Good Samaritan - Rescue Vs. Medical

[DV_EMT]

Hi all,

Been a while since I posted up here, but I had a good question brought up to me the other day and I thought I'd share it with you.

Scenario:

Your driving down the highway (far from EMS/Rescue) when you see a car on the side of the road. The car has two occupants inside (one driver and one passenger). You pull over to help as a good Samaritan. There is smoke in the car, but no fire, and you see fluid running from the car down the road. You do not have any access to the passenger's side (not even from the windshield). the only way to get to the passenger is by removing the driver.

now here comes the fun part....

Your driver has an impaled object in his abdomen. He is not "pinned", and he is A/O x3 (or 4 - suffice to say he's talking and with it).

Your passenger is out cold. You can't get to them without removing the driver, and you do not see any chest rise. The PT looks slightly gray/ashen.

The driver side airbag deployed, but the passengers did not.

As a 1st responder, what do you do? You have no backboard, no KED board, nothing but a bunch of BSI supplies and a pocket mask.


let me know if you want any additional information. I'm very interested to see the responses!

 

[spinnakr]

I know there are some here would say they'd never stop. I'm not one of them, so whatever. For brevity/clarity, I'll say the driver is male and the passenger is female.

First, call 911 - of course. Would mention being off-duty EMS/fire (well, that is, once I graduate as fire II in 2 weeks) and would say that lifeflight will almost certainly be needed. Hopefully local LEO's would get there faster in order to make a landing zone - perhaps the road? All depends on terrain. If they've closed down the freeway to land lifeflight in Cleveland, then they can close a highway in the middle of nowhere.

Second: I'd try to get a pulse on the passenger - which would unfortunately entail reaching across the driver. Ideally I'd just figure out if she is breathing - but if I have zero access, look listen feel won't work very well. To be honest, I'm not sure how it would be possible to have absolutely zero access to the passenger without her being completely entrapped and/or underneath the dash. Either way, if I didn't get a pulse and breathing from the passenger in ten seconds, I'm going to call it a day with her. Basic triage - better to save one than loose both, and if they don't have an airway, they're dead. Since you said she doesn't look like she's breathing, I'll operate on the assumption that she isn't.

That leaves me to tend to the driver. However, I need a little more info on the impaled object - what is it, is it caught on anything, etc etc etc. How about my surroundings? Is this a forest or the desert? Is there a grade to the road? Do I have a blanket in my car? Where is the smoke coming from? What color is the fluid and does it smell? Is the wind direction with, against, or perpendicular to traffic? What's the weather like? Paint me a picture and I'll tell you a story...

 

[atropine]

Given your senerio, I would wait for the fire, since this is clearly an extrication/rescue, and what I mean by that the car battery must be diconnected to prevent possible passeneger side airbag deployment. Many factors in this case come to play with saftey.

 

[DV_EMT]

That leaves me to tend to the driver. However, I need a little more info on the impaled object - what is it, is it caught on anything, etc etc etc. How about my surroundings? Is this a forest or the desert? Is there a grade to the road? Do I have a blanket in my car? Where is the smoke coming from? What color is the fluid and does it smell? Is the wind direction with, against, or perpendicular to traffic? What's the weather like? Paint me a picture and I'll tell you a story...

For Scene Purposes:

- it's nighttime (lets say around 9ish)
- lets say its in a desolate area (not a desert... but deserted)
- 0 wind

In order to "entrap the patient" lets say the driver lost control and hit a large boulder that has crushed the passenger side windshield and has made it impossible to access the passenger side (assuming its a 2 door coupe).

The smoke is of unknowns etiology, but it is inside the car (not billowing out of the engine). Note: the airbag did deploy.

The fluid is clear and odorless, but upon arrival you do not notice its presence because it is nighttime and no odor is present

Weather is around 55-65 degrees

The impaled object is not long, maybe a foot in length total, maybe 2-4 inches wide. It could be wood or metal... whatever it is, it isn't restricting the drivers ability to be extracted. It is in the drivers abdomen. right in the middle.

 

[LucidResq]

I would call 911 of course.

I had a friend who came upon an accident in which the driver was unconscious and the cab was rapidly filling with smoke. He simply punched a window out. I don't carry a window punch but this is something I would consider doing if smoke is also filling the passenger compartment in this scenario. Another set of friends got through a car window fairly easily with an avalanche shovel once... something I do carry in my trunk.

Then I would quickly get the hell away from there.

 

[LucidResq]

As a 1st responder, what do you do? You have no backboard, no KED board, nothing but a bunch of BSI supplies and a pocket mask.

