help needed with research for a fiction novel

[writerwithquestions]

Hello all!
I am a senior in college and I am writing a fiction novel for my senior project/thesis. In one of the important scenes, a new EMT who is doing “on the job training” in Boston, MA responds to an accident where a commuter train has struck and killed two people (the passengers on the train turn out to be fine).
I found this forum while doing research and I was hoping those of you with experience could answer some of my questions (listed below) about EMS experiences and protocols. Realism is very important to me and I would like to accurately represent your profession. If you are able to answer any of these questions, I would greatly appreciate it. Thank you so much for your time.
-Tia

QUESTIONS:

What is the protocol once you have arrived at the scene of an accident such the one described above? How are roles assigned in the treatment of multiple patients at a chaotic scene?

Once arriving on the scene, who do the EMT/paramedics get the details of the situation from? (The cops? The dispatcher?)

How likely is it that more than one ambulance would arrive at the scene of a serious accident? How many ambulances might be at an accident of this nature? What other emergency vehicles might be present?

If more than one ambulance is at the scene, how do the EMS workers communicate with each other?

If people have died at the scene (in this case, the two people hit by the train), do the ambulances take the bodies or are coroners called in?

Would the amount of paperwork for the EMTs at the scene be more or less (or no different) if a pt was dead once EMS arrived?

What were some experiences (medical procedures, certain cases, protocols, etc.) you found challenging (initially struggled with or had trouble getting used to) when you were first starting out? In other words, what actions come only with experience?

What were you initially afraid of? (Not just life and death situations, but also the little things you worried about messing up or mixing up, etc.)

I would be extremely grateful to any help or insights you can offer. Thank you.

 

[writerwithquestions]

Also, what do you do while waiting for a call/assignment? Where do you wait?

 

[rmellish]

Quite a few of your questions are agency specific. Different services vary as far as SOPs.

I think it would be safe to bet on two ambulances, maybe more.

Initial information comes from 911 callers to dispatcher, but this information tends to be nonspecific, jumbled, and frequently incorrect. Expect misunderstandings like "The commuter train has wrecked" instead of simply hit two people.
Law enforcement on scene will usually update dispatch, or in some cases communicate directly over a tactical frequency.

Fire/Rescue would be on scene as well.

 

[rmellish]

Hello all!
What is the protocol once you have arrived at the scene of an accident such the one described above? How are roles assigned in the treatment of multiple patients at a chaotic scene?

Hopefully incident command will be established. Victims will be triaged, with critical transported as soon as possible.

Once arriving on the scene, who do the EMT/paramedics get the details of the situation from? (The cops? The dispatcher?)

See above post

If more than one ambulance is at the scene, how do the EMS workers communicate with each other?

I can't speak for Boston, but where I work 911 we have an 800mhz radio network with both agency specific frequencies, and tactical frequencies. Tacticals are used so all units responding to an incident can communicate.

If people have died at the scene (in this case, the two people hit by the train), do the ambulances take the bodies or are coroners called in?

Depends on the system. Where I work, definitely not Boston, obvious mortality becomes a coroner's case. I would guess that most busy urban EMS systems don't bother with body transport anymore.

Would the amount of paperwork for the EMTs at the scene be more or less (or no different) if a pt was dead once EMS arrived?

Same to less. If they were already dead with no treatment initiated, probably less.

What were some experiences (medical procedures, certain cases, protocols, etc.) you found challenging (initially struggled with or had trouble getting used to) when you were first starting out? In other words, what actions come only with experience?

What were you initially afraid of? (Not just life and death situations, but also the little things you worried about messing up or mixing up, etc.)

I would be extremely grateful to any help or insights you can offer. Thank you.

Hope some of that helps, I skipped the last two, might come back later.

 

[writerwithquestions]

Thank you so much for your answers!

 

[rmellish]

No problem, I'll probably add more when I have a bit more time.

