Ok so I guess my first question from y'all would be how would you go about securing scene safety on the freeway? You are in the merging lane on the far right and when you locate the collision it is nearly even with you on the far left with a curb in the gorepoint.....do you cut a hard left and hop the curb and park perpendicular to the scene (since you otherwise have no other room to maneuver) or try to pass it and loop around, or even get off at the next exit, hop back on the opposite way and loop around the far way....or another option?
Use the gutter lane, then swing hard and block all traffic with the unit; too bad, so sad, yaaay LA traffic. Bottom line for me? We'll get there when we get there, safe and efficiently. I don't think I need to ovet think this. At least like I said block with the unit, at most park directly in front of the scene.
Anyway, so you get over and start assessing your patient. You find an adult male laying supine almost completely underneath the pickup truck. His hips are pressed up against the driver side front tire with his legs sticking out and his head under the middle of the truck, kind of curled up against the tire (as opposed to laying flat and straight like in EMT class scenarios).
How long has he been pinned? I'm guessing not long? But more importantly, if we can't get him out without the help of the "big burly firemen", you can ask for Bicarb orders juuuust in case; next question...
He is wearing a thick leather jacket and does have a helmet on, not a full face helmet though. It's dark and you can't see much of anything without the aid of a flashlight.
Cool, use my lights, any and all. Unit lights, LE's mag light (I know they're holding), my partners, and of course my trusty Surefire; either way, again not a huge issue...
However, your patient is alert and talking to you in full sentences with a patent airway, but cannot remember what happened, does not know where he is. He does know his name, but not his age. The cop on scene says he has been asking the same questions about what happened to him several times now.
So, clearly at the very least a concussion. High flow O's for the TBI, and keep em' talking until he can be freed.
You do not see any immediately obvious bleeding, nor any obvious