# You're apart of the MVA!



## mikie (Aug 25, 2008)

Your enroute to the hospital, lights & sirens (since everyone has a different name for it, I'll leave that simple)....

You have a full arrest patient.  Suddenly... You're hit by another vehicle who didn't care to yield at a busy intersection.  Pretty significant damage to their vehicle, not so much to the big rig.  Driver might have injuries, hard to tell from initial size-up.  

What do you do?  Stop and get out?  Keep rolling?


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## NJN (Aug 25, 2008)

Working an arrest, notify PD, keep rolling, maybe leave a basic there with the medic's flycar to attend to see whats up.

I had an experience where we were transporting a diff. breather and we rolled up on a MVC. One of our basics stayed at the scene with the medic's flycar to make sure of no injuries while we continued to the hospital with the two medics.


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## KEVD18 (Aug 25, 2008)

have the driver call it in and keep going. you cant save them all.

now of your were working a half arrest, it would be a totally different story.....


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## VentMedic (Aug 25, 2008)

You still have to think of what damage that might have been done to your vehicle even though it may not be readily visible especially if the other car did sustain considerable damage. If you are driving a vehicle that might in any way be damaged, you are further jeopardizing eveyone in your truck as well as other people in cars on the street. I would consider that truck dead and call for a backup unit. If you are already working the code and with questionable effectiveness while running L&S, depending on how well the people in the back were able to maintain their balance, the survival rate of the patient is very small. What you are doing will be essentially the same as what a hospital ED will be doing. 

Have the person driving your truck call in the accident and request however many trucks it will take to get the patient in your truck and for the others in the other vehicle to the hospital . 

It would not be wise to leave the scene if there are other people injured. It also might not be that wise to leave only one person at scene depending on the neighborhood and other potential hazards.  

Safety first. Protect the living which disqualifies the patient in the back of your truck.


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## ffemt8978 (Aug 25, 2008)

KEVD18 said:


> have the driver call it in and keep going. you cant save them all.
> 
> now of your were working a half arrest, it would be a totally different story.....



Considering you were involved in the MVC, as described in the initial post, you're required to stop and remain on scene.  Anything else is considered leaving the scene of an accident and you could be charged for that.

I would remain on scene, call it in, and request another rig (or two) to respond.  Since you've just been involved in an accident, there is a high probability that somebody on the EMS crew is injured, in addition to the driver/occupants of the other vehicle.


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## KEVD18 (Aug 25, 2008)

i have to say i didnt full read the original post. i wasnt actually aware the ambulance was involved in the mva until ff corrected me. my bad.

that being said, depending on the status of the patient in the back, my answer might not change.

picture this: 2 vehicle mva(ambulance and passanger car occupied x1). your partner is commited to the patient in the back of the rig. you begin to asses the driver of the other car and immediatley realize they need spinal precautions. once you apply that collar, you're commited to manual traction until properly secured. so now you cant do anything else. you cant even take your hand off to talk into your radio.

so that is just one patient. what if that vehicle was occupied x7?


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## Jon (Aug 25, 2008)

Well... state law says I can't leave the scene of an MVA without at least exchanging info... I think it further requires that if there are injuries, all parties remain until released by PD.

So I call for more ambulances:
1 for our patient so everyone can keep flogging the dead guy until we walk into the ED and they call the code.
At least 1 additional for injuries to the other driver, as well as my crew. Probably with a fire response as well... and my boss/chief/supervisor.

Some additional thoughts:
Cardiac arrest isn't an excuse to drive like a moron... especially when you are transporting to the ED. If the patient has been in arrest with EMS for 20+ minutes, plus being down prior to EMS arrivial.... they are dead. D.E.A.D. DEAD. Survivial to hospital discharge in that case is rediculously unlikely.

Further... running emergently doesn't let you blow traffic lights in many places. PA law says that an ambulance must stop at every stop sign and red light... and only proceed when other drivers yield the right-of-way.



PS... my laptop is OOS... and I can't use Firefox on the squad computer... so I don't have spellcheck - sorry!


