# Thoughts on this one.



## klauss (Apr 7, 2008)

This is based on actual events that I witnessed from a few feet away( just as a bystander)  many years ago.

A 10 year old child is sitting on his bike at the end of a drive way. Older sister turns into the driveway and hits said child, panics and hits the gas instead of brake. This results in the child and bike being drug under the car until it hits the wall of the garage and stops. Child is tangled in the bike while partially under the car screaming in pain.

Nearest hospital is 25 minute ground trip not sure for air.
How do you respond?


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## AJemt (Apr 7, 2008)

&quot;A 10 year old child is sitting on his bike at the end of a drive way. Older sister turns into the driveway and hits said child, panics and hits the gas instead of brake. This results in the child and bike being drug under the car until it hits the wall of the garage and stops. Child is tangled in the bike while partially under the car screaming in pain.

Nearest hospital is 25 minute ground trip not sure for air.
How do you respond? &quot;

well i would hope FC was also dispatched with me (for extrication purposes and stabilization of vehicle) as well as either i am on an ALS transporting unit or i have ALS with me (squad or whatever).  first is the child still under the car?  also was he run over or just dragged?  is he between the two sets of tires *front/back* or partially underneath a tire?  i'd want a second transporting unit on standby (why did the sister turn into the driveway if the kid was there?  didn't she look?  is she drunk? on drugs? low blood sugar or other medical issue?  is she injured?), and depending on what i find on initial assessment, i would most likely put a chopper in the air.  that being said, treatment is basic trauma protocol.  extricate with spinal immobilization, board and collar pt, monitor airway, vital signs, treat major injuries first (airway) and if no chopper or too far away transport emergent rate, care for all other injuries enroute (broken arm, etc.)  probably gonna be an als pt so IV, cardiac monitor, etc.  notify the hospital of what you have and any issues, and get the kid to the trauma room/ED.


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## Ops Paramedic (Apr 10, 2008)

Answering your question you posted:  "With great calmness..."

Firstly, as the kid is screaming, he has a very intact airway, and for the time being there is good oxygenation to the lungs.  My next step would be to call for help, i.e. someone who is not in a state of panic, to assist you, possibly with contacting/activating the EMS in the correct fashion.

If the people know that you have some form of trainig, you will look to you for help, so stay calm and follow your treatment regime: Triage, (Between the kid and sister, although i would guess the kid is worse off) SABC etc..  Don't forget to try and make/be a friend for the kid, ou will get a lot further!

Good luck with your studies.


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## BossyCow (Apr 10, 2008)

AJemt;74924
transporting unit on standby (why did the sister turn into the driveway if the kid was there?  didn't she look?  is she drunk? on drugs? low blood sugar or other medical issue?  is she injured[/QUOTE said:
			
		

> She's a female teen driver.. doesn't need to be drunk or on drugs!  Personally, with a kid under a car, I'm not going to spend any time thinking about the driver of the car until I determine how injured her brother is. If there's extra personnel on scene, I would have them take care of her. LEO should be called.
> 
> Where is the kid in relation to his parts and the car parts? Was he just dragged or was he hit/run over? Besides trauma, you have to look for burns from the exhaust. Screaming is good!  is he bleeding? What are the visible injuries and how close can you get to him?


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## Jon (Apr 10, 2008)

I'm treating this as If I'm a bystander, and I'm in MY neighborhood, and it is MY neighbor.... which makes my getting involved a little different than if it were someone I'd never met... but let's not get into the "bystanders should just stand back" discussion!

My first step is to secure the vehicle... that means that I probably get the vehicle into park and get the girl OUT of the drivers seat... if I can chock the wheels with something handy (like a big rock) that wouldn't be a bad idea. I'd probably even do this before or during my call to 911... because the last thing I need is an inexperienced teenage driver trying to "back up and make it better".

So.. the next step is to get 911 on the phone, and get the calvary coming... I'd identify myself to the call taker as an off-duty EMT... and make it VERY clear that I needed FD, probably a 2nd rescue, ALS, BLS, and aeromedical on standby. 

Of course, now I've got the sister running around and screaming... which isn't helping matters... she needs to either shut up or go away... but the PD should be onscene in about 4 minutes, so that would be THEIR first job.

Depending on the kid's position, the vehicle needs to be lifted. Many of the driveways in my neighborhood have a slight uphill slope, so that will make things more complicated. If the kid is under the vehicle, FD will have to lift the car with airbags, high-lift jacks, or a combination thereof... after they stabilize the car VERY well.

If I can access the kid's head, I'm going to take manual C-spine stabilization and start TALKING to him, try to calm him down a little, and work on a primary assessment by talking with him, and trying to figure out what hurts.

If this happens during the day on a weekday, the VFD will be short-staffed and there won't be a bazillion people onscene looking for something to do, so I'll likely end up involved in the assessment and packaging of the patient. If it is weekend or in the evening, the vollies will show up in force, so I'll be out of the picture and talking with the PD about what I witnessed.


Assuming I'm still around the patient, once the vehicle isn't preventing their movement, stabilize the patient as best as possible and get the patient out from under the car. Once the pt. is out from under the car, then we do a head to toe assessment for major life threats (severe bleeding, etc) then we have to get the bike and Pt. seperated. If we can do that without cutting the bike, it will probably take less time..but we've got a full set of hurst tools... so if we want to cut the aluminum tubes of the bike,  that isn't a problem. While we are doing this, we need to work on the airway... if it is still patent, he gets O2... if it isn't, he gets an adjunct or intubated.

Once we get the Pt. and bike disentangled, we need to get the Pt. fully immobilized to a LSB or Pedi-immobilizer and splint what fractures we can... then run to the LZ or TC.  

Given that I am a primary EMT with the local FD, but I'm not active because of volunteer politics, I would probably be pushed out of the way as soon as possible... of course, because I'm a member and primary, I might end up riding it in... depends on lots of interpersonal interactions on the scene and who is (and isn't) around.... I _love _volunteer FD's.


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## certguy (Apr 11, 2008)

Jon , 
  Good job . I'd probably do pretty much the same thing . If the car was lifted by the bike , I'd improvise some cribbing to help additionally stabilize the car .  Several years ago we had a similar call here in the valley . The dad worked for a local tree service and was backing his truck and didn't see his 2 y/o son behind him . Mom saw this happening and tried to grab the boy , resulting in both of them getting run over ( and I think trapped under the vehicle ) The child died and  the mom suffered major injuries . Medics and FD did a great job under the circumstances . The community came together to help the family .


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