RENO - Rushing to the rescue of 40 tourists in a bus crash in the remote high desert, doctors, paramedics, state troopers and national guard pilots sprang into action under an emergency plan more typically used for wildfires.
The wreck on a rural highway near Tonopah, Nev., put the injured more than 200 miles from the nearest medical trauma centers - Reno to the north, or Las Vegas to the south - roughly the distance from New York City to Washington D.C.
''It was dead square in the middle of the state,'' said Lt. Col. Cindy Kirkland of the Nevada Army National Guard.
Three military helicopters, two Blackhawks and a Chinook, were sent to the scene because hospital helicopters typically cannot travel that far and don't have room for multiple patients, she said.
Seventeen of the most seriously injured were flown to Washoe Medical Center in Reno and nine to University Medical Center in Las Vegas. Other less seriously injured patients were treated at Nye County Regional Medical Center in Tonopah.
As many as 50 workers at Washoe Medical Center were involved in the effort, along with an estimated 25 volunteer firefighters from the Tonopah area, dozens of law enforcement officials and an unknown number of volunteers, hospital officials in Reno said.
''We used an incident framework we use for wildfires and stuff like that - the non-normal times,'' said Gene Spoon, chairman of emergency management at Washoe Medical Center.
The remote nature of the wreck was one of the biggest challenges, he said.
''We were living in a trauma situation known as the 'Golden Hour,''' Spoon said, a 60-minute window within which critical injuries must be treated to increase patients' chances of survival.
''Knowing we had 75 minutes air time from Tonopah, we knew we were already outside that window,'' he said.
Many of the injured were transported first to Nye County Regional Medical Center, where the patients were prioritized and arrangements made to move the most seriously hurt to Reno or Las Vegas.
Gov. Kenny Guinn approved activating the National Guard helicopters.
''We put in a call to our aviation unit,'' Kirkland said.
''And they just happened to have aircraft and crew standing by for another training mission, so they were in the air within 10 minutes.''
Only one emergency room physician was on duty at Nye County Regional Medical Center at the time but family practitioners from surrounding communities converged on the small town, Spoon said.
''Everybody here is so impressed with the work they did in Tonopah,'' said Kate Griswold, spokeswoman for Washoe Medical Center.
''They must have had every person with any medical training helping from miles around,'' she said.
At the scene of the crash, ''the walking wounded'' helped with the more seriously injured passengers, said John Brown, 47, of Scotland, whose wife Audrey, 44, remained hospitalized in Reno on Friday.
Passers-by began to stop and state troopers were on the scene within 15 minutes, Brown said.
''The fire brigade cut away part of the bus,'' he said. ''The emergency people all worked very well.''
He and his wife were transported to Reno in one of the Blackhawk helicopters.
''It's quite an experience,'' he said.
The Reno Fire Department provided lights and law officers closed off the streets around a park across the street from Washoe Medical Center so the military helicopters - too large for the normal landing pad - could touch down.
One of the problems with patients sent to Las Vegas was there was no room for the Blackhawk helicopter to land near the hospital, so it had to go to North Las Vegas Airports, where passengers were loaded onto ambulances.
''That erodes your Golden Hour,'' he said.