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## traumateam1 (Aug 31, 2008)

I actually have a few mixed feelings about this.. having never been in this situation I'm not 100% sure of what I would do. However this is how I feel... IF you have 2 medics in the back (paramedic and basic) than you could leave the basic there with some supplies and keep going.. however that's never the case here it's a 2 person medic team and if additional hands are needed than you bring a firefighter. So lets see the cardiac patient is technically and clinically dead.. however that doesn't mean that you don't really mean that he should get a higher priority than the MVC patients. In fact, according to triage protocols, cardiac arrest patients hve the lowest priority. Now seeing that you are already working on the cardiac patient that doesn't mean you can abandon him for others. Okay so I'm rambling now... What I would do is call for 2 more cars code 3 (lights and sirens), fire/rescue, and police. Get my partner to keep working the code, and go and assess the patient(s) in the vehicle. Tell everyone to not move and keep their heads/necks still. Assess for any major bleeds. Ya know the ABC's. Your partner can do the one man CPR situation for a few minutes while you help the people in the car.
So after all that rambling that is what I would do:
Call for assistance, let my partner do 1 man CPR protocols for a few while we wait for assistance, initiage triage protocols and triage the people in the vehicle.
Well, that's what I would do, sitting here in my nice comfy couch.. I wont know exactly what I would do until I am faced with the situation.. but I figure it would go something like posted right above.


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## ffemt8978 (Aug 31, 2008)

And the moment the rig leaves the scene of the accident, you've opened yourself up to criminal and civil liability.  Not to mention you've made it almost impossible for any investigation to clear you of any wrong doing.

If you're working a cardiac arrest when this happens, take this into consideration.  The patient you were transporting is a corpse.  You've got several new patients, including your crew, that need you more.  It now becomes a triage situation, and you save who you can.


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## MMiz (Aug 31, 2008)

I'm fairly certain we covered this topic either in EMS class or Continuing Education.

My response:

Driver immediately calls it in via radio, requests additional transporting unit for code in back and and then dials 911 to report the accident.  _I've found that calling it in often guarantees a faster response time if our agency isn't dispatching the area.  _I'd pull off to the side of the road if possible, activate my lights, and check the condition of my patient and partner in back.

Our service states that once I make visual contact with a patient, I am assessing them, so either I get a refusal or transport.  I'd then approach the other vehicle and check their status.  Unfortunately once I do that, I'm stuck with the patient until I get a refusal or can transport.

I then notify my dispatch on the situation, and wait until additional units arrive to transport my patient, take over the other scene, or transport multiple patients.

Not to be a cynic, but there isn't much a BLS unit is going to achieve by getting a patient in cardiac arrest to the hospital five minutes faster.  Lets look at the timeline:
0:00 - Patient experiencing pain in chest
0:30 - Patient or family calls 911 with information
1:00 - Unit dispatched
5:00 - Unit arrival (under the best of circumstances)
6:00 - First contact with patient (you're fast)
7:00 - First intervention
17:00 - Loaded into rig and start transporting (you have one of those power cots)

Really, is waiting another five or so minutes for another unit going to make things that much worse?  Once you create another scene, it's your responsibility to deal with it or hand it off to the same or higher level of care.


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## marineman (Sep 9, 2008)

In WI we are required to remain on scene with the accident. However my local protocols say the only way we transport a PNB with lights and sirens is if they have a shockable rhythm so all hope is not necessarily lost for the cardiac patient. Call for 2 additional rigs, 1 for the cardiac patient and one for the patient in the other car and call a tow for our rig until it's cleared for service by a qualified mechanic.


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## imurphy (Sep 11, 2008)

If you're involved in an accident it usually goes like this:

Stop. Get backup units. Tell your supervisor. Leave the state, before supervisor shows up and save him a murder charge


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## mycrofft (Sep 11, 2008)

*imurph, great!*

1. Do not leave anyone behind ever. After an MVA you might be subject to assault and/or robbery, and maybe there without equipment or a ride home. Bummer.
2. If spinal precautions are probably needed, don't do anything until you have completed triage of the scene. What does a first aider do until the squad arrives? Keep the victim still (unless airway is threatened).
3. Becoming my favorite subject, are we in rural Wisconsin during a snowstorm, or across the street from Cedars of Sinai Medical Center, or 12th and Vermont in SoCentral L.A.?  If backup is going to be rapid, dont' start a one man "mass cas".
4. But do stop.

