scenario-vehicle crash

[windsong]

Whats would Keenve from the movie "Speed" would say, you've got an Ak47 pointed at you, they tell you to leave the pt alone, whatcha gonna do?, the telling part is added new.

So you've got some person pointing a gun at you, telling you to let the person die, are you just going to stand there OR are you going to save their life?

[Asysin2leads]

Ummmm, I suppose reporting a sudden and equally mysterious mechanical problem with the ambulance is out of the question, lol. Okay, here we go.

Enroute: Request fire and PD, get a message to any air evac and have them go into standby mode just in case.

Have partner give report over radio, conduct rapid triage.

Bleeding man is either yellow or red depending on whether he can walk or not and his mental status, during triage, quickly control any life threatening bleeds, use a tourniquest if necessary. If he isn't breathing, reposition his airway. If he still fails to breathe, he's a black tag. Walking man is green tag unless there's something you're not telling me. For instance, if he was talking about the flipped over Jeep, and pointing to the moaning bush at the time, we would upgrade his status.

Unconscious female is red, and at this time, highest priority.

Moaning bush is also probably a red, but maybe he's just a wussy who wants someone to help him up.

The flipped over Jeep patients (if there are any), are black tagged. Mammalian dive reflex or no, in START triage anyone without an airway is black tag, and I would say being upside down up to your neck in water would qualify. Use C4 plastic explosives and/or thermite charges to destroy the Jeep to prevent any well meaning whackers who may arrive from going near it and becoming casualties themselves. If the patients are entrapped, but without airway compromise, they will be a good project for the hose monkeys when they clear up at the hospital. Throw some blankets at them and tell them to hang tight, with definite pun intended.

The most important thing to do at this point is to get everyone up out of the weather. Tell walking man to go into the back of the ambulance and stay there. Assuming all three patients need to be boarded and collared, do so, then get them into the back ASAP, with whatever immediate interventions (bleeding control, only really, anyone not breathing is also a black tag.) If the ventilations need to be assisted, do so, with a BVM while moving. Get her into the back and have your partner stay with her while and do advanced airway management if necessary. Enlist the help of the walking man, if possible, to retrieve the bleeding dude. If not, do what ever is possible with a single rescuer where the patient is, maintaining body heat will be a high priority. Repeat with the bleeding man if he is indeed unconscious. If you can get every one in, put one on the stretcher, one on the bench seat, one on the floor if necessary. Transmit message for ALS unit (if we're not an ALS unit), and one additional BLS unit for transport. If the patients in the Jeep are black tagged, make sure you give the irstatus, lest we complicate the situation with a big red truck full of heroes barreling into the scene for a rescue.

Rule out medical causes for unconscious female, secure airway, lidocaine, RSI if necessary if you suspect head injury. See if bleeding man is still bleeding, assess hemodynamic status. See how Mr. Bush is doing and treat accordingly. Find out why he is moaning. Give Mr. Walker some hot cocoa and a cookie for his help.

Unconscious female needs to be medevaced, bleeding man too if he seems to be exsanguinating, which the unconscious female seems to be. If she's already at the point of unconsciousness from blood loss, she probaly ain't gonna make it to the trauma center even by air. Plan accordingly. if Mr. Bleeder seems stable, send him to the trauma center. Mr. Walker can get some more hot cocoa and cookies at local hospital.

I'm assuming I am still a paramedic and my partner is too and I have a great big non-type II ambulance at my disposal.

Patient prognosis:

The Jeep family: Dead, unless they are up out of the water

Ms. Sleeper: If its a medical condition causing her unconsciousness (maybe she's that woman who seems to exist in scenarios that is a diabetic and crashed or is having an MI and crashed), she'll probably be ok, if its a head injury that did it, she might be okay if we get her to surgery quickly, and if its blood loss, she's probably dead.

Mr. Bleeder: Needs a trip to the trauma center, but will probably be okay, use the medevac on him if Ms. Sleeper succumbs in the mean time.

Mr. Walker: He'll have a great story for the grand kids.

If we get out of this scene with Mr. Walker and Mr. Bleeder okay and the other two dead, and no one else gets hurt, I'd still call it a success. You've crashed your car in -10 weather in the middle of no where. You can't expect miracles.

[Just Plain Ruff]

we have room for 3 patients in the ambulance

1 in front seat

1 on bench seat and one on stretcher.

maybe one more on the medics seat

you have now covered all the available areas on the ambulance and you have more patients.

