Triage scenario

[musicislife]

Youre a first responder, first guy on the scene of a head on crash, one occupant in each car. The ambulance will not be there for 15 minutes.

First PT: Not breathing, no pulse...move to next patient.

Second PT: Unconscious, severe bleeding from his arm- control bleeding, assume head stabilization.-maintain airway

Would you let the ambulance take care of the other PT when they arrive?

[nypamedic43]

Here in NY, a fatality is left where found. I would do what I can for the living patient. Depending on entrapment, I would assume c-spine control and talk to the patient. They may be unconscious but they may still hear you. Once the fire dept gets there, extrication can take place and the patient can be backboarded. Hopefully by then the ambulance will be there and can take responsibility for the patient and get them to definitive care.

[Bernhard]

If first patient not breathing AFTER checking (and if needed: opening) the airway, then he would be seen by the second ambulance to arrive. And most probably then declared death on scene (after having a ECG applied and asystole approved).

The first ambulance to arrive would instantly be pointed to patient #2, who still lives.

This is generally speaking, in reality it strongly depends on circumstances. And I think as ambulance provider I would check both patients myself instead of let me beeing assigned by a random first responder...

[DFIB]

On the first patient i would open his airway. If he spontaneously begins breathing I would check the other patient. Although this is triage I would not consider it an MCI. I would check for other corroborating signs of death and then move to next patient.

The ambulance crew can confirm DOA but should care for the live patient.

[Stjarna]

Open the first patient's airway and check for breathing. Yes? Let him be seen. No? Move to the next patient. Allow the ambulance to see whichever was more critical- the unconscious one with the now open airway if that's the case, and if not then the second patient.

[Bieber]

First patient, open the airway, if still pulseless and apneic, then no. Triage code black (obvious death). We no longer run "blunt blues" unless the cause of their arrest seems to have a medical etiology.

[Just Plain Ruff]

patient 1 - dead - nothing you can do move on to next

patient 2 - try to stop the bleeding - and wait for the ambulance.

15 minute ETA of ambulance just makes the 1st guy 15 minutes deader.

And yes, the higher level of care should go check patient number 1 to evaluate deadness and then come see your patient. What should really happen is that the crew should split off and one check dead guy and the other begin on your patient.

[paramedicmike]

What should really happen is that the crew should split off and one check dead guy and the other begin on your patient.

Splitting crews makes me nervous. A guy I used to work with and I split up on a call to evaluate two patients. He disappeared. I didn't know where he'd gone. I couldn't see him. He wouldn't answer on the radio. Turned out we both had really sick patients and we both had our hands full. We were both stuck not being able to help each other and not really being able to help our patients by ourselves. Help finally arrived and we were able to manage things. Afterwards, we sat down and had a good long talk about what had happened. Neither of us saw what was coming. Neither of us were willing to let it happen again.

Yes. It's an anecdotal, one time event. I'll even concede that there may be times and circumstances where you have to split up (MCI, for example). However, if it can at all be prevented I will not split crews.

Edited May 30, 2012 by paramedicmike

[craig]

Youre a first responder, first guy on the scene of a head on crash, one occupant in each car. The ambulance will not be there for 15 minutes.

First PT: Not breathing, no pulse...move to next patient. Basic airway management? still apnoeic DEAD

Second PT: Unconscious, severe bleeding from his arm- control bleeding, assume head stabilization.-maintain airway Maintain basic airway as Pt is unsconsious control heamorrhage wait for ambulance to arrive, extricate via recognised methods

Would you let the ambulance take care of the other PT when they arrive? what other patient? there was only two wern't there? Police to oversee the recovery of the deceased and of course the attending ambulance is to take charge of the unconscious patient....what other patient was there?

[Just Plain Ruff]

Splitting crews makes me nervous. A guy I used to work with and I split up on a call to evaluate two patients. He disappeared. I didn't know where he'd gone. I couldn't see him. He wouldn't answer on the radio. Turned out we both had really sick patients and we both had our hands full. We were both stuck not being able to help each other and not really being able to help our patients by ourselves. Help finally arrived and we were able to manage things. Afterwards, we sat down and had a good long talk about what had happened. Neither of us saw what was coming. Neither of us were willing to let it happen again.

Yes. It's an anecdotal, one time event. I'll even concede that there may be times and circumstances where you have to split up (MCI, for example). However, if it can at all be prevented I will not split crews.

I don't split crews if they are going to be far apart but if there are two cars in a wreck, they are probalby close to gether. I was assuming they were close.

So I have the medic go to the unconscious dude with the OP and the EMT or medic partner check the dead guy because they aren't really dead until someone higher on scene than a first responder says so in my olde system. You gotta get a strip on the dead guy. So that's the reason for splitting the crew.

I do completely understand what you mean by splitting crews but there are still two patients on this call until patient 1 is determined dead by me or my partner. So I have to get one of the two of us on my ambulance to run a strip. And I'm not going to be that medic who relied on my first responder to tell me the guy was dead when he wasn't. I want me or my partner to make the determination.

Let me ask this mike

Let's say you are the first crew there. Do you and your partner go to the first car together and then to the 2nd car or do you stay split up and tackle one patent for each of you? That would be splitting up wouldn't it?