# Arrive on scene...



## Alas (Apr 8, 2011)

Arrive on scene to a 4 pt mva mci. Which comes first:
1 Triage
2 Request additional resources.

thanks.


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## bigbaldguy (Apr 8, 2011)

Scene safety


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## Ewok Jerky (Apr 8, 2011)

What about BSI?


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## JPINFV (Apr 8, 2011)

I would argue rapid triage first. After all, what resources are you going to request? Do you need extrication? Are the 4 "patients" patients due to being in an accident or do you have 4 people requesting transport?


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## Alas (Apr 8, 2011)

Bsi Scene Saftey first thanks for the lookout,
but i wanted to know which of the two came first. I also agree with your post JPINFV. thanks for the input.


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## BEorP (Apr 8, 2011)

Alas said:


> Arrive on scene to a 4 pt mva mci. Which comes first:
> 1 Triage
> 2 Request additional resources.
> 
> thanks.



Can't say I really understand the question... addition resources are easily requested while triaging assuming you have a portable radio. If not, hopefully you could have realised there were multiple patients as you pulled up to the scene and you could request additional resources based on that (then update the other crews or modify your request once the patients have been triaged).


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## DesertMedic66 (Apr 8, 2011)

JPINFV said:


> I would argue rapid triage first. After all, what resources are you going to request? Do you need extrication? Are the 4 "patients" patients due to being in an accident or do you have 4 people requesting transport?



Agreed. You might only need just a single ambulance. Or you may need more ambulances. If they are trapped then you need fire. Is HEMS going to be needed? Triage first so you know what you are dealing with and what you will need. In EMT school we were told to "call the world out". I hate getting called out, making it 3/4 the way to the scene, and then cancelled. And have to drive back and right a report on the cancelled call.  (I understand it's part of the job. But since I hate it, I don't want to do it to other people).


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## usafmedic45 (Apr 8, 2011)

> Is HEMS going to be needed?



The answer to that is generally 'no' except for a very small percentage of EMS jurisdictions in the US.


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## GirevikMedic (Apr 8, 2011)

I would be more inclined to list is as:

1) Request resources upon initial scene size up 
2) Triage
3) Re-evaluate resources needed

There's nothing wrong with getting a quick idea of what you're dealing with and requesting what you could possibly need only to cancel what isn't needed en route. It's better than being caught with guard down. JMO


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## Veneficus (Apr 8, 2011)

I would see what I had first.

Unless there was something obvious like bodies or body parts laying all about, I would be hesitant to call out the world.

Even if things look like a catastrophy, usually when a capable emergency person shows up on scene things tend to get better rapidly.

As was mentioned earlier, I agree that the resources you need will depend on what you find, but I would add also what you have to start with.


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## DesertMedic66 (Apr 8, 2011)

usafmedic45 said:


> The answer to that is generally 'no' except for a very small percentage of EMS jurisdictions in the US.



Yeah I know. Its just an option that is out there when considering a scene size up. I've seen HEMS used a couple times in this area and read about it being used 5+ times a month in this area.


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## JPINFV (Apr 8, 2011)

firefite said:


> Yeah I know. Its just an option that is out there when considering a scene size up. I've seen HEMS used a couple times in this area and read about it being used 5+ times a month in this area.



However "used" and "needed" are two different questions.


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## GirevikMedic (Apr 8, 2011)

Veneficus said:


> I would see what I had first.
> 
> Unless there was something obvious like bodies or body parts laying all about, I would be hesitant to call out the world.
> 
> ...



I would agree with this. I think the geography of your area plays a role in this decision as well. In one of the areas I work it's a mix of urban and rural. The population base is almost completely urban while the actual area is mostly rural. As a result, we have designated areas where HEMS is automatically requested by dispatch. If anything we'll request another ground unit based on call info en route. Most times we don't need either but due to our geographics when we do need HEMS and/or a second ground unit, not calling for resources is just asking for the shaft. 

That's the area though.


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## mc400 (Apr 8, 2011)

I am very lucky in my system on our mct's we have pretty good info on most calls regarding approx pt numbers and number of vehicles. We are dispatched based on the 911 info. All engines are ALS and most ladders are as well. All MVA's on a highway/freeway gets BC, Eng and rescue (ambo), rollovers get the same but with a Ladder co. added. Any basic mva gets Engine and Rescue. You give an on scene report, medic gets out and does a rapid triage # of pt's and severity of injuries (Immediate, Delayed, Minor, etc) Then you balance what you need....2n1, 3n1, 1st alarms, etc. Plus ask for number of rescues you need, or you can piece out the balance asking for just ambo's or just manpower for refusals etc. BSI is a given as is scene safety in the real world


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## DesertMedic66 (Apr 8, 2011)

JPINFV said:


> However "used" and "needed" are two different questions.