 

[medicdan]

I suggest you get in touch with BostonEMS-- they would be glad to tell you how they would handle that scene. Take a look at the MA EMS protocols, found at www.mass.gov/dph/oems and take a look at an EMT textbook, it will explain how we do it. It is also worth checking the news archives, there have been two train collisions in MA in the last year or so, one involving the commuter rail (near canton/stoughton, as I recall), and the other on the green line in Newton.

Good luck!

 

[Meursault]

Most of the communities in this area have their MCI (Mass Casualty Incident) protocols online. Try Googling for them; they'll give you an idea of how things would look on-scene, at least until incident command realized that there were very few injuries and sent everybody away.
Additionally, see if you can find the news helicopter footage from that Green Line crash: it shows the way units stage and work pretty well.

I'm not working 911, so other posters will have to fill you in on the specifics.

 

[Jon]

I'm not from BostonEMS... so I can't help you with their agency protocols.
Generally:
EMS/Fire response varies based on dispatch location, as well as local standards/procedures. In a rural/suburban area with multiple municipalities and/or fire/EMS agencies... you will see variations in what the "standard" apparatus assignement is for a MVC (vehicle collision)... some places just get an amublance unless there is entrapment... and the ambulance may just be BLS unless there is some reason to have ALS dispatched, while some places give you rescue trucks, ALS units, BLS units, pumpers, and a ladder truck to block the scene... for any MVC call.

That said, in an urban department, they are going to have a standard across the board. They are all going to be following the same procedures and using the same radio system... and I'm sure that all EMS can talk with other EMS, and all Fire can talk with other Fire (and they might be able to talk to one another, too) and all PD can talk with one another... AS LONG AS ALL UNITS ARE FROM THE SAME AGENCY. If EMS activates their disaster plan and starts bringing in "outside" ambulances... they might not be on the same radio frequency... then things get relayed through dispatchers.


Urban systems have lots of resources. Boston likely has a strong technical rescue group (either FD, EMS or both) and many of their folks are likely involved with a FEMA US&R task force. The city will have various units with rescue capabilites thorughout the city (usually ladder trucks and specially designated Engines), and 1 or more "Heavy Rescue" units. There will be an element of the department(s) trained for rail rescue.

The standard EMS crew's responsibility for patient care might only start AFTER the patient is exricated... or the EMS crew will be working WITH rescue folks during the operation.


I can't help you that much... because I don't know how Boston is set up. Spend some time on their website.

Look at their plans: http://www.cityofboston.gov/TridionImages/EMS_Service_Zone_090607_tcm1-2268.pdf

 

[mycrofft]

Look at real incidents. Murphy's Law of Combat applies:

"When the balloon goes up, the OPS PLAN goes out the window".
FDNY almost lost the apex of their command structure on "9/11" when they set up their command post, per the plan, in a lobby of a building which was on fire and, unbeknownst to them, going to fall down in a matter of a little over an hour.

Units will start arriving fairly haphazardly. The paramilitary types (fire and police) will have the most structure, EMS will tend to "go for it" because establishment of a perimeter, command post and Entry Control Point are not part of their tasking. Fire and LE will perhaps try to pull EMS out of an unsafe situation, and EMS may resist. Commo will have planned freqs etc but in the event if ther is a mass response there will be units out of commo due either to dead batteries, dead radios, operator error, frequency is overloaded, or wrong freq.
Once it is established the living are gone and the remainder are dead, LE will cordon it off and start forensics work, as well as try to fend off souvenier hunters and sneak thieves ("vultures").

 

[IrishEMT]

Hello all!
I am a senior in college and I am writing a fiction novel for my senior project/thesis. In one of the important scenes, a new EMT who is doing “on the job training” in Boston, MA responds to an accident where a commuter train has struck and killed two people (the passengers on the train turn out to be fine).
I found this forum while doing research and I was hoping those of you with experience could answer some of my questions (listed below) about EMS experiences and protocols. Realism is very important to me and I would like to accurately represent your profession. If you are able to answer any of these questions, I would greatly appreciate it. Thank you so much for your time.
-Tia

QUESTIONS:

What is the protocol once you have arrived at the scene of an accident such the one described above? How are roles assigned in the treatment of multiple patients at a chaotic scene?

