Scene control

[Jwan]

https://m.facebook.com/story.php?story_fbid=1075800935763699&id=100000014081798

I just watched this. The thing that was in my mind during the whole rescue was how there were so many people trying to "help" which seemed to of created a classic "to many chefs in the kitchen" kinda scenario. Was this scene handled correctly? Or should the paramedics/responders have a better handle on the scene and instruct other bystanders to stand back and let EMS work

 

[WildlandEMT89]

My thoughts based on what I can see are that the scene was somewhat mismanaged.
If anything I wouldn't want to work on extricating a pt trapped under a vehicle being held up by a sole jack where bystanders (even with the best intentions) are pulling on my patient.
It was a hell of a rescue, but could it have been run a bit better? Sure. Calls that run perfectly are rare in this line of work, we can only strive to do our best in any given situation.
But it's also very easy to armchair quarterback.

 

[Jwan]

My thoughts based on what I can see are that the scene was somewhat mismanaged.
If anything I wouldn't want to work on extricating a pt trapped under a vehicle being held up by a sole jack where bystanders (even with the best intentions) are pulling on my patient.
It was a hell of a rescue, but could it have been run a bit better? Sure. Calls that run perfectly are rare in this line of work, we can only strive I do our best in any given situation.
But it's also very easy to armchair quarterback.

I'm not so much focusing on the rescue and techniques used, only that it would of been significantly less chaotic and possibly less stressful on the PT if the responders had better managed the scene and managed to have the crowd stand back as to better rescue the PT. The clear agitation of the PT is noted mostly after bystanders and responders are yelling back and forth.

 

[Mufasa556]

I saw this on the news yesterday. The FF you see in the video was off duty and stopped to help.

In the early few minutes, it's hard to control scenes like that. You have a bunch of people who have good intentions, but no experience in emergency situations. They'll start doing wacky things. I've seen people break out windows on a fender bender accident. Watched two guys rip the front bumper off a Honda Civic. For what reason, I still can't figure out. My personal favorite, watched a high school kid run out into traffic with a road flare like he was recreating the Trex scene from Jurassic Park. The best thing to do is give them jobs that make them feel like they're helping, but also get them out of the way.

Honestly, I'm surprised that so many people actually stopped to help.

http://abc7.com/news/motorcyclist-rescued-from-underneath-truck/694533/

 

[OnceAnEMT]

My personal favorite, watched a high school kid run out into traffic with a road flare like he was recreating the Trex scene from Jurassic Park.

 

[islandmedic]

Kinda hard to judge the scene management by the responders when they aren't even on scene yet. In my experience this is a typical layperson response to an accident. I think the off duty firefighter did the best he could. He tries to assign tasks to people and speaks/moves with purpose. That's not a car I would want to be under.

 

[DesertMedic66]

https://m.facebook.com/story.php?story_fbid=1075800935763699&id=100000014081798

I just watched this. The thing that was in my mind during the whole rescue was how there were so many people trying to "help" which seemed to of created a classic "to many chefs in the kitchen" kinda scenario. Was this scene handled correctly? Or should the paramedics/responders have a better handle on the scene and instruct other bystanders to stand back and let EMS work

As some others have said first responders were not on scene yet. The only people on scene were bystanders and an off duty FF on his way to work. On the 91 freeway in CA it's nearly impossible to have crews on scene in the 3 minutes of the video play time.

 

[CALEMT]

But it's also very easy to armchair quarterback.

Trying to keep this in mind. Could the scene could have been ran better? Sure, but it looks like the off duty FF was trying to do the best with what he had (not much). Talk about controlled chaos at its finest. You have a crowd of people with the best intentions and absolutely no experience or training in emergency situations. I for one would not want to be under that vehicle trying to extricate the patient with a simple jack holding the vehicle off the patient. I would like to think when responders got on scene crowd control went into effect.

 

[Jwan]

As some others have said first responders were not on scene yet. The only people on scene were bystanders and an off duty FF on his way to work. On the 91 freeway in CA it's nearly impossible to have crews on scene in the 3 minutes of the video play time.

When I first posted this I was not aware of the one being an off duty FF, pair that with a snapshot of someone in a road vest in the back and looks like a responder team. Anyhoo, I'm not bashing anyone as it may seem simply jus bringing up a point of discussion as to what went on. Personally I think it's great people helped it restores a tiny bit of faith in humanity, however IMO it would be beneficial for all involved if the off duty FF would control the scene and monitor/assess the PT until help does arrive. People jacking up the truck and yanking on the pt could very well cause more harm then good.

 

[DesertMedic66]

When I first posted this I was not aware of the one being an off duty FF, pair that with a snapshot of someone in a road vest in the back and looks like a responder team. Anyhoo, I'm not bashing anyone as it may seem simply jus bringing up a point of discussion as to what went on. Personally I think it's great people helped it restores a tiny bit of faith in humanity, however IMO it would be beneficial for all involved if the off duty FF would control the scene and monitor/assess the PT until help does arrive. People jacking up the truck and yanking on the pt could very well cause more harm then good.