Once again I know that lol. Our local hospital installed a HEMS landing pad because the police and fire got tired of having to close down the road for HEMS to land. And the airport was right next to my high school so I got to see how often they got called out. Whether they were really needed or no I dont know as I was not on the call.


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## firetender (Apr 8, 2011)

If you're coming up on a scene of an accident with multiple vehicles involved and a telltale sign like no one is walking around in the vicinity than it would be wise to alert dispatch to start backup by another ambulance, non-emergency and then, after triage, you either step it up or cancel. As a last resort, have them send Brown!


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## enjoynz (Apr 8, 2011)

firetender said:


> If you're coming up on a scene of an accident with multiple vehicles involved and a telltale sign like no one is walking around in the vicinity than it would be wise to alert dispatch to start backup by another ambulance, non-emergency and then, after triage, you either step it up or cancel. As a last resort, have them send Brown!



I think the response time for Brown wouldn't be so good. lol.


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## Shishkabob (Apr 8, 2011)

We worked a 3 car mvc on new years with one fatality. Initial reports were 5 vehicles with heavy entrapment.   Two of the vehicles were onlookers.   8 patients, one doa. We were first on. 

We initially asked for hems launch (we're rural) and an additional ambulance before we even got on scene due to PDs report. On scene, we triaged, canceled the helo, and had 5 further ambulances come in. 



Moral? Call what you think you need, when you think you need it, and cancel when you find out you don't.   Granted like I said, we're rural, so we don't have the luxury of having a backup unit minutes away and have to plan ahead.


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## Melclin (Apr 8, 2011)

I don't think you can necessarily say one before the other. Its a dynamic process. But I figure you're probably after a straight answer for some kind of test.

When you arrive, make a windscreen sitrep if you think its necessary, then update the information as you go along. Confirm the location, the type of incident, access and hazards, rough number of people involved. Doesn't have to be an exact number of patients, all the emergency management guys (or whatever your equivalent is) have is dispatch information which is really just the product of a random word generator. They would rather be told that an accident involves say... about 30 people and 10 mins later be told the actual number of patients is 4, because until you've said 30, they don't really know if they need to gear up for 100 patients or 2 patients, so it gives them an extra ten mins to prepare for a situation in which there may be up to 30 patients. 

At 'the big one' our voices on the radio like 10 minutely sitreps as a minimum even if there is nothing more to report, if I remember correctly. 

Do you guys use the ETHANE mnemonic?


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## cruiseforever (Apr 11, 2011)

firefite said:


> Once again I know that lol. Our local hospital installed a HEMS landing pad because the police and fire got tired of having to close down the road for HEMS to land. And the airport was right next to my high school so I got to see how often they got called out. Whether they were really needed or no I dont know as I was not on the call.




Do you go straight to the helicopter or stop in the ER?  Hope you do not have to transport a long distance just to make fire and police happy.


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## boombox (Apr 19, 2011)

i learned this from a lady that has 20+ years in already and hasnt seemed to fall short yet. When you arrived at a 4 pt MVA, expect the worse scenario. i would say at minimum you should have requested other units en route, with ALS if not already there, and a care flight ready on call if available, and a fire engine for lift assist and in case a fire springs up. then triage and asses, consider what you actually need and either turn some back or wait for arrival.   She always says to call what you might need in worse case and turn back what you dont need in the end.


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## abckidsmom (Apr 19, 2011)

In my practice it goes like this:  step out of the ambulance, look around at all the patients, briefly, call for a second truck if needed.  If they're going to be refusing treatment, and there's one that needs immediate transport, I will package the patient, start the refusals, and let the second truck finish them, depending on the ETA of the second ambulance.

Otherwise, I'll get the refusals and transport the patient(s) needing tranport.

And about HEMS:  Call, or do not call.  Do not put them on standby.  Like you, they live on standby.  The only thing that will happen if you put them on standby is that they will check the weather.  You still have a decision to make.  Just make the decision already.  It kills me to hear people put the helicoptor on standby, like that's doing a single thing for the patient.


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