# Mvc



## EMT11KDL (Nov 24, 2010)

Your 1 of 2 EMT or Paramedics on an Engine. 

Dispatched to a 2 vehicle accident.  4 patients. Extrication needed.  One vehicle traveling lets say East another Vehicle Traveling North.  One of the vehicles blows a stop sign.  Speed posted 55 mph.  T-Bone Accident.  

Fire Department and PD block of the road to secure the scene for safety and not letting any vehicles through.. you also establish a triage area inside the safety area and put up cones for that area.  

You find 3 kids (under age of 12 lets say for this) and one adult. Kids are green patients.  One with a laceration on leg.  One with laceration to the head from broken glass.  One with minor abrasions, adult is a yellow, complaining of neck and back pain.  Also weakness in extremities.  (Extrication needed to get the patients out).  You are treating the patients and you have other Ambulances en-route to your location.  

After about 5 mins or so you realize, as some of you might have already did, your missing a patient.  A driver from one of the vehicles.  you find the driver about 50 feet away in the crowd of bystanders.  (he also looks like a bystander due to his posture and how he is acting).  

Now the question is... Would you have went looking for the "Driver" or would you have sent someone else to try and find the driver? (remember there is only two of you that are EMS, and you have 4 patients)


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## LAS46 (Nov 25, 2010)

Well since you said there is FD & PD on the scene then I would have sent them after the other driver so that we could continue with the 4 PTs we already have. Once we knew the condition of the other PT we then may have had to split up to treat the other patient as well. In most of todays cities our Firefighters are also EMTs so they could take care of the other Driver PRN depending on the status of each of our PTs.


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## C.T.E.M.R. (Nov 25, 2010)

Have someone else find the PT. treat who we know are there, and then take care of the other Pt.


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## amberdt03 (Nov 25, 2010)

I would have sent a police officer to go find the driver, that way he/she can deal with the fact that they basically "ran" from the scene.


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## gfblanco (Dec 3, 2010)

I would have definitely have asked a PD officer to get the driver and focused on getting the pt I was working with packaged and transported.


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## EMSDude54343 (Mar 11, 2011)

im assuming that none of the others on scene besides you and your partner are medically trained. assuming this i would have sent my partner or myself to look for the other pt with pd or fd assist and have someone from pd or fd assist whoever is left with the 4 pts, because they are stable. 
i would do this in case that upon finding the other pt they are critical and in need of immediate medical attn (immediate airway assistance etc), however, if the 4 pts werent as stable as stated then just send pd or fd to find the other driver.


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## FrostbiteMedic (Mar 11, 2011)

EMSDude54343 said:


> im assuming that none of the others on scene besides you and your partner are medically trained. assuming this i would have sent my partner or myself to look for the other pt with pd or fd assist and have someone from pd or fd assist whoever is left with the 4 pts, because they are stable.
> *i would do this in case that upon finding the other pt they are critical and in need of immediate medical attn (immediate airway assistance etc), however, if the 4 pts werent as stable as stated then just send pd or fd to find the other driver*.


 I don't know how it works everywhere else, but around these parts once we have touched that patient, we can not leave that patient without a _good_ reason (i.e.-the other driver was found by PD/FD/bystander laying in a ditch unconscious and in need of immediate intervention, and the patients that I have are all looking good). Even then, either myself or my partner would go work on that patient while one of us took care of the others until back-up arrived. You always have to ask yourself the following: what if? What if, while we are looking for the driver, one of our "green" patients encounters some medical issue that we did not see? We have extra hands on the scene, so lets use them to find that missing patient....


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## Farmer2DO (Mar 12, 2011)

amberdt03 said:


> I would have sent a police officer to go find the driver, that way he/she can deal with the fact that they basically "ran" from the scene.



Perhaps he didn't "run" from the scene.  Perhaps he was altered.  That changes everything.  

As the first EMS people on scene, you have a responsibility to ALL the patients.  That's one of the fundamentals of triage.  Whether you send someone else to find that driver, or do it yourself, until someone else takes over that task from you, it is your responsibility.  If that ever goes to court, and that driver suffered a negative outcome, the "I was committed to my patient" argument won't stand.  If you're overwhelmed, call for more help.  But the first in unit has a responsibility to identify and triage all the patients.  

*What if, while we are looking for the driver, one of our "green" patients encounters some medical issue that we did not see?*

Actually, the opposite premise is true when performing triage.  You have to know that status of all your patients before you can know who gets transported first or even how many units and what level care you will need.  If someone is stable, move on and evaluate the next patient.

One of the providers needs to step back and take charge, for the sake of the entire scene.


