# Firefighter trapped



## Tjfemt911 (Dec 1, 2009)

You get a call to an accident up the freeway. You get there and the car is in tangles. Your medic partner goes to check out the other vehicle and you go to the smashed up car. Once you get there, all you are able to do is reach your hand in to the patient’s neck and feel no pulse. Firefighters immediately rush over to you and tell you that extrication is on its way. They also are frantic and tell you that it's one of their firefighters trapped in the car. 

What would you do (as an EMT-B)??


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## bunkie (Dec 1, 2009)

Is the scene safe? If not, why are you on the scene? 
Can you get to the pt? 
Is there no other way to gain access to the car? How far out is the team?


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## Tjfemt911 (Dec 1, 2009)

bunkie said:


> Is the scene safe? If not, why are you on the scene?
> Can you get to the pt?
> Is there no other way to gain access to the car? How far out is the team?



Yes. The scene is safe. I forgot to mention BSI-Scene safe.
No. The only way you can even touch the patient is getting your arm so slightly in to not find the carotid pulse. 
No. No other way. I wasn't told how far the team is out.

(I had an interview on Tuesday and this was the scenario they gave me.)


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## JPINFV (Dec 1, 2009)

Trapped?

Sorry... can't do much until they extracate him. Unless the extracation takes seconds, it's not going to be a happy ending.


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## bunkie (Dec 1, 2009)

JPINFV said:


> Trapped?
> 
> Sorry... can't do much until they extracate him. Unless the extracation takes seconds, it's not going to be a happy ending.



Exactly. It sucks but it's going to suck no matter who the pt is in that situation. I think they throw the firefighter thing in to see if you are going to treat the patient differently.


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## Luno (Dec 1, 2009)

Any black tape handy?  If you can somehow worm your arm in to attach a 3 lead to confirm asystole, but get the sheet ready.


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## zmedic (Dec 1, 2009)

The answer is if you can pull them guy out with what's on scene you do so and start CPR, if you can't you deal with your other patients and try to ensure the "frantic" firefighters don't do something stupid that will get themselves or someone else killed (like wandering into traffic). 

Also I'd note that if firefighters are on scene, unless it's a volly service responding POV they should have some tools to work with. Maybe not jaws but they should have hand tools, crowbars, etc. Maybe use a jack to make some more space. It'll make them feel better to do something while you are waiting. 

Though in truth, if you are just an EMT, figuring out how to get the patient out of the car is the FDs job, your job is to tell them how sick the guy is and provide what care you can until extraction occurs.


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## redcrossemt (Dec 1, 2009)

Tjfemt911 said:


> You get a call to an accident up the freeway. You get there and the car is in tangles. Your medic partner goes to check out the other vehicle and you go to the smashed up car. Once you get there, all you are able to do is reach your hand in to the patient’s neck and feel no pulse. Firefighters immediately rush over to you and tell you that extrication is on its way. They also are frantic and tell you that it's one of their firefighters trapped in the car.
> 
> What would you do (as an EMT-B)??



Would want to know how long it's going to take to extricate the patient. If it's only a few minutes to get the patient out, our protocols would require basics to work the patient. Paramedics could call it if the ECG shows asystole.

If it's going to be more than a few minutes to get the patient out, and I didn't have a protocol that allowed me to not start resuscitation, I would call medical control and advise them of the patient's condition (pulseless, apneic), extended extrication time, no possibility of doing quality CPR, no availability of ALS, and get permission to not start resuscitation.

Again, you would want to be careful in how you handle the firefighters' coworkers, and make sure that they stay safe. I would request a senior fire officer or chief ASAP, as well as my supervisor.


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