Opinion Wanted

[James_ffemt]

I would like to know everyone's opinion on what you would do in this situation. Received a call for two vehicle MVA. Upon arrival we find two vehicles with major damage. One of the vehicles (#1) has been T-boned on the drivers side and pushed into a telephone pole causing about 40% intrusion on passenger side. Windshield is spiderwebed and also broken out on one side. Car #2 has significant front end damage. Driver of car #1 is lying outside of vehicle on ground upon arrival with a deputy (also paramedic) holding c-spine (only occupant of vehicle). (We asked and were told that someone drug him out of the car before our arrival. Driver of car #2 (only occupant) is still inside car. My paramedic checked on car #1 pt. and pt complains of pelvic pain and also possible loss of consciousness. I check on driver of car #2. She is complaining of neck, lower back, and left leg pain. Pt. of car #1 is packaged and placed in ambulance. We have called for another unit to transport driver of car #2 because my partner is flying the other guy out from the airport which is close by. I stick with pt. of second car. Collar applied and ff/emt is holding c-spine from back seat. I get a set of vitals. BP 170/110, pulse 98, and respirations are 18 NL. Pt has a history of high bp. She is answering all questions asked. ALS unit that was requested is about 8-10 min out. Ok, so here is the question. The paramedic on the other truck was pissed because I did not move her out of the car onto a LSB and put her in the middle of the street until they arrived. I did not do this because of a couple of reasons. 1. she was hysterical and anytime you acted like you were going to touch her she would scream. 2. It was hot outside and would have even been hotter lying on the blacktop. 3. The only place to put her was right in the middle of the accident scene. The ambulance we were working out of was not big enough to hold two pt's and two medics be in the back. Would you have waited to take her out and place her right into the awaiting ambulance or would you have got her out and put her on the ground and waited? You guys let me know.

[Eydawn]

I think you made the right decision. How long does it take to do a rapid extrication? Maybe 2 minutes at most if it's tricky? What was the guy's hurry?

In my opinion, you are safer inside of the vehicle as long as you don't notice anything that would compromise that safety. I know I wouldn't want to be lying exposed in the middle of an accident scene on the blacktop; if a lookee-loo lost control of their vehicle, and ended up in the scene, it would be far better to be inside a steel cage (albeit an already crunchy one).

As long as there were no factors indicating that immediate removal was in the patient's best interests, I think you acted wisely in waiting for the unit to get there. She didn't seem to need any advanced maneuvers ASAP and was stable... so, why pull her out and let her freak out more? Ick.

What do YOU think?

Wendy

CO EMT-B

[JakeEMTP]

Was vehicle # 2 running to provide A/C? If not it can get extremely hot inside a vehicle as you are aware. Perhaps you could have boarded her and held a sheet with assistance from the hose monkey to shield her from the sun, but It wasn't essential to remove her from the vehicle IMHO.

Just tell the 2nd medic to chill, board their patient, and transport. It was your patient until they arrived so you did what you thought was best as the patient advocate. Since you didn't have access to any pain medications prior to moving her and due to her response to any sort of movement I think you were correct in leaving her in the car.

I had a call yesterday in which a young woman was thrown from a horse. She had a pelvic fx and complained of lower back pain. When we tried to roll her onto a LSB she just screamed. We established a 18g in the left AC and gave her 50mcg of Fentanyl and 3 mg of Versed before we could even move her.

I realise my example isn't the same as yours but in a way it is similar. Without pain mgmt, leaving her in the vehicle was perhaps a good thing.

[Kaisu]

The arriving medic comes across as a lazy sob that didnt want to do the work of the extrication. I think you did the right thing. You were looking after your patient.

[James_ffemt]

I feel the same as all of you. I believe he was lazy and didn't want to do his job. Two other paramedics and the supervisor agreed that it was my call and that considering the factors I was right in my decision. Thanks guys!!!!!!!

[p3medic]

I'm not so sure he was being lazy, you had the equipment to properly imobilize the patient and waited for him to show up before doing it. The patient has been involved in a serious accident and has several apparent injuries. The best thing you can do for this patient is transport, and if the patient was packaged prior to ALS arrival they could facilitate transport immediately. Instead they would have to spend more time doing a job that should have been done already. Just my 0.02

[BEorP]

ALS unit that was requested is about 8-10 min out. Ok, so here is the question. The paramedic on the other truck was pissed because I did not move her out of the car onto a LSB and put her in the middle of the street until they arrived. I did not do this because of a couple of reasons. 1. she was hysterical and anytime you acted like you were going to touch her she would scream. 2. It was hot outside and would have even been hotter lying on the blacktop. 3. The only place to put her was right in the middle of the accident scene.

If we are treating this as a significant traumatic event (as I think we are) then maybe the Paramedic's point was that you wasted critical time. If we are looking at the "platinum 10 minutes" and the transporting vehicle taking 8-10 minutes to get there, that time is all but up upon their arrival.

From your points...

1. It's going to hurt no matter what. I don't see this as being a reason not to move her. I do not know what the ambulance service or your fire medic can do for pain and maybe this would change my answer though. Even with pain meds though, it's going to hurt.

2. As was mentioned previously, it can get pretty hot in a car. Also see #3.

3. I have no idea where this happened, but unless it was the middle of a highway there must be some other place to put her. Even if there isn't, try other options as have been pointed out.

Was the medic lazy? Maybe. But does that mean that you did the best possible thing for your patient? Not necessarily.

[strippel]

Had a slightly similar occurrence a few years ago. I was working a BLS quick response vehicle, and was dispatched to a crash, car vs pole. (it was a small town, our truck for that area was out, another BLS was responding from a further station, along with my ALS supervisor).

A female with seizure history, seized while driving with her grandchildren in the car. Low speed crash, not too much damage (the car was still drivable), children were properly seat belted, self extricated, outside with friendly bystanders.

The patient was still seat belted in the car, seizing. Volunteer fire is pissed, want me to yank her out of the car, and place her immobilized on the street. Luckily, there was a vol EMT on the scene helping me. We had a collar and oxygen on her, and were attempting to keep her calm and still. She was sitting in the drivers seat, still seat belted. There were no safety hazards, and nothing for her to hurt herself on. When the BLS truck got nearby, the EMT and I finished immobilizing her, and placed her directly on the arriving litter.

The patient had no obvious injuries, and was not a load and go (with nowhere to go). I didn't see a need to lay her on the hot asphalt until the BLS Arrived.

[Richard B the EMT]

I feel you did nothing wrong.

I also mention, while awaiting additional units to respond in, I have placed patients already on the Longboards, on top of vehicle hoods and trunks.

The person who complained about the patient not being ready to immediately be placed into his ambulance was wrong. I think, as someone else already posted, this person was simply wanting someone else to do his job, and he was lazy.

[p3medic]

Why shouldn't the patient have been packaged and ready to load upon ALS arrival?