How much is someone off duty able to control a scene? What authority does he have when he is off duty? Some bystanders think they are Gods and know exactly what needs to be done and how to do it and then act upon those thought.

How much assessing could the off duty FF do? The patient is yelling and talking, cool nothing else I can do for him. Being off duty you can really only help with CPR and major bleeding (both of which this patient did not need/have).

 

[LACoGurneyjockey]

When I first posted this I was not aware of the one being an off duty FF, pair that with a snapshot of someone in a road vest in the back and looks like a responder team. Anyhoo, I'm not bashing anyone as it may seem simply jus bringing up a point of discussion as to what went on. Personally I think it's great people helped it restores a tiny bit of faith in humanity, however IMO it would be beneficial for all involved if the off duty FF would control the scene and monitor/assess the PT until help does arrive. People jacking up the truck and yanking on the pt could very well cause more harm then good.

It's very easy to say "just control the scene". It's much more difficult to execute. If you've been in this position it becomes a lot clearer just what kind of chaos you're trying to control.
Everyone is scared, and everyone thinks that their single action may save this mans life. It's not as simple as "would everyone please calm down and step back". That doesn't work, especially with the 1:10 ratio he was dealing with. The off duty FF did everything right as far as I can see. Tried to get people out of the way for a moment, asked for more jacks, and tried to calm his patient and prevent movement.
I was off duty and came up on almost the exact same thing, except mine wasn't breathing. I only had 5-6 concerned bystanders trying to help, and one still managed to get out of his sedan with a haligan. When they're not used to it, people get a wee bit silly under stress.

Edit: or what Desert said

 

[Jwan]

How much is someone off duty able to control a scene? What authority does he have when he is off duty? Some bystanders think they are Gods and know exactly what needs to be done and how to do it and then act upon those thought.

How much assessing could the off duty FF do? The patient is yelling and talking, cool nothing else I can do for him. Being off duty you can really only help with CPR and major bleeding (both of which this patient did not need/have).

Being in uniform and identifying himself as an off duty FF holds enough weight. Simply addressing the crowd and stating that the best thing for the PT right now is for him to be left where he is until help arrives.

Further assessing a PT can simply be watching them, asking questions, no equipment needed other than a mouth to speak eyes to see and a brain to know what to look for.

Again I want to reiterate that I'm not condemning the FF on his actions only offering up a discussion point as to what could of been done or what would anyone else of done different to assure a better outcome for future pts in a similar situation.

 

[Jwan]

It's very easy to say "just control the scene". It's much more difficult to execute. If you've been in this position it becomes a lot clearer just what kind of chaos you're trying to control.
Everyone is scared, and everyone thinks that their single action may save this mans life. It's not as simple as "would everyone please calm down and step back". That doesn't work, especially with the 1:10 ratio he was dealing with. The off duty FF did everything right as far as I can see. Tried to get people out of the way for a moment, asked for more jacks, and tried to calm his patient and prevent movement.
I was off duty and came up on almost the exact same thing, except mine wasn't breathing. I only had 5-6 concerned bystanders trying to help, and one still managed to get out of his sedan with a haligan. When they're not used to it, people get a wee bit silly under stress.

Edit: or what Desert said

Believe it or not I have been in situations like this both overseas and here in the states. People want to help and while I understand it may be difficult simply asserting a leading figure in himself and directing the onlookers can go along way. People naturally follow especially in situations where they are out of the element. Taking hold of the situation isn't always the easiest thing however in this case it could of greatly improved the whole situation.

 

[Jwan]

https://www.psychologytoday.com/blog/naturally-selected/201204/natural-born-followers

@DesertEMT66 @LACoGurneyjockey

 

[DesertMedic66]

Have you never had a scene where bystanders didn't listen to you? Yes there will be people who follow but there will also be people who do not.

I have ran into many people who have the viewpoint "I'm right and everyone else is wrong". So no, being off duty and in uniform is not always going to be enough, some would argue being on duty and in uniform is not enough. Scenes can be hard enough will a full crew of firefighters on scene. This was one off duty FF so of course the odds are going to be enough. Unless he gets more people on scene who are on the same page as him, he is very unlikely to control the scene (let alone this happening on the 91 in SoCal).

The easiest way to control a scene is to get bystanders off of the scene. Good luck getting at least 10 people off the scene and still talking to the patient as a single off duty personnel.

I don't know about you but it is very hard to assess a patient who is prone, in full gear, and under a car. My first task would be getting him out from under the car, which is what was trying to be done.

 

[DesertMedic66]

Incase nobody saw the ABC7 link above the patient was transported with minor injuries only.

 

[Jwan]

The easiest way to control a scene is to get bystanders off of the scene. Good luck getting at least 10 people off the scene and still talking to the patient as a single off duty personnel.

Upon noting the PT was A&O and not noticing any life threatening injuries, turning your attention to the crowd and instructing bystanders to leave the PT be for his and everyones saftey would be the next step, once you got a handle on the crowd you can then turn your attention to the PT and stay with them till help arrives.