What do you mean?! I always keep at least 2 backboards, a KED, a stair chair and a stokes in the back of Camry!

 

[NYBLS]

Treat what you can without removing either patient. You moving the pt with the impaled object could cause a major abdominal bleed. If you move the one with the impaled object for the unconcious pt, you now risk having two dead patients and no way to help either (except basic CPR).

 

[mycrofft]

Window punch

If there is actual smoke there is either fire or an electrical arc. This is a scene safety scenario.
Call 911, of course! Ten points.

I know what I think I would do, but these "declare death ->triage" scenarios irk me.

 

[firecoins]

Passenger is dead. Move on with it. MCI protocols. Nothing you can do until 911 arrives. Sorry.

 

[trevor1189]

Passenger not breathing and trapped. Trauma arrest, move on. If this is really out in the sticks, then they are not going to have a pulse by the time they are extricated if they aren't breathing now.

Did anyone consider the smoke is just from the airbags?

^ Just read the OPs update. People often report the car is on fire or it's smoking when they witness these crashes early on. It's my understanding the airbags have a fine dust in them to assist with lubricating them on deployment. This is the dust that causes brush burns to the face on occasion.

Also fatality in the vehicle means driver obviously meets trauma center designation. Call 911 back and tell them you need a helicopter launched.

 

[spinnakr]

Absolutely 100% agreed. The butt of a knife would work, or the tool kit in your car (EVERY car these days has them - for changing flats and such). There's a lot of things that can break tempered glass if you know where to hit it. Try the metal pointy part of your headrest.

If there is actual smoke there is either fire or an electrical arc. This is a scene safety scenario.

Agreed - but my fire training is telling me to get this guy out while the getting is good. Fires, especially with modern synthetics, can spread EXTREMELY rapidly. If you got flame impingement on the gas tank... well, you might not get an explosion, but you'd have a hell of a fire.

these "declare death ->triage" scenarios irk me.

Me too.

Back to the scenario: is the abdominal impalement through and out, or is it just lodged?

Did anyone consider the smoke is just from the airbags?

Excellent point. If it's night and it's dark, can we see any heat sources/where the smoke is coming from? And, for that matter, what is the smoke like? Is it thick, billowing? Brown, black, or white? Etc etc.

^ Just read the OPs update. People often report the car is on fire or it's smoking when they witness these crashes early on. It's my understanding the airbags have a fine dust in them to assist with lubricating them on deployment. This is the dust that causes brush burns to the face on occasion.

Sort of. It's the airbag itself that causes the burn - it's just like rugburn - friction, plain and simple. The dust is harmless - usually talc or some such. However, if you've ever seen an airbag deploy... it doesn't look anything like smoke from a car fire, hence the above question. However, the ignition charge FROM the airbag can and sometimes does catch the airbag itself on fire - in which case, you need to get the airbag away from the ignition charge, being careful not to burn yourself.

Agreed on the medivac.

Also, I really like this scenario.

 

[Sandog]

No fair changing the scenario...

First post.

Your driving down the highway (far from EMS/Rescue) when you see a car on the side of the road. The car has two occupants inside (one driver and one passenger). You pull over to help as a good Samaritan. There is smoke in the car, but no fire, and you see fluid running from the car down the road.

Second post.

The fluid is clear and odorless, but upon arrival you do not notice its presence because it is nighttime and no odor is present

 

[spinnakr]

Nice catch, Sandog.

A couple more questions about the impalement:
Color of the blood? Quantity? Quality? Any other fluids?
By right in the middle, do you mean (essentially) the navel?
What kind of pain is he in from the impaled object?

Somewhat unrelated question: what kind of car am I driving (this is serious)

 

[MidwestFF]

Scene Size-Up
Call Dispatch / 911 Report
Assume Command
Advise of accident with injuries while staged at a safe distance.
Request air to be put on standby, if out in the sticks.
Request LEO / Fire / Rescue / EMS

Put on my Bunker Gear
Approach and severe battery connections (Depending on model of vehicle Airbags may still be live for 30 + minutes)
Make patient contact, quick ABC's on both passengers.
If passenger has obvious injuries not conducive to life, given the MOI and the amount of damage described to the vehicle, passenger is probably un-salvageable especially if there is an extended transport time via helicopter or ground.
Leave patient(s) in place

Call dispatch back
Provide Scene size-up
Advise of probable fatality
Request ETA's of previously requested resources
Request Air, Immediate Launch (Our system if bird is available it will be off the ground in under 7 minutes, 2 if on standby.)

