My First MCI

[fiznat]

I've been a "cut loose," medic for just about two years now. I feel fairly confident with my knowledge and skill although I admit that every once in a while a call comes around that really kicks my ass. Such was the case this past week.

Just after signing-on in the morning I was given a call that originally came in as "boy who fell off his skateboard" and eventually evolved during our response to "car overturned down an embankment, multiple patients including one traumatic arrest." I was the second medic on scene, the first being a fly-car medic assigned to that area. Turns out there were five patients, all of them critical and two of them entrapped within the car which was pretty much unrecognizable.

I've never been on a scene (as a medic) like this before. I understand that there were "only" five patients but this was early in the morning during crew changes and that number of critical patients really stressed our resources. By any standard of measurement this was definitely a "MCI" for us which required proper triage and scene control. Most of that triage was being handled by the medic who arrived on scene first, who was categorizing the patients and assigning duties to firefighters when I got there. The scene was chaos though, with firefighters and police yelling at the top of their lungs, ejected patients on the ground seemingly everywhere, and a very impressive mechanism. I was immediately assigned to one patient, and set to work with my partner doing what we had to do.

I guess it is hard to explain, but the way I feel this call "kicked my ass" wasn't the medicine, but how I handled the call on-scene. I don't think I did anything wrong per-se, but I was very disappointed about my overall scene awareness when I thought about it later. I brought my gear down to the patient (who was down a steep embankment and on the ground a few yards from the car) and did my thing, but the whole time now that I think about it I had pretty much no awareness of much else that was going on with the scene. I found out later that a few yards to my left was the traumatic arrest which had been black-tagged, but the truth of the matter is I never even noticed him there. We were a couple yards from the car that they were cutting, and the thought never crossed my mind to move the patient farther away so that we could avoid the firefighters and any possible debris. There were many other things I missed or didn't see that I probably should have as well. I was thinking about my patient (who was unresponsive and barely breathing) and how we were going to get him up that hill-- and pretty much not thinking about anything else. In short (and in retrospect), I got tunnel vision.

If possible, I'd like to hear about some of your experiences with crazy scenes and MCI's- particularly about maintaining a "bigger picture" mindset about the scene while you're also trying to care for a critical patient who really demands your attention. How do you manage to take everything in? How do you keep your head up to look around when your patient needs your focus right away? As a medic with plenty of hands to help, what jobs do you do and what jobs do you assign so that you can "step back" and get a better look at the situation?

Apologies for the long post. Any advice would be appreciated. Thanks guys.

[mediccjh]

The best thing I can tell you to do on a clusterf--k (or any MCI, for that matter) is to grab your patient, get out of there, and do everything on the way to the hospital.

MCIs suck, especially when they're not controlled. Having PD and FD running around like chickens with their head cut off doesn't help either.

Always remember to keep cool (or at least look it) in front of your patient.

[chbare]

I agree with Mediccjh. Get your patient and get out. First on scene, sucks to be you. In addition, there will always be some incident that will throw you for a loop. Prior to heading over to the sand box, I was working a rotor shift and had one of those calls of a lifetime. We received a call for a helicopter crash of all things. Honestly, I initially thought we were going on another training mission, as this was at a military range, and we had been doing "training missions" to help prepare soldiers training for OCONUS deployments to work around an aircraft. However, range control indicated this was in fact an actual call.

When we got closer to the scene, another helicopter was flying a high recon pattern around a rugged canyon and we received report from the pilot. Immediately, the gravity of the situation sank in. We had to land over 100 meters from the crash site, then scramble up the canyon to reach the site. Amazingly, both pilots involved survived, the scene was safe, and we had the foresight to call for another helicopter en-rout to the scene.

I took one patient, and my partner took another. We performed primary surveys, identified obvious injuries, gathered history, placed IV's, and gave pain medications. When the other helicopter arrived, we had the crew package and take the patient who we thought had the most serious injuries, then we packaged and flew the other patient.

Never had an experience like that. Just like you, I felt like I had my ass handed to me. However, it sounds like you did a good job.

Take care,

chbare.

[firedoc5]

I don't think you did anything wrong really. But it sounds like it was a learning experience. You might want to sit down with those who were also there and have a debriefing on what everyone could have done differently. Believe me, you can have more than a dozen MCI's and you will always come up with other options, even if everything went as smooth as silk.

Keep up the good work and implement what you learned the next time.

[AnthonyM83]

Dude, I know exactly what you're talking about. I've been on some scenes where there is so much going on, yet afterwards when people are recounting it, I remember about an 1/8 of that, because I was zoned in on my patient.

It used to happen at car accidents a lot (regular ones with multiple minor injuries...not like the one you had) until I made myself pause before going in to a patient and doing a walk-through. It let me know extent of situation, details on damage to vehicles (important if you're going to be explaining the MOI to the receiving ER doc), and where everyone else was (potentially a safety issue, too).

