Am I the only one shocked by this LAFD care?

[Jeff2mars]

Hi!
Am I the only one shocked by this injured driver let alone without any firemen around her before she's treated by EMTs ?
I'm so so surprised of such an attitude from a big fire department, whose some firefighters are paramedics on top of that!

In my country (France), EMTs and firefighters are the same people trained for both first aid and firefighting, it may help, but even though it wasn't the case, i'd not understand if firemen let a patient alone like that...
Starts at 00:16

 

[WolfmanHarris]

Care to elaborate on what shocked you, I'm not seeing it. I see a fire crew arriving scene on a moderate severity MVC, conduct a scene size-up and then off camera begin treatment. Despite the youtube title, I don't think that pt was ejected so much as laid down on the ground.

Beyond that I'm really reluctant to judge out of context or at the very least with more patient details or incident history. Only time I've shown up on TV (that I know of) it looks 100% like I'm grabbing the patient's *** since you can't see his handcuffed hands and the hand injury I was assessing.

 

[BobBarker]

Yes, please share what you think what they did incorrectly. It looks like they had one engine there at the time, which is 4 FF/EMT's. Their paramedic resource(ambulance) is still enroute along with their light force(ladder truck, additional engine) due to the nature of this call as a partial ejection. They can't just jump immediately to that patient, they have to size up the scene and make sure the vehicles won't catch on fire anytime soon before treating. It looks like some people subdued a suspect that tried to run from the accident and since LAFD almost always arrives before LAPD to scenes, they have to make sure it's safe as well.

 

[DesertMedic66]

Scene size up. Have to find out what you are dealing with before you focus on one patient. You are not going to see very many US providers running around on the scene of a call.

What I'm more interested in was were they cutting up a sheet to secure her on the backboard? That's a new one I don't think I will be using anytime soon

 

[BobBarker]

Scene size up. Have to find out what you are dealing with before you focus on one patient. You are not going to see very many US providers running around on the scene of a call.

What I'm more interested in was were they cutting up a sheet to secure her on the backboard? That's a new one I don't think I will be using anytime soon

It's whatever sheet or blanket they normally use to cover the patient. They just cut it and then use that to secure them to the backboard. Quite common for LAFD and never heard of a problem. Most of the time, they have it already cut so they can immediately start securing as soon as the backboard is on there but in this video it looks like they were cutting it while the patient was there, which is not ideal.

 

[Jim37F]

First of all, just for clarification, particularly for our international members, yes the Los Angeles City Fire Department (LAFD) is the sole EMS provider within the city limits of Los Angeles. Every LAFD Firefighter is trained at a minimum to the EMT-Basic level, and many are indeed Paramedics. Their Rescue Ambulances are all staffed either dual FF/EMT or dual FF/PM (Members do rotate regularly between the "box" and the suppression apparatus, I believe they strive to staff each engine company and truck company with at least one paramedic when staffing allows).

The video starts after LAFD is on scene. We do not know how long they were on scene prior to the video starting but it does look like they had only arrived seconds earlier and are still assessing the situation.

We first see the patient 0:16 into the video where I am a little perplexed over the one firefighter who walked by her. What we do not know is how she ended up in that position or how long she's been there. Did she truly get partially ejected during the crash and land like that? Was she helped out of the car and assisted to the ground, either by a bystander or maybe even that same firefighter? We simply do not know, there's not enough information in the video to truly pass judgment.

However it does look like he is part of the truck company, and it does look like they just arrived on scene within seconds of the video start, so they're most likely still assessing the scene, such as how many patients are there? How many are in that car, how many in the other? Are any of the bystanders patients? Is there anyone trapped, is there any extrication required? What other hazards need to be mitigated before scene safety is assured? That's the truck company's primary job on a call like this, extrication and hazard mitigation.

What we DO know from the video, after we first see the patient at 0:16, the camera person then immediately walks away towards the back of the taxi cab where we can no longer see the patient and what is or is not being done with her. You can see at 0:40 (25 seconds after our first "patient contact") that the Rescue Ambulance has arrived on scene and is directly in front of her (and when we get a look at which Rescue it is later I can tell you that is an ALS Paramedic Rescue due to its two digit unit number..all the BLS EMT Rescues have an 800 series unit number).

After focusing on the crowd for a bit, in the background, 1 min after pt contact at approx 1:16 we can see the medics assessing the patient. So we have paramedics working on the patient 1 min after we first see her while the truck guys are doing truck tasks, identifying and mitigating any of the many possible hazards a traffic collision scene like this presents.

