Ambulance accident

certguy

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It's a relatively slow summer weekend shift and you're on your way to your residence to pick up an extra uniform after a pretty knarly GI bleed call . You're two blocks from home , waiting to make a right on red , when your partner notices a couple friends who work for a competitor company approaching in thier POV's . ( they just got off work from thier station about a half mile away , they're also boyfriend - girlfriend ) The girl's in the lead , smiles , waves , and pulls directly in front of a station wagon going approx. 50 mph through the intersection . Her car is t - boned and does 3 rolls before impacting your modular rig just behind your door . You and your partner are both stunned and can't tell if you're hurt yet . Your friend is screaming in the upside down car . There's no noise initially from the other car but then you hear children screaming and you can see 2 adults in the front seats , not moving . The boyfriend is already running through traffic screaming his partner's name while running past the station wagon .

To quote a line from the movie Speed ; POP QUIZ HOTSHOT ! WHAT DO YOU DO ?

This scenerio is based on an actual incident .
 

Sapphyre

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Hmmm,
Step 1, call it in.
Beyond that, not sure yet
 

enjoynz

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Ditto, to the first two threads!
Plus Safety First! Once that is sorted, grap the Resus (Jump) Bag and head for the Patients (the parents of the car with the kids in it) that are not moving first!

Cheers Enjoynz
 

Grady_emt

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7256 Radio, we have been involved in a 41 (MVC) at Maple and Elm, our crew is OK, three vehicles involved - one overturned, out checking:" This for us would automatically start Fire, PD, a supervisor as well as two additional GEMS units.

I suppose we are lucky to have many units inservice at all times:
1) If we witness an accident we call it in, and then start assessment so long as we are not transporting a critical pt.

2) If there are no injuries, we are to go back to our unit and "zip-it" until PD or a supervisor arrives to avoid conflits with bystanders/others involved.
 
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certguy

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HAPPY EASTER EVERYBODY , sorry I didn't update yesterday but there was a lot going on family wise . Here we go ;

You regain your composure enough to call it in , requesting a full rescue response and air in the process , then realise with a shock , that your partner and the boyfriend ( both excellent EMT's under normal circumstances ) are trying to right the car with her in it . You yell for them to knock it off and get thier heads in the game . Thier panic stops and the training kicks in . PD is arriving in force already and is setting up traffic control . You run to the station wagon and find both parents unconscious , driver is pinned in by the steering wheel , and 1 infant and 2 toddlers in car seats in the back , all conscious , crying , with apparent small lacs from flying debris , but no major bleeds . That's all for now , gotta get ready for church .
 
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certguy

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Also , the friend in the rollover vehicle is conscious , c/o neck , back , left shoulder , and left rib pain . She is hanging upside down from her seatbelt .
 

Sapphyre

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Collar the friend. Allow either your partner, or the boyfriend to stay to keep her calm. The unconscious parents, ABCs ok? Is it possible to get the kids out, carseat and all? (hmmm, maybe I'm off base here)
 
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certguy

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Fire arrives on scene as well as two additional ALS and 2 bls units , 1 engine assists extricating your friend and the balance of the response is invloved with the remaining extrications and setting up an LZ for air . Your triage is ; 2 red tags , 1 still pinned in , 1 yellow tag , 3 green tags ( peds ) . This doesn't count you and your partner , still involved in pt. care .


Good thinking about the car seats . Add a little padding , and they're like an improvised kiddie KED .

Vitals on red tag passenger ;
pt. still unconscious/unresponsive
b/p 90/60
pulse 136
resp. 34 shallow
skins pale , cool , diaphoretic
pupils PEARL
lungs clear bilat.

on assessment , you find multiple lacs , none appear serious , seat belt bruising is evident across chest and abd. Abd is rigid to palpation . Priapism is present ( this is a male ) . Deformity noted in right tib/fib area and right humerous . 6 - 8 inch space intrusion from dash board noted .


All 3 green tags vitals wnl , only apparent injuries are the lacs mentioned earlier . Extrication still in progress on the other red and yellow tags . More to follow .
 
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certguy

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Reaper and Airway junkie have a good point . Start triage with yourself . This scenerio is based on an actual accident involving me and my partner . The pts. in the station wagon were changed to make it more challenging . The rest is the real deal . I think I probably did my best deer in the headlight imitation watching that car rolling at us . It happened too fast to get out of the way and your mind refuses to believe what you're seeing . 2 major points ;

1 . In a situation like this , it's easy to get caught up in the adrenaline rush and pt. care and forget that you're a pt. too .

2. Given the right circumstances , if the pt. is a family member or close friend , even the best of us can panic and vapor lock on our skills memory .

How do we combat this ? Mentally step back , take a deep breath , and think before you act . No action without a plan first . Though my partner and I both AMA'd , we were both sore for several days afterward and probably should've been evaluated in the ER . DON'T TRY TO JOHN WAYNE YOUR WAY THROUGH A SITUATION LIKE THIS , GET TREATED AS NEEDED .


Back to the scenerio , both trapped pts. have now been extricated . Here's the info ;

Red tag

22 y/o female , restrained driver pinned in by dashboard and steering wheel intrusion . Steering wheel was bent and had to be removed by fire to extricate . 8 - 10 inch dashboard space intrusion . Dashboard was resting on her knees .

pt. unconscious / unresponsive .
b/p 86/p
pulse 140
resp. 38 shallow , labored
skins pale , cool diaphoretic
pupils sluggish
diminished lung sounds right side , left clear

on trauma assessment , you find a large lac. on the right lower jaw , a symetrical chest movement on the right side . Tracheal deviation noted to the left , bilateral deformity midshaft femur , and open wounds on both knees .