So, I guess my answer is don't v-line directly for your patient, take a better scene survey even if it takes you half a minute. Then every now and then look up from your scene and re-evaluate. Whenever someone else comes up to you to ask questions (scene commander, for example) is a good time to really give him and the scene your attention (rather than just shouting a quick answer and going back to your patient). Also, helps you keep track of your resources better when it's time to get out of there.

Just my thoughts on it. Like the others said, it's probably good to just get the heck out...but still want to keep aware...

[crotchitymedic1986]

NO matter how many calls you run, and how much experience you gain, you will always find that one call that bitch-slaps you from time to time. You probably did fine, as long as you were treating the most critical patient, since you were the first transport unit on the scene. As a senior medic, I always made a point of walking the entire scene first, before I got lasered into one patient, to look for missed patients, scene hazards, the most critical patient, and making sure the dead patients were dead. I would then make sure we had adequate resourses enroute, then I would start treating the most critical patient.

I would say the biggest thing is to make sure you identify all hazards -- there is only so much you can do for patients, but you cant do that if you are dead OR injured. I remember one cluster, where a large utility truck struck a power pole, flipped upside down. The driver was dead, and seatbelted in. Diesel fuel was leaking everywhere, but since the driver was dead, no one was in any panic mode. When one of the cops reached in to get dead guys ID, he hit some button somewhere, and something on the truck started arching electrical sparks all over the place (into the spilled diesel fuel). The hose monkeys hadnt pulled a line yet, so the scene went from peaceful to immediately chaotic, and everyone realized that if this were a gasoline powered vehicle, we would have all burnt up. LESSON LEARNED.

[firedoc5]

Oh yea, beware of the dreaded "tunnel vision". :wink:

[toutdoors]

Fiz, I agree with pretty much everything that has been said. From the sounds of it, you did what you had to do. The most positive part that I read from your post is that you are rethinking the whole thing, and what could you have done different. Not that you should beat yourself up over it, but be honest with yourself, and your crew. This way you will learn, and be better prepared next time you get a call like this. As you are well aware, you can run a hundred calls with no problems or weird occurances, but then that next call comes in and it is one that leaves you asking questions. As you get onto more calls with multiple patients you will get better at being able to keep a bigger picture in front of you; but like someone else said, sometimes you just don't remember much of anything else other than what you are doing. You might be surprised at how much you subconsciously took in, and don't recall.

Critiques are great for re-hashing a large scale incident like this, and for people to point out what went good, and what could have been done a little better. The funny thing I have noticed about critiques (both fire and medic side) is that they are rarely 100% honest. Most of the time we say "Yep, we dun did good huh", and walk away thinking that we really pulled something off. The reality of it being that there were things that could be improved upon. A critique should not be used to completely embarass someone, or point fingers, it should be an open forum in which all agencies and parties involved openly communicate what went great, and what needs work. Then come up with a practical solution to remedy the area(s) that need improvement. Otherwise don't waste the time with the critique.

[tskstorm]

I found myself on a call where a taxi cab hit a gentlemen on a moped and the moped went out of control and ran into a cafe which had people dining outside.

Most patients had small injuries, the main patients I focused on/saw was the driver of the moped, 40 y/o male full CNS trauma, no feeling from neck down. 35 y/o female with crush syndrome, was pinned between the moped and a fixture inside the cafe and a 40 y/o female with penetrating trauma to the back.

We had 3 BLS ambulances on scene, while I was there, 2 FDNY FF trucks, and we were lucky enough to have an ER Attending eating at the cafe that day.

I noticed, The EMT's on scene, did something similar to you, they all just focused in on what they were doing. I felt like a fish out of water not quite sure what to do, so I took it upon myself to direct and over see the FF's who were helping immobilize the patients, and prepare them for transport. We luckily had enough personnel on scene, we did not have to triage much, and the Physician on scene gave us a through report on arrival.

I'm not sure whether or not I would have been better served focusing on any one patient like everyone else seemed to be or if it was better I did what I did.

I think I had a fairly good big picture the entire time, I was on scene, but as the First arriving ambulance, as soon as the Moped driver was fully immobilized and ready for transport we took him to the nearest lvl 1 trauma center, which was a whole 5 blocks away .... I know crazy, lvl 1 trauma center 5 blocks away?

[Just Plain Ruff]

Just worked one Friday night like this.

Had 3 vehicles, major damage on 2 of the 3.

Had a unconscious gal in the backseat of vehicle 1, unconscious in front seat of veh 1

Had rigid abdomen and recent gastric bypass surgery on driver of car 2

Chest trauma on backseat passenger in car 2

bilat lower extrem injuries in passenger in car 2

All patients met trauma criteria to go to trauma center yet the closest center is 65 miles away.

We called 5 helicopters in for all 5 patients and all went well.

We ended up with 4 ambulances on scene which depleted our units and a mutual aid unit from 17 miles away.

All went well but unfortunately you can't take care of every patient initially. Quick scene size-up call for all thehelp you need, call early.

Once I knew patients in 1st vehicle were being seen, and patient 2 and 3 in the vehicle I was at had medics I was able to take care of mine.

Being triage officer sucks if you ask me.