# Screenwriter wants to keep it real



## goldenbram (Oct 19, 2009)

I am writing a screenplay which involves a 2 car crash and EMT transport and maybe you all can help me keep it real.  Here is the scenario:

EMTs arrive half an hour after the collision which took place on a rural area and road and involved two vehicles.  One vehicle is turned on its side and the other has ended up off road.  There are two people involved.  One young girl is up and walking around and complains of blurry vision and pain on her right side.  The other person is a middle aged man, unconscious still in the overturned vehicle.

ETA to nearest hospital is 15 minutes.

My questions:

1. Would fire, police and medic be dispatched to this scene?
2. Who would retrieve the unconscious man from the vehicle.  How long would it take and what would be some precautions to be aware of?
3. The girl - what would she be hooked up to and why.  I am guessing a c-collar and board, but you can tell me more.
4. I want the EMT dialogue to be realistic.  What would the girl overhear them saying to each other.  How would they talk to each other and then how would they talk to the girl?  
5.  Would both patients be transported in the same ride?  I sure hope so for my story...
6.  The unconscious man would be hooked up to what and why.  He will become conscious during the transport.  He then start to seize halway there.  What would be your guess as to why and what would you do to control

Thanks so much everyone.


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## EMSLaw (Oct 19, 2009)

Some of the answers are going to depend on where you are...

Usually the police are first on the scene for a MVC.  They're closer.  But they'd certainly be there, and they'd probably sit that girl down and, depending on their level of training, give her oxygen and bandage any initial wounds.  

Medics would be called to this sort of MVC as well, at least here, because there is a significant MOI for trauma purposes.  In some places, though, only medics answer 911 calls, so... then they'd obviously show up, wouldn't they?  

You're going to need the fire department, too.  It's going to be hard to get the driver out of the overturned car otherwise, short of just grabbing him and yanking him out.  You're also going to want a second ambulance.  An unconscious patient in an overturned vehicle is going to be a priority transport with a mechanism of injury that calls for the nearest trauma center.  Depending on where you are, and the weather, and other considerations, he might be taken out in a medivac chopper.  

Let's assume that the unconscious man was not in an overturned vehicle, but was in a car right-side-up.  Since he's unconscious, we need him supine (on his back) to treat him.  This takes three or four people, and a backboard, to do a rapid extracation.  One secures the head, you put the collar on, then get in the passenger seat, move his legs over, someone shoves a backboard under his butt, you turn him as a unit, put him on the board, put him on the ground, and strap him in.  There's more to it than that, but that's basically the story.  

If he had obvious life-threatening injuries, then he's getting pulled out of the car, because saving his life is more important than c-spine.  

The other driver is getting a backboard as well, and a rapid trauma assessment, and would be heading to the trauma center, probably in her own, personal ambulance, unless for some reason there was no other rig available.  It's going to be hard to care for two seriously injured patients in the back of the same ambulance (though you could do it if you had to).  

I'm sure others will have more insight.


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## zappa26 (Oct 19, 2009)

1)  Yes, police, fire, and EMS would all be dispatched.  Police would probably show up first and start performing basic care.  Fire and EMS would show up later, since this is in a rural area they could be from a VFD and take a while longer to respond.  Fire would be needed to extricate the man from the overturned car and take care of other scene-safety issues.  Police, once relieved of medical care, would begin accident reconstruction and investigation.  EMS would provide medical care and transport.  A helicopter is a possibility, based on how you want to write the screenplay.

2)  Fire would be the ones to extricate the man from the vehicle.  The police may or may not attempt to get to him while he's still in the car, but the firemen would be the one to make sure the car is stable, get in there, immobilize him, and get him out.  I'm not a fireman but I'm guessing it could take anywhere from five to fifteen minutes, depending on how damaged the car is, how serious his condition is, their available resources and tools, etc.  Precautions to be aware of would be the potential for the car tipping over or moving, as well as a potential fuel leak or other hazmat, or the possibility that the airbags could go off if they didn't already deploy.

3)  The girl would very likely be immobilized via standing take down.  The police may already have recognized the need for this and begin holding manual stabilization.  As far as I know, there's not a whole lot any level of EMS can do for blurry vision, and abdominal pain is also a pain to take care of.  She may be hooked up to an IV for pain management depending on the severity of her pain.  A medic's input would be valuable here.

4)  The EMTs on scene would be talking about prioritizing care, going over assessments of each patient, etc.  They may or may not have a personal connection with the Police or Firemen, or they could be the Firemen too.  The girl would be dealt with based on her age/maturity and mental status.

5)  It's very rare for more than one patient to be transported in the same ambulance.  It is possible though, and more likely to happen in a rural area with a lack of resources.  But it's generally advised against to have patients transported together who were riding in different cars, as an argument could occur, as well as the potential for HIPAA violations.  You could resolve this by flying the unconscious man out, or having a second ambulance arrive on scene.