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## EMSDude54343 (Mar 18, 2011)

frostbiteEMT said:


> *I don't know how it works everywhere else, but around these parts once we have touched that patient, we can not leave that patient without a good reason* (i.e.-the other driver was found by PD/FD/bystander laying in a ditch unconscious and in need of immediate intervention, and the patients that I have are all looking good)



That rule goes out the window with MCI's, in order so most effiently establish pt care at an MCI you must first identify ALL pts on scene then work on the most critical pt until further help arrives. The rule you stated is a good rule when there are enough personell on scene, but how do you know whether or not that other pt you havent found is more critical then the one your attending? If you find that you are with a pt and cannot leave, have someone else medically trained continue triage. But if your the first arriving unit your first priority after assuring personal, crew then scene safety is to establish triage. If you dont triage, how are you going know how much more help you will need?


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## EMSDude54343 (Mar 18, 2011)

Farmer2DO said:


> One of the providers needs to step back and take charge, for the sake of the entire scene.



I agree, effective scene management is always best practice!


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## FrostbiteMedic (Mar 19, 2011)

EMSDude54343 said:


> *That rule goes out the window with MCI's, in order so most effiently establish pt care at an MCI you must first identify ALL pts on scene then work on the most critical pt until further help arrives.* The rule you stated is a good rule when there are enough personell on scene, but how do you know whether or not *that other pt you havent found is more critical then the one your attending?* If you find that you are with a pt and cannot leave, have someone else medically trained continue triage. But if your the first arriving unit your first priority after assuring personal, crew then scene safety is to establish triage. *If you dont triage, how are you going know how much more help you will need?*



So I need to abandon the patients that I have here to hunt for another patient who may or may not be anywhere near the scene? What if that other patient has chosen to flee and is long gone? If it is an engine, then I have another firefighter at least with me. I will send someone to look for the other patient, but I am not going to leave the patient(s) that I have to hunt for the other patient myself. If another patient is found, then I will triage them. Till then, these patients are the ones requiring my attention.


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## Chimpie (Mar 19, 2011)

Touching a patient and initiating care are two different things. I would hope your SOPs touch on this.

I agree, however, that you probably don't want to  leave your patients to 'search' for another one.

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## FrostbiteMedic (Mar 19, 2011)

Chimpie said:


> Touching a patient and initiating care are two different things. I would hope your SOPs touch on this.



I realize that, and I did mean the 'touch' part in a more figurative sense. My SOP's don't cover this issue....I think I might need to have a talk with mi directore.....


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## EMSDude54343 (Mar 20, 2011)

in this specific case, like i said in my original post, myself or someone else would search for the remaining driver for triage, and someone would stay with the pts, but if they are all stable, it is safe to leave them for a minute or two to assess the scene. if the pts i was with were not stable then i and my partner would not leave them and pd or someone else would be sent to find the missing person. Assuming that the other driver may have 'fled' the scene is not a safe assumption and can land you in legal trouble should something happen to the 'missing' dirver. what if that other driver had a closed head injury and wasnt alert, wandered off in confusion but collapsed in the ditch and ended up dieing or haveing a serious long term disabilty because no one went to search for them?

But if its only you and your partner on scene and it appears to be an MCI both people should start triage. have you all been trained on S.T.A.R.T. triage? that is where i was taught how to traige. if your agencie does not have any standard triage techique's i would recommend that your agencie ensure everyone is skilled in triage, there are many technique's out there START is jsut the one i prefer and is pretty simple to learn.  

http://www.start-triage.com/START_TRIAGE.htm 

obviously if there are enough personell on scene that someone can stay with the pts already identified and another person to go 'searching'/triage the other parties involved then by all means that is the way to go. one of the first things we were taught in emt school, was when arriving at a possible MCI you have to do a full scene assesment (triage) to ensure you have enough help enroute to assist. even a quick once around would normally suffice. 

im not trying to say anyone did anything wrong while handleing this scenario, just my suggestions. i wasnt there, i didnt see all that was going on, reviewing a case after the fact is always easier than the actual incident itself. like everyone else says, these are just my $.02


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## Farmer2DO (Mar 21, 2011)

EMSDude has it right.

If you have more patients than you have providers, then you need to evaluate the ENTIRE scene for the number of patients and the severity of their injuries.  Unless someone has an immediate threat to life or limb, do a quick evaluation (30 seconds) and move on.  How do you know the person next in line isn't more acute and more in need of your services?  And assuming the person ran from the scene?  As we say in these parts, you might as well staple your card to the PCR.  Just because you make contact with a patient does not mean you are permanently tied to that patient.  Quite the opposite.  As an ALS provider coming into a scene where BLS is already on scene, I am going to expect that triage has been done, and all patients are accounted for.  By someone.  Delegate if you need to, but someone needs to do it, and as a provider of EMS, you need to make sure it gets done, one way or the other.


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