Car Accident W/ Entrapment

[uglyEMT]

Ok I want to preface this by saying I am making this up from my head. The included pic was just randomly picked off the net on a google search (wierd car accidents) and I am making up the scenario based soley on the photo.

You are dispatched to a 2 vehicle MVA w/ entrapment unkown injuries at this time. You are on a BLS rig with ALS responding to scene. Fire and Heavy Rescue are also dispatched.

At your disposal are 2 more BLS rigs one ALS unit. Air transport is available if requested.

Nearest Level 1 is 30 minutes out by driving

Nearest Burn Unit is 45 minutes by driving

Nearest Hospital is 20 minutes by driving

Im going to run this scenario step by step so everyone can follow.

so without further ado.... heres the scene

I have modified the photo to blurr the license plates

45 yr old Female in the truck unrestrained. 55 year old male driver in the car along with a 21year old female passenger both restrained. Airbags have deployed in the truck.

Yes the scene is inside the residence's garage.

Edited November 9, 2010 by UGLyEMT

[Richard B the EMT]

That 2 vehicle stack looks unstable. I'd try to establish voice and visual contact with anyone in the vehicles, while awaiting that Heavy Rescue to place cribbing blocks to brace the upper vehicle for scene safety.

Is there a light fixture possibly in contact with the blue vehicle, causing both to be electrified, thus an electrocution hazard to rescuers?

Did the blue vehicle enter the garage, and end up on top, or did the red vehicle force the blue one up top when it entered the garage? Debris sandwiched between the vehicles indicates a high speed impact through the garage door.

Definitely don your hardhats as well as your usual protective gear, as that suspended ceiling might also come down.

More to come (from everybody!)

Also, how steady is the floor? Just thought there might be a basement underneath, and the floor is not intended to support the weight of both vehicles. Cribbing to the basement, also, if needed.

[uglyEMT]

all good questions. Nice we get to move foward.

Ok heavy rescue is begining to brace both vehicles.

You have made voice contact with all related parties. Female in the truck is unitelegable but is responding.. The two people in the red car are verbal and can answer your questions.

Power to the garage has been shut off by FD.

Looking at the picture and having part of the garage door between the two I would say the truck went through the garage door and landed on the red car.

Floor is poured slab, no basment.

now what?

[fakingpatience]

Is the garage safe to enter? The roof looks a little iffy in the pictures to me. For now, I stand back and let the fire guys do their extrications, and try and talk with the people in the car.

The people in the red car are able to speak well you say, do they complain of any injuries? How did the accident happen according to them?

The woman in the blue car, what kind of responses is she giving?

How far away is the ALS unit? Is there another BLS unit available? Based on injuries, we would probably be fine with 2 units, but if one of the people in the red car are hurt worse, then we might need a third unit. I don't think I'd call for a helicopter, unless we needed another ALS unit and non were available.

Once the people are extricated, what is my first impression of all 3?

Thanks for all these scenarios everyone, they are fun!

[WolfmanHarris]

Based on number of Pt.'s I'd have two more units attend as well as SRU. (Count them as a single ACP for the purpose of the scenario)

Once the vehicles have been cribbed and fire's comfortable with entry I'd get a medic into each vehicle for assessment.

Where do we stand for each patient on:

- LOC/GCS

- Gross hemmorhage

- Rapid trauma survey

Prolonged extrication is sufficient to pre-alert HEMS to respond. How's the weather and time of day as well as distance to Regional Trauma centre?

[Chief1C]

Stabilization jacks on the truck, 6x6 crib the roof w/ 2x4's and plywood w/ wedges. Crib the truck in place, put in a ram outside the door of the car. Remove the side of the car, behind the driver door. KED the driver and remove. KED the passenger and remove. Same for the driver of the truck. Except, barring any serious injuries to the driver of the pick up, I'd be more concerned w/ removing the victims of the car first. Although, it appears the passenger and driver compartment of the car are fairly well intact. I've been on a wreck where a car was upside down on another car w/ entrapment, it was close to a two hour extrication time. One drove off an embankment, and came down on top of a car on another street.

[scubanurse]

would say the truck went through the garage door and landed on the red car.

What were the two people in the red car doing in a closed garage then? Maybe get a CO reader out and check levels.... could the people in the red car be suffering from some carbon monoxide or were their pants around their ankles?

[Bieber]

All right. I'm not a fire/rescue/anything guy, so to begin with my role is going to be to stand back and let the fire guys do their job. Whatever they need to do to secure the scene for my entry, let 'em do their thing and as soon as it's secure I'll move in. It looks like accessing the truck driver shouldn't be too hard, though I think climbing into the truck might potentially cause the roof of the car to collapse more so ideally I want to get the passengers of the car out first if that's the case.

It sounds like the patient in the truck is more critical, however, so if there's any way to safely get the truck driver out without endangering the car occupants (again, this is gonna be fire's call, I don't know about that kind of stuff) I'd prefer that but I'll defer to their judgement.

Does fire advise a prolonged extrication? If so, I'm going to consider the air transport but I want to get a better idea of what's going on first. Can we access the patients enough to assess them or at least get a verbal account of the verbal patients' injuries?

Also, in this scenario, are we assuming the role of BLS providers or can we input ALS care as well?

Edited November 10, 2010 by Bieber

[Richard B the EMT]

What were the two people in the red car doing in a closed garage then?

They might live at the accident location, had gotten into the car from inside the house, but hadn't yet opened the garage door, or started the engine.

Edited November 10, 2010 by Richard B the EMT

[uglyEMT]

Ok all good questions

Ok all the scene is secured, fire guys did their thing, everything is safe. Before any cutting they want to know what EMS wants done. No CO detected as per FD, red vehicle wasn't started yet. Truck shut off on airbag deployment.

As per the original post Helicopter is available, we are mid day sunny skys light winds. If necessary a ball field is a few blocks away. You are on the BLS rig with an ALS unit on scene with you (non transport unit) there are 2 more BLS units available and one ALS (again non transport).

Times per the OP

Level 1 is 30 minutes out by road

Burn Center is 45 by road

Local Hospital is 20 minutes by road

Now for our patients. (this is what you see upon getting into the garage to guide extrication crews)

Patient 1 Driver of Truck

45 yr old female

Communication is unintelegable mostly moans but responds when asked questions

She was unrestrained

Windshield is spidered above the steering wheel with visable blood and hair on it

Steering wheel appears bent foward

Her position is against the wheel slumped foward and to the drivers door

Visable blood from her head and on her cloths

Airbags did deploy

Front of vehicle is heavily damaged mostly on driver side

Does not appear to have intrusion into passenger compartment

There is an odor of ETOH eminating from the vehicle (can not tell if its the patient or the vehicle itself yet)

Patient 2 Driver of Red Car

55 yr old Male

Communication is verbal, complaining of severe pain everywhere

He is restrained in the vehicle

His position is foward and twords the passenger side

Bleeding from his head

Roof is crushed down into the passenger compartment almost to the door

Patient 3 is Passenger in Red car

21 year old Female

Communication is verbal, complaining of severe pain to her arm and shoulder feels numb everywhere else

She is restrained in the vehicle

Her position is against the passenger door, head foward

No visable blood

Remeber folks this is the intial assesment to guide the extrication crews, no vitals have been taken yet.

I know I am going slow with this but want to give a good step by step to a multi patient MVA with confined space also a factor so other may learn. I know this assesment was probably done by 3 responders (be they als or bls) in 30 seconds to a minute by it is a vital step in the process. Especially when it comes to deciding the priority of the patients.

Thanks for the responses

PS: Again this is a made up scenario, not a real case.