There appears to be an edit shortly thereafter at 1:22, can't be sure exactly how much time was edited out, though it does appear to be no more than a few seconds. The cameraman then walks back around to where we can see the patient at approx 1:45, barely a min after we first see her, the patient is loaded on the backboard on the gurney with what looks to be at least 5 firefighters directly assessing her injuries, trauma stripping her clothes as part of said assessment and securing her to the board.

We all know that even a simple traffic collision call is far more chaotic and things don't happen the same nice neat way they go down in the vacuum of a classroom. The only thing I can find in the video to truly have any real concern about is the one firefighter walking past the patient in the opening seconds, I would much rather have seen him at least stop and talk to her for a bit, hold c-spine until the Rescue medics arrive, but really, as I said earlier, we don't know what assessment she has had or not had already and there are lots of other important tasks all needing immediate attention all at the same time.....and 1 minute after this one concern, she is actively being assessed and treated and being readied for transport, so yes while we can certainly Monday morning quarterback everything we would have done differently or better, ultimately I am not terribly concerned about this crews performance on this call.

 

[Jim37F]

What I'm more interested in was were they cutting up a sheet to secure her on the backboard? That's a new one I don't think I will be using anytime soon

Yeah, every time I've seen LAFD backboard someone, they've always used cut up sheets tied around the patient as the straps. Always found that a bit weird lol but hey, if it works....

I suppose it does make some sense in that with that method you don't have to worry about fishing out straps that invariably get stuck underneath the board lol but yeah, still a bit wierd lol

 

[EpiEMS]

Yeah, every time I've seen LAFD backboard someone, they've always used cut up sheets tied around the patient as the straps. Always found that a bit weird lol but hey, if it works....

Seems like a deviation from normal practice...I checked to see whether LACo EMS required straps of any particular kinda, but no specific ones were listed. I'm really surprised that they don't specify a particular type or approval. (FWIW I've never seen cut up sheets used anywhere before as straps - the closest I've seen is triangular bandages as "encouragement" restraints.)

 

[Jim37F]

Seems like a deviation from normal practice...I checked to see whether LACo EMS required straps of any particular kinda, but no specific ones were listed. I'm really surprised that they don't specify a particular type or approval. (FWIW I've never seen cut up sheets used anywhere before as straps - the closest I've seen is triangular bandages as "encouragement" restraints.)

I don't think there's any specific requirements from County EMSA on backboard straps, we currently use the nylon straps with buckles (have to make an 'X' over the patients chest), my last job when I was a Glendale AO we used spider straps (which I kinda liked a bit better, never had a problem with the buckles getting stuck under the board lol but they can easily become a big messy velcro ball). My first 911 job before that used the same nylon straps we do know, but they had an extra chest strap (make an X with a line thru it)

 

[EpiEMS]

@Jim37F, those all sound like reasonable options (spider straps, nylon backboard straps), but sheets seem odd, you know what I mean?

 

[akflightmedic]

Looks like a serious case of Status Dramaticus to me....

 

[DrParasite]

I know I am.......

this is how it is supposed to be done

 

[Jim37F]

@Jim37F, those all sound like reasonable options (spider straps, nylon backboard straps), but sheets seem odd, you know what I mean?

haha yeah, def agree, always looks odd when I see them do the sheet thing lol Maybe next time we're both at a hospital together I'll ask

 

[EpiEMS]

haha yeah, def agree, always looks odd when I see them do the sheet thing lol Maybe next time we're both at a hospital together I'll ask

Please do - it seems so odd!

 

[luke_31]

The sheet thing is probably just a cost saving measure as you just throw the sheets out with each patient. Probably cuts down on any damaged, missing, or too badly contaminated straps that would need replacement. I did my internship with LAFD and the sheets worked pretty well for immobilizing patients. Normally they have the sheets already cut and ready to go, but if they got a new stock and were busy they probably didn't have time to prep them in the station.

 

[Tigger]

Couldn't make it through the video...not really thrilling stuff.

 

[cruiseforever]

Removing the pt. from the backboard would have been nice once she was on the stretcher.

 

[Jim37F]

Removing the pt. from the backboard would have been nice once she was on the stretcher.

but..but...but one little movement and she'd be paralyzed for life! Strapping her s-shaped spine to a rigid flat hunk of plastic is the only sure fire way to ensure she cannot move!

 

[VentMonkey]

Eh, I watched about 30 chopped seconds as well before turning it off. Looks like the typical "urban EMS call" I grew not so fond of, and hardly pine for.

Also, am I the only one who finds the thread title an oxymoron?

 

[gonefishing]

but..but...but one little movement and she'd be paralyzed for life! Strapping her s-shaped spine to a rigid flat hunk of plastic is the only sure fire way to ensure she cannot move!

They do this to everyone.

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