Yellow tag

21 y/o female
conscious , a&o x 4 denies LOC
b/p 148/86
pulse 100
resp. 28 shallow , non labored
skins pink warm , moist
lung clear bilat.
eyes PEARL

On trauma assessment , pt. c/o neck and back pain , 10 on 1 - 10 scale , neuros intact but unable to grip with right hand . Deformity noted right shoulder . distal pulse present . hand is numb and cool to touch . pt. c/o pain to right rib area . apparent seat belt bruising noted . Pt . has multiple small lacerations on her upper torso . 1 1/2 foot space intrusion noted on right side of vehicle , which rolled 3 times per witnesses before striking an ambulance . Pt. was hanging upside down for several minutes by her seatbelt .

There's your info , you're good to go except for trying to get the 2 EMT's involved to stop long enough to get checked out . Aside from needing a uniform change ( code brown ) they appear okay at this time .
 

wolfwyndd

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Wow. I'm three days late on this one so lemme back up a couple of steps. If this happened to ME in one of our rigs I'd have to treat this as a mass casualty incident considering we only have TWO ambulances. Which would, make me the incident commander until further notice.

Noting that I'd see if I can flip on my own rig lights to see if they work, if they do, great, it'll help mark the scene until PD / Fire / someone else takes traffic control. Step two, call it in to dispatch request Fire, PD, our other ambulance and it looks like we initially have 9 patients. That would require Pleasant Hill's ONE ambulance, Tipp City's THREE ambulances, and Union's THREE ambulances. Partner, you get to be EMS Scene Command until further notice.
 
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certguy

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Wolfwynd , good thinking about the lights . That's exactly what I did along with initial triage and scene safety .


The golden hour's ticking guys , isn't anyone going to treat these pts ?


What do you suspect the injuries are on the male red tag ?

On the female red tag , seeing bilateral femur fx. what else would you suspect related to these injuries ?

On the female yellow tag , what level of care would you want to send her to ?

Though the peds appear to only have minor lacs. , what would your other concerns with them ?

How does MOI figure into your care on all of these pts. ?
 

wolfwyndd

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Well, the red tag guy you mentioned earlier said seat belt signs and priapism. So I'm gonna guess possible internal bleeding into the abdomen, right leg tig / fib fractures AND spinal cord injury. I wouldn't place any bets on this guy surviving for very long. If I remember from my classes / refresher courses, priapism is a very serious indication that this guys pretty toasted.
 
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certguy

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Wolfwyndd ,

Priapism's an indicator of a possible pelvic fx . Given what you see on assessment and the v/s , how would you treat this guy ?

What about the others ?
 

Jon

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Wolfwyndd ,

Priapism's an indicator of a possible pelvic fx . Given what you see on assessment and the v/s , how would you treat this guy ?

What about the others ?
Pelvic fracture? I thought priapism was a sign of a head injury.
 
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certguy

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Hi Jon ,

I looked it up just to be sure , and by Emergency care of the sick and injured , nineth edition , they sure don't say much , just that " certain spinal injuries and some diseases can cause a painful erection called priapism . " I may be wrong , but I also remember it being taught as a possible indicator of pelvic fx. Can anyone shed some light on this ? Calling Rid !!!!
 
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certguy

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Okay Jon ,

I found it . I wanted to make sure I was putting out good info soooooo , According to www.emedicine.com , in an article last updated june 2006 , priapism can be caused by pelvic trauma , which is what I've been taught for years .
 

Grady_emt

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How many Whirley-Birds are enroute??? What is the transport time to Highest Level trauma center available by ground? Combined to-scene, on-scene, transport times by bird? How long was the extrication?

If its gonna take the bird longer than ground, first due ALS unit will PUHA (Pick-Up-Haul-A$$) with the male critical as he has already been packaged.

Female critical is also low-sick, poss intubation while awaiting extrication as well as IV access. With the bilat femurs, she could be bleeding out (possible to loose over 1000cc blood each femur internally), and she probably has a hemo/pneumo developing that will require decompression. If a second bird is enroute it may be more practical to transport by air depending on ETA.

Female Yellow is still considered a critical pt due to the seatbelt bruising and possible intra-abdominal injuries. Also, the potential decreased perfusion to the hand (despite a pulse, there may be decreased but not absent perfusion), and the MOI. If the male left by ground and there is a bird available, she may go by air as well.

As for the Green folk, how bad is the bleeding to the facial lacs. Being as vascular as the face is, it may cause an airway issue in a pedi pt that young who may not be able to keep the blood clear from the face. Also, padding the voids of the carseat will work fine so long as the carseat is still intact (no damage). Both PHTLS and EPC are currently advocating this over a LBB when age/size appropriate.
 
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certguy

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Good job Grady ,

Level 1 trauma center 30 min. out by ground , 10 by air . 1st copter now 2 out . 2nd just ordered , eta 15 .

Extrication times ;

Red tag female ; 20 min.

Yellow tag female ; 10 min.


Good call on the yellow tag . Though vitals are stable , with circulatory comprimise in the arm , possible internal trauma from the seat belt that she could be compensating for , and MOI ( multiple rolls , 1 1/2 feet of space intrusion ) she should definitely go to the trauma center as a precaution .


On the green tags , there is no airway comprimise from bleeding , blood loss would be a concern , but all v/s still good . Due to MOI , I would suspect possible neck trauma to the toddlers , the infant should've faired better , being seated backwrd in the car seat . All 3 should be padded into thier kiddie KED's ( car seats ) .
 

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