and bruises and sore wrists or ankles. Hospital staffers were able to treat and release all of them within about two hours after they arrived at the hospital, he said.
While he has seen many terrible accidents in his 40 years as a paramedic, EMS Director Wilkerson said this one stood out.
"When it involves kids, it takes it to a different level," he said.
"I think the worst part was watching parents go into the rooms and come out sobbing," one emergency room staffer said. "A lot of them had to be wheeled out in wheel chairs."
Many firefighters and emergency rescuers are only now coming to terms with the emotional impact of Monday's rescue effort.
"We are very good at taking care of business while it is going on — there was no yelling, no screaming, everyone was very methodical," Fire Chief Adams said. "They're trained to do what they do the emotions don't come into it until it is over."
But at the same time, he said, "In your mind you're going, 'How could this happen?' There is kind of just disbelief."
"We all have children, grandchildren, nieces and nephews. Those kids were our family," Wilkerson said. "We hurt just like everyone does."
Contact staff writer Steve Johnson at 423-757-6673, firstname.lastname@example.org, on Twitter @stevejohnsonTFP, and on Facebook, www.facebook.com/noogahealth.
This story was updated Nov. 23 at 12:05 p.m. with minor correction to lead paragraph.