I don't know about you but it is very hard to assess a patient who is prone, in full gear, and under a car.

Sure you aren't able to do a full assesment but thats the job of the responding medic. Your assesment should be just looking for changes in mental status, bleeding, and any other noteworthy injuries or symptoms (remember your the off duty person in this one not the responding EMS)

My first task would be getting him out from under the car, which is what was trying to be done.

Your first task as an off duty personell would be to extricate a breathing (somewhat) coherent PT who is showing no signts of hemmorage or other traumatic injury? Rather than wait for backup and the correct equipment for the job?

If anything I wouldn't want to work on extricating a pt trapped under a vehicle being held up by a sole jack where bystanders (even with the best intentions) are pulling on my patient.

I agree @WildlandEMT89 This isn't the type of rescue someone off duty with no equipment should be making on his own or with the help of unqualified bystanders, if the PT was unresponsive, not breathing, or anything suggesting a critical status then my viewpoint would obviously change on this however as a professional (wether it be EMS, FF, or any medical personell) should you be putting yourself, the pt, and the willing helping hands in danger by attempting to rescue this person yourself?

 

[DesertMedic66]

Upon noting the PT was A&O and not noticing any life threatening injuries, turning your attention to the crowd and instructing bystanders to leave the PT be for his and everyones saftey would be the next step, once you got a handle on the crowd you can then turn your attention to the PT and stay with them till help arrives.

Noticing life threatening injuries is next to impossible when someone is in full motorcycle gear with the visor of their helmet down. Blood tends to pool inside of them very well before spilling any out or soaking thru. Trying to talk to someone in full gear, while under a car, on a freeway in SoCal, with a dozen bystanders, while the patient is panicked? Good luck with that.


Sure you aren't able to do a full assesment but thats the job of the responding medic. Your assesment should be just looking for changes in mental status, bleeding, and any other noteworthy injuries or symptoms (remember your the off duty person in this one not the responding EMS)

Refer to above about riding gear.

Your first task as an off duty personell would be to extricate a breathing (somewhat) coherent PT who is showing no signts of hemmorage or other traumatic injury? Rather than wait for backup and the correct equipment for the job?

My first task as an off duty personnel would be to avoid the traffic and get to work on time. What "special equipment" do you plan on responders using? Hydraulic cutters? Not going to cut anything. Hydraulic spreaders? Not going to be very high up on my list to use. Hydraulic rams? Great if I need to roll a dash off a patients leg, not my first choice for lifting a side of a car. Air bags? let me grab an SCBA bottle, cribbing, and then set it all up. Car jack? Perfect. Just get the car lifted enough to slide the patient out (car jacks are not hard to use safely and I'm not planning on spending any time under the car. I'm more concerned about oncoming traffic as a safety hazard.

 

[Jwan]

Noticing life threatening injuries is next to impossible when someone is in full motorcycle gear with the visor of their helmet down. Blood tends to pool inside of them very well before spilling any out or soaking thru. Trying to talk to someone in full gear, while under a car, on a freeway in SoCal, with a dozen bystanders, while the patient is panicked? Good luck with that.

Again I think your missing the point, your not a responder dispatched to the call, you are a bystander, do what you can from where you can leave the rest to those who are currently on the job.

My first task as an off duty personnel would be to avoid the traffic and get to work on time. What "special equipment" do you plan on responders using? Hydraulic cutters? Not going to cut anything. Hydraulic spreaders? Not going to be very high up on my list to use. Hydraulic rams? Great if I need to roll a dash off a patients leg, not my first choice for lifting a side of a car. Air bags? let me grab an SCBA bottle, cribbing, and then set it all up. Car jack? Perfect. Just get the car lifted enough to slide the patient out (car jacks are not hard to use safely and I'm not planning on spending any time under the car. I'm more concerned about oncoming traffic as a safety hazard.

By "special equipment" I simply mean the jacks and any other pertanent equipment used by EMS or FF personell, not some janky one found in someones trunk. If your first task is to get to work on time why previously mention you would pull them out? Again try to keep the distinction between responding to a call and pulling over to help as a bystander.

 

[DesertMedic66]

Again I think your missing the point, your not a responder dispatched to the call, you are a bystander, do what you can from where you can leave the rest to those who are currently on the job.



By "special equipment" I simply mean the jacks and any other pertanent equipment used by EMS or FF personell, not some janky one found in someones trunk. If your first task is to get to work on time why previously mention you would pull them out? Again try to keep the distinction between responding to a call and pulling over to help as a bystander.

my first task may be different from other people's. It may be in this FF's protocols to stop and render aid off duty if he is in uniform.

I was simply making a statement about what can be done by a bystander. What should or shouldn't be done is a value statement and has a lot of factors. I was also making a statement that trying to do any sort of assessment (on or off duty) is going to be extremely difficult on this patient until he is somewhere he can be assessed properly.