Once you reach your limit of taking care of the patients you can handle with no belief that more resources are gonna get to you any time soon you've done all you can.

I had a call where we were the only ambulance int he county and we had 4 trauma codes/drownings from a car wreck

we worked 2 of them and called the other two. We were the only ones on scene with our nearest next ambulance was 45 minutes away and no helicopters flying.

They all 4 died and were all under 17 We met our limit and we took the two that got out of the car first by fire. The other two died in the car.

[iMac]

PRPG.....I hate you...... What a cruel scenario....

[anon311]

Just to clear something up about this scenario - you CAN'T leave, right? It seems that people posting towards the beginning of this thread were saying leave the Jeep family for dead and bring everyone else to the hospital ASAP. You have to stay on scene until you can transfer care to other basics/medics, no?

[EmergencyMedicalTigger]

I'm going to hit my easy button I got from Office Max...

[shrevo23]

prpg & medik8

It's not nice to post a scenario like this and not let everybody know how it turned out.

I know it is an old post but we would really like to know how it was handled. And don't tell me it was so easy that a caveman could have done it.

kris

[PRPGfirerescuetech]

Sorry it took me so long, heres the end of the call....almost a year later...lol. It seems i forgot i even posted this...

Mitigation

EMT from MICU establishes command, dedicates 2 radio channels to the assignment, and begins triage.

Everyone on scene in a trauma patient, and mitigation of the incident is completely intrinsic on making sure you come to this conclusion.

Triage evaluations:

Trauma patient #1: (bleeding man by truck) Male, 50’s approximate, was driver of white pickup now in 2 pieces. Alert but not oriented with +LOC. Chest and abdominal pain, denies head / neck / back

Trauma patient #2: (moaning bush) Female, late teens, altered conciousness (AVPU-P) Heavy facial trauma but self maintaining airway upon EMS arrival. Noted small metal shard impaled R lower abdomen, with full abdominal evisceration.

Trauma patient #3: (girl at the end of the blood trail) Female, 20’s, heavy facial and upper chest trauma, facial anatomy change, JVD, flail chest, HR: 28, RR 4, grey in color.

Trauma patient#4: (guy walking around) Male 40’s, trauma to the hands and lower arms. Patient was a pedestrian and put his hands up to avoid being hit by the rolling white pickup truck, and was struck on the arms as it flipped past him. No LOC with full memory of the incident, denies spinal pain/deficit, but several large lacerations to the hands and a likely R wrist fx.

JEEP in water:

All subjects still alive inside vehicle, unable to make access to patients. Radio room advised.

Triage findings:

Jeep: Not considered until access could be made.

Patient priorities:

#1: Yellow

#2: Red

#3: Red

#4 Green

All patients immobilized due to trauma with exception of #2. #2 left to self maintain airway due to lack of manpower.

Radio dispatch contacted, 6 ALS requested. Of the 6, 2 were local (within 10 minutes) and the other 4 with various ETA’s, up to 30 minutes.

Radio dispatch contacted, flight services checked to see if willing to land at lighted air strip.

1 helocopter accepts, other 8 decline. Helicopter in air, willing to accept two non critical, or 1 critical.

ASSISTING MICU #1 arrival

MICU#1 given red level trauma #3. Transports to local community hospital.

Moved to patient #2, secured to spineboard, abdominal eviceration covered and impaled object secured. Medication assisted intubation utilized, medic continues ALS care with patient, moved patient to 1st arriving trucks litter.

Moved patient #1 to benchseat, primary assessment and o2.

ASSISTING MICU#2 arrival

Assisting MICU paramedic gets into truck with 2 trauma patients, EMT from assisting truck drives 2 paramedics, and patients #1 and #2 to airstrip for flight service.

Trauma patient #4 left on scene with EMT from primary truck #1. 12 minutes later,

ASSISTING MICU #3 arrives. “trauma” patient #4 moved to litter, crew ground transports patient to trauma center.

Arrival of rescue company, with a group of well trained “rescuemonkeys”

CHIEF of another EMS service arrives to assist. (and thank Christ for this…because I was out of paramedics…)

2 patients inside jeep, one DOA on fire department access, another in respiratory arrest.

Respiratory arrest extricated after windshield cut out

Downturns to cardiac arrest.

EMT and Chief from other service transports arrest to local community hospital.

DOA released to FD until arrival of state police.

*lessons*

1. Always bring your easy button

2. Debate asking for resources from local medical command facility.

This call actually was the focus point of the region expanding their MCI plan.

Thoughts from all?