Speaking of "one man mass cas", I wonder what the legal civil and professional take is on when triage overtakes the standard duty to act, and when disaster triage overtakes regular triage? (If it's Watts at 2 AM Saturday, it's battlefield triage, MIDE, and use the minimals for perimeter defense).


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## knxemt1983 (Oct 3, 2008)

mikie333 said:


> Your enroute to the hospital, lights & sirens (since everyone has a different name for it, I'll leave that simple)....
> 
> You have a full arrest patient.  Suddenly... You're hit by another vehicle who didn't care to yield at a busy intersection.  Pretty significant damage to their vehicle, not so much to the big rig.  Driver might have injuries, hard to tell from initial size-up.
> 
> What do you do?  Stop and get out?  Keep rolling?



in Tennessee you can keep going if you are loaded, and running hot, but you have to immediately notify dispatch, then inspect as best you can, and let the other party know why you are leaving, then drop off the pt and go back for paperwork. if there is any question about vehicle integrity then you stay put and call another truck to continue transport. 

this happened to me once, only it was a minor fender bender, rear end. I radioed it in, started another truck and fire engine, gave them a card with the companies contact info, our names and medic number, then continued and went back after the call. all in all it only took about 30 seconds to a minute to get it all done and get back on the road. The officer said that was the right thing to do.


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## Meaganbutterflyemt (Oct 12, 2008)

I would say that have someone call it in. I mean there are more then one fire/rescue/ems department in that area I hope. If you stop that patient you have in the ambulance is going to have that risk of dying.


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## ffemt8978 (Oct 12, 2008)

Meaganbutterflyemt said:


> I would say that have someone call it in. I mean there are more then one fire/rescue/ems department in that area I hope. If you stop that patient you have in the ambulance is going to have that risk of dying.



If you're working them as a code, they're already dead.

Just because you're driving code 3 does not mean that you are free or exempt from all traffic laws.  If you reread the original scenario, you're struck by a vehicle that "who didn't care to yield at a busy intersection".  What this tells me is that the other vehicle had the right of way except that you were running lights and sirens.  Since every law about driving with lights and sirens states (in one way or another) that you must exercise due care and regard for others while driving in emergency mode, the law is going to assume that it is your fault for causing the accident.

You also have a legal responsibility to stop and remain at the scene of the accident.  If you leave the scene, here are some things that could, probably would, and definitely should happen to you:
1) Lose your driver's license 
2) Face criminal charges for leaving the scene
3) Civil liability - prepare to hand over ALL of your personal property
4) Agency liability - they're going to be cutting a big fat check, and their insurance will be looking for somebody to pay the bill
5) Loss of EMT cert - You may or may not (depending upon your state) have a legal requirement to stop and render aid, aka Duty to Act.  Your state Dept. of Health would probably take a dim view of this incident if you left the scene, regardless of whether or not you had a duty to act, because you still broke the law by leaving the scene.
6) Increased insurance premiums for your personal auto insurance.


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## gillysaurus (Oct 12, 2008)

In my state it's illegal for an ambulance to leave the scene of an MVA it's a part of. Running emergent or not, with a patient or not, at fault or not, the EMTs have to call another ambulance (or two) to take over what they were doing until everything with the accident gets sorted out. If they were in an MVA and just drove away, they could be charged with abandoning the scene of an accident and fired from the company. That goes for every EMT on board, not just the driver.

Also, what kind of image does it send about EMS if an ambulance is in an accident and the just drives away? It looks *incredibly* irresponsible when Joe Normal does it, so what does it say when the people who are *supposed* to be saving you don't bat an eyelash because they're "too busy"? Would you trust that EMS company after you saw that, as a layperson? I know I wouldn't.


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## mbcwgrl (Oct 12, 2008)

If you only stop briefly and then leave.... THAT IS HIT AND RUN. In Colorado you can kiss your certs good bye because it is a FELONY!!!! If I were in that horrible situation, I would definately stop check for other injuries immediately call for another ambulance and Police emergent even if there are no other injuries. Where I work there are tons of cops around all of the time and the city isnt really all that big (tons of people in a very small area). As soon as 1 police officer arrived I would continue to transport while throwing my business card out the window at the cop and yelling where I am transporting the patien to ..... In all reality, every situation is different and it is very easy to say what I WOULD do, but it could be very different in real time!


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