Once arriving on the scene, who do the EMT/paramedics get the details of the situation from? (The cops? The dispatcher?)

How likely is it that more than one ambulance would arrive at the scene of a serious accident? How many ambulances might be at an accident of this nature? What other emergency vehicles might be present?

If more than one ambulance is at the scene, how do the EMS workers communicate with each other?

If people have died at the scene (in this case, the two people hit by the train), do the ambulances take the bodies or are coroners called in?

Would the amount of paperwork for the EMTs at the scene be more or less (or no different) if a pt was dead once EMS arrived?

What were some experiences (medical procedures, certain cases, protocols, etc.) you found challenging (initially struggled with or had trouble getting used to) when you were first starting out? In other words, what actions come only with experience?

What were you initially afraid of? (Not just life and death situations, but also the little things you worried about messing up or mixing up, etc.)

I would be extremely grateful to any help or insights you can offer. Thank you.

First, if this train was going full-speed, those people would be known as "pink mist", if they weren't in a car on the tracks. But onto questions:

We triage and set up an incident command. Usually first person on scene, or highest ranking, will be IC.

We typically get what info we can out of dispatch, which is 9 times out of 10 is pretty unfruitful and only tells us what we already know. That, or dispatch forgot what they dispatched us for.

You should have as many ambulances as you have patients, ideally. The unwounded not so much, but you should have, minimum, two rigs there. And fire, so that they can cut up the car because firefighters really like to do that and play with their toys. We communicate using radios or MIRS, especially if there is more than one agency responding.

EMT-Bs also don't diagnose death, unless it's obvious. Obvious signs of death include dependent lividity, maggots, rigor mortis, injuries incompatible with life (ex: all the organs fell out, pink mist, etc), and decapitation. Or if the paramedic said the pt. was dead. We find it bad form to leave the body where it is if we've already moved it, so we'd take them in if we had been playing with it. It's just poor form to take a body BACK to the scene.

Paperwork is always a :censored::censored::censored::censored::censored:. At an MCI, it would be ridiculous. Pretty much everything would have to be documented meticulously so as to avoid a lawsuit, especially if it's a probie who is nervous and scared and doesn't know all the acronyms yet.

I had difficulty with patients who were nonverbal, or non-English speaking, and for some reason I get those all the time. Deaf-mutes, autistics, brain-damaged, immigrants who only speak Hmong, sliding down the AVPU trail... you name it, if they can't speak, I've had it.

 

[writerwithquestions]

Thank you all so much for your answers and suggestions, they were all very helpful.

 

[KEVD18]

if you want true boston specifics, go straight to the horses mouth.

chris stratton is the pio over at boston ems
jennifer mehigan is the director of media realations.

either should be able to help you out with exactly how boston ems would handle it.

emailems@bostonems.com
(617) 343-2367(phone)
(617) 343-1199(fax)
767 Albany Street(us mail)
Boston, MA 02118

 

[writerwithquestions]

First, if this train was going full-speed, those people would be known as "pink mist", if they weren't in a car on the tracks.

Could you elaborate on the concept of "pink mist"?

I have heard the term used in a military context, referring to a sniper shot or a bomb explosion.

In this case, what does the term refer to? Is it commonly used (or is it considered slang/casual and therefore not used "officially")?

 

[writerwithquestions]

First, if this train was going full-speed, those people would be known as "pink mist", if they weren't in a car on the tracks.

Also, in this particular story, the couple were walking on the tracks when they were hit by the train (no car).

 

[writerwithquestions]

Thanks for the info KEVD18, I'll give them a call.

 

[KEVD18]

basically when something like a human body interacts at a high rate of speed with an item(like a bullet or a train) the fluid in the body(blood) aerosolizes or at the very least appears to do so. spreading a fine mist of red fluid against a sunny backround makes it look pink.

its about as far from an official term as you can get.

basically is means that the person was turned into vapor. immediatley killed and broken into many many many tiny pieces.

the human body does not deal to well with this sort of accident.

