# Single Green Car looking for Lonely Telephone Pole



## JAM-EMT (Apr 24, 2008)

It is around 3 pm, school is letting out and you get called to the scene of a single car accident. High speed impact on two telephone poles. Front is compacted by first impact. Backseats and trunk are ripped apart by second impact. Car is sitting horizontal blocking the road. Two pts, male 16 y/o driver, female 15 y/o passenger. Country road about a mile from the high school. Small amount of traffic, mostly students and buses. Telephone pole #2 is on fire, gas tank is exploded, but not on fire. A passer-by and first responder who passed the scene are stopped. Fire, Police, Highway Patrol, Electric Company are on the way.

What do you do?


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## Chimpie (Apr 24, 2008)

So there car is not on fire.  Is pole #2 jeapordizing the scene?

If not, check the two vehicle occupants.


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## JAM-EMT (Apr 24, 2008)

The car isn't on fire, Pole two was about 20 feet from the car, after this part I don't remember too much. I'm just wondering what happened after this point seeing that the next thing i remember is being in the hospital. It happened about three years ago.


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## Jon (Apr 24, 2008)

It depends - if wires are on the car... I've got to wait until PECO shuts them down (unless the local FD has a hot-stick).

Next step in "scene safety" is to ensure that there is fire protection (because of the fire onscene)... so a charged handline or a FF with an extinguisher who is watching the car.

Once I can gain entry... rapid assessment. Due to the hazards involved (gasoline+fire) rapid extrication - probably after FD pops doors and removes roof, stabilization in rig, then aeromedical flight to TC. Same for both occupants.


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## AJemt (Apr 24, 2008)

1st is safety - park the ambo in such a way as to block the scene from traffic as much as possible but still in a safe place so as not to jeapordize MY safety.  4Ps of safety - Personal, Partner, Public, Patient (yes pt is last)  first make sure you and then your partner are safe, then make sure no one else will be hurt or in danger, then deal with the pt or pts.
are wires down or is the pole posing a safety hazard? if wires are down on top of hte care nothgin can be done until the electricity is shut off.  if they are down but off on the side post a couple of jr ffs or police officers and tell them to take out anyone who tries to go past (similar to a tail blade person with a chopper on a hot load/offload).  get a ff on the front of the car with a can or charged line for fire suppression - request a second ambo and depending on pt severity/distance to hospital/extrication time request a chopper for one or both pts.    while checking scene safety look around the car for other damage - ex windshield damage indicative of a head hitting, bent steering wheel, bent gas pedal, airbags deployed? if not be careful - they hurt!    don't forget fire police/police to shut down the roadway.  any witnesses who can tell you what happened (IE was the car swerving first and the driver waving his hands around - possibly allergic to bees and had a bee in the car and was swatting at it - you may have a medical problem on your hands in addition to the trauma).
get ff to stabilize car (chock blocks, whatever) and pop doors/remove whatever necessary to access pts.  c-spine, collar, rapid extrication to LBB & litter, secure to board & litter.  while taking c-spine/collar also do rapid assessment - ABCs, major injuries, L/S high and wet while strapping to board.  START triage to determine which pt goes first.  if chopper than send most severe pt first; if transporting a pt by ground L&S with ALS.  BLS RX includes vitals every 3-5 minutes, high flow O2, full assessment, re-assessments every 3-5, pupils check, LOC assessment, and notify the hospital/MC.  get a FF to look for purse/id in the car if there's a chance, if not don't worry about it you can get it later.  don't forget you will prly have to cut clothes in the rig to check for hidden injuries.....
if blood glucose checks are BLS for you than don't forget that - otherwise the medic will take care of it (IV, monitor, BGL, etc.).
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how far apart are the two poles? estimate of speed?
also how badly is the pole on fire....is it possible for your partner to take your little can and knock it down while you begin pt assessment?


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