Triage driver in place to the best of your ability and availability of resources, only remove driver from the vehicle if there is imminent danger of fire, explosion, or your patient is crashing and you need access to attempt further stabilization.

When local AHJ shows up transfer command, continue to be involved only to the extent that you are requested to do so by command.

Even if not requested by LEO or other agency, write a 'report' so that you have a record of the events for your own personal file. You will probably never need it but it may save your butt if you get sued later.

 

[Akulahawk]

Call 911, give them a situation update. Passenger is triaged dead/nonsalvable. Unless there's immanent danger, driver stays in the car. I would check for the best way to do an emergent rapid extrication of the driver in the event that I have to evacuate the car, but other than that... I just don't see an immediate need to do it.

 

[Sandog]

Nice catch, Sandog.

A couple more questions about the impalement:
Color of the blood? Quantity? Quality? Any other fluids?
By right in the middle, do you mean (essentially) the navel?
What kind of pain is he in from the impaled object?

Somewhat unrelated question: what kind of car am I driving (this is serious)

Upon further thinking, what fluid leaking from the car would be clear and odorless? Only thing I can think of is the windshield wiper container... :wacko:

Sorry, if I were able to see this liquid, smell or not, I would be thinking gas. Other fluids would drain rather quickly, most likely before I arrive on the scene.

Strangely enough, my instructor posed a similar question and said this was a real situation that he responded to. hmm.

 

[spinnakr]

Upon further thinking, what fluid leaking from the car would be clear and odorless? Only thing I can think of is the windshield wiper container... :wacko:

Sorry, if I were able to see this liquid, smell or not, I would be thinking gas. Other fluids would drain rather quickly, most likely before I arrive on the scene.

Strangely enough, my instructor posed a similar question and said this was a real situation that he responded to. hmm.

I guess if you want to split hairs, clear and colorless are two different things. If it's summer, it could be condensate from the A/C; it could also be the working fluid from the A/C, possibly brake fluid, engine oil if newly changed, engine coolant, WW fluid (AS YOU said), etc etc etc. I'm going to assume at least combustible no matter what (possibly flammable, but the only flammables in a car I would THINK you'd be able to smell. But I might feel at least a little better about the situation if I couldn't smell anything.

Because of the smoke, there's definitely a risk to life within the car. Depending on the answer to the questions I asked last night, it might or might not justify removing the driver from the vehicle...

MidwestFF - by the OP, I'd say you cheated - "As a 1st responder, what do you do? You have no backboard, no KED board, nothing but a bunch of BSI supplies and a pocket mask."

 

[nemedic]

MidwestFF - by the OP, I'd say you cheated - "As a 1st responder, what do you do? You have no backboard, no KED board, nothing but a bunch of BSI supplies and a pocket mask."

Not necessarily. The bunker gear could arguably be considered part of BSI gear and basic protection that would normally be carried by someone in a "desolate area" by a "first responder" as a good portion of the rural areas of the country are staffed by predominately volly fire/ems, who may or may not be responding POV with bunker gear in the trunk

 

[mcdonl]

Not necessarily. The bunker gear could arguably be considered part of BSI gear and basic protection that would normally be carried by someone in a "desolate area" by a "first responder" as a good portion of the rural areas of the country are staffed by predominately volly fire/ems, who may or may not be responding POV with bunker gear in the trunk

Not me. I would be too worried someone from www.emtlife.com would show up on duty and see me there with my bunker gear on in the middle of the night, in a desolate area at the scene of an accident

My first call as the EMT a few weeks ago had an Intermediate, a Basic (Both full time FD) and two RN's on scene in traffic when we got there with rescue. None of them had any equipment at all.

I keep my jump kit in by truck as I live on the remote end of town and when I am on duty (Actually on duty, legally, on the schedule...) I respond with my POV but my bunker gear stays at home when not on duty. I only keep the jump kit in the car as I have two kids who are mouthy so bleeding control could happen at any moment.

 

[spinnakr]

Not necessarily. The bunker gear could arguably be considered part of BSI gear and basic protection that would normally be carried by someone in a "desolate area" by a "first responder" as a good portion of the rural areas of the country are staffed by predominately volly fire/ems, who may or may not be responding POV with bunker gear in the trunk

Okay, but that wasn't the scenario. The scenario was that you were off-duty, just driving by, and that is what you have. Otherwise, I'd have a jump bag with me, along with various short-term and long-term wilderness survival items, etc etc.