 

[BossyCow]

Could you elaborate on the concept of "pink mist"?

I have heard the term used in a military context, referring to a sniper shot or a bomb explosion.

In this case, what does the term refer to? Is it commonly used (or is it considered slang/casual and therefore not used "officially")?

In EMS slang is almost official. We wouldn't write it on a report, but would probably use it when giving a verbal report to the ER staff.

Often in trauma there are not identifiable pieces left. I recall a traumatic amputation of a leg from a car wreck that didn't leave anything big enough to be classified as anything but 'meat'.

 

[EMT-P633]

QUESTIONS:

What is the protocol once you have arrived at the scene of an accident such the one described above? How are roles assigned in the treatment of multiple patients at a chaotic scene?
One person of the crew is triaging patients. - sorting the wounded, there are 4 levels. dead, critical, urgent, minor/walking wounded. the other either sets up incident command. or starts treating critical patients.
Once arriving on the scene, who do the EMT/paramedics get the details of the situation from? (The cops? The dispatcher?)
Initial information comes from the dispatcher, once on the scene, we recieve info from bystanders, officers, fireman, patients, just about anywhere we can find it.

How likely is it that more than one ambulance would arrive at the scene of a serious accident?
very likely
How many ambulances might be at an accident of this nature?
2-4
What other emergency vehicles might be present?
fire trucks, police cars, news crews,
If more than one ambulance is at the scene, how do the EMS workers communicate with each other?
If the crews are working close together, usually verbal, if they are spread out a bit... radio, usually a hand held portable when away from the unit, if in the unit, we use the mounted radios.
If people have died at the scene (in this case, the two people hit by the train), do the ambulances take the bodies or are coroners called in?
In cases involving death, especially those caused by accident weither intentional or unintentional. they must be investigated, a medical examiner would come to the scene, do their investigation, and file a report with the police, etc etc, the actual transport of the bodies could be done by either the ambulance or the coroner, that would depend on the local EMS service's protocols.
Would the amount of paperwork for the EMTs at the scene be more or less (or no different) if a pt was dead once EMS arrived?
In my experience, at the scene there would be little to no difference in the amount of paperwork involving a DOA. the same assessment and documentation i perform for the living or the dead both take about the same amount of time.
What were some experiences (medical procedures, certain cases, protocols, etc.) you found challenging (initially struggled with or had trouble getting used to) when you were first starting out? In other words, what actions come only with experience?
First starting out - starting IV's, intubations, developing a style of history taking.
What were you initially afraid of?
finger / toe nail injuries, to this day they still give me the willies.
(Not just life and death situations, but also the little things you worried about messing up or mixing up, etc.)
Paperwork, making sure I correctly filled out all the paperwork; My partner, worried that we wouldnt get along, work well together, not do what he wanted, that he would do what i needed.
I would be extremely grateful to any help or insights you can offer. Thank you.
I can offer that you contact Boston FD, I do believe that both FD and EMS are run by the same department, talk with thier public affairs officer and he will have alot of inside info for ya.

As for what we do when we are waiting for a call. you name it, watch TV, sleep, talk, eat, read, train, play practical jokes, hit on the hot ER nurses, did i mention practical jokes?

hope this helps!!!!

 

[KEVD18]

im going to jump in again and clarify two of p633's comments

1) in massachuesetts, at least in regions 4 and 5(the only two i have worked and and thus have direct knowledge, also region 4 is metro boston) ambulances do not transport corpses. that is the job of the medical examiners office. we only transports people who are not clinically alive to a receiving hospital, which in this case would be comperable to bringing coals to newcastle.

2) boston ems and boston fire are not the same agency!!! emd is a third service which has complete autonomy from both pd and fd. they frequently operate with each other and as such have interoperability procediures and what not, but they are completely seperate.

again, your best bet is to submit a request directly to boston ems either through the media relations dept or the punlic information officer. failing that, if you contact me privately, i might be able to put you in contact with a field level employee of the dept who can give you accurate infor abotu that particular dept.