6)  The unconscious man would be also immobilized, and probably hooked up to a heart monitor (EKG), as well as an IV for pain management or other medications.  He could seize because of a brain injury or a seizure disorder.  Another idea is that he could be diabetic, this could explain the differing levels of consciousness, the seizure, and as well it could be the reason for the accident in the first place.  I'm not a medic so I can't tell you which medications would be used to control his seizure, maybe some valium?

Hope this helped, good luck with your writing!


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## firetender (Oct 19, 2009)

*Use it; I get a cut!*



goldenbram said:


> There are two people involved.  One young girl is up and walking around and complains of blurry vision and pain on her right side.  The other person is a middle aged man, unconscious still in the overturned vehicle.



INT. AMBULANCE, NIGHT

The headlights of the truck reveal an overturned car, still steaming but without any fire, and a young girl, scantily clad, holding her right side below the rib cage, walking nearby unsteadily, as if confused. MEDIC, behind the wheel, throws the gearshift lever into park, and looks at the scene for a moment. His partner, ROOKIE, nervously looks at MEDIC, waiting. MEDIC opens his door.

                            MEDIC
            Find out how many.

Medic starts to get out.

                            ROOKIE
            What about Triage? We're supposed to...

The ambulance door slams.

_Take it from there and best of luck!_


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## Onceamedic (Oct 19, 2009)

It is not unusual for me to transport 2 and sometimes 3 injured persons on an MVA.  We have a huge coverage area and are the only transport.  On a scene with greater than 20 minute response time and a high index of suspicion for serious injuries, I will call in a rotor.  Usually I will put the rotor on standby (via dispatch) and wait for first on scene - often law enforcment and/or a volunteer fire department - to provide a status update, when I will make the decision to launch or not.

On calls with 20 minutes or less response time (or if rotors are not available), I am the only way those patients have to get to the hospital.  I run with an EMT partner, so I am the only medic on the scene.  My EMT partner will assist with triage and packaging.  He drives.  I will grab an EMT on the fire department to ride in with me and give me an extra pair of hands in the back of the rig.  

With two patients, especially if they are critical, I will often call for a second medic rig to intercept me, giving me two medics in the back.  It is a dynamic, rapidly evolving situation.  

I don't spend a lot of time talking to a medic partner.  They get a quick status update - like on the lines of
"ambulatory on scene - no loss of consciousness- no complaints of neck/back pain, no vitals yet" or
"roll over, ejected-unconscious on scene, 20 minute extrication - BP dropping fast".  

They know what they are doing.  If I am at the front of the rig and they are at the back, I will toss 'em the gear they need as I am working on my patient.  

An EMT I will direct, requesting things like "strip a line for me" or "get vitals" or "do you have pulses?"  stuff like that.

With patients, if they are conscious, I tell them what I am doing and why - but fast, reassuring them as I go.  Stuff like " I don't think you have a problem with your heart, but I'm going to hook you up just to be sure"  or
"I have to start an IV.  You may need medicines and fluids."  
All the while I am doing an assessment.  In the book, the assessment is stated as SAMPLE - S signs and symptoms, A allergies, M medications, P pertinent past history, L last oral ingestion and E for events.  In the field it is never done this way.  What I will do is say things like "where are you hurting?" "do you take any medications?" "are you allergic to anything?"  and in trauma, the important things are "did you lose consciousness?"  "tell me what happened?"  - to establish their level of consciousness and recall of events.
When I do a secondary trauma assessment, I say things like "I am just going to examine you.  Tell me if anything hurts" as I palpate.  
If I have to cut clothes off, I say things like "I'm sorry, I have to cut your shirt"  If they object I say "I know, it sucks, but I have to make sure you don't have other injuries."

I never tell a patient they will be alright.  If they are stable, I will say "So far you are doing really well for me.  I'm going to take care of you.  We will be at the hospital in about 15 minutes."

If they are serious, I will say "You are seriously injured.  We will do everything we can for you.  So far, you are hanging in there. We'll be at the hospital soon"


As others have stated, what happens to them is highly dependent on where they are injured.  Things are totally different in an urban area vs. rural and in different states.

Good luck.  Please don't inflict another Trauma type piece of crap on us. ^_^


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## mycrofft (Oct 19, 2009)

*Write your characters, that will dictate what they say.*

Youngsters past porbie status will be brusque and abrupt, probies might apologize for everything, and the longer they are at it they will either be relaxed and personable, or do whatever it takes to get it done with the least friction in the least amount of time so they can "7".


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## goldenbram (Oct 19, 2009)

*Thanks everyone*

Your responses are very helpful and I will certainly use them as a jumping off point. 

Feel free to keep it coming.  I particularly like the examples of dialogue that you might hear on this type of scene.  I would also imagine there is some humor used not only with the patients but also with each other.

Ilike to hear the abbrevations and shorthand used - just let me know what that is as well.

Thanks so much.  I really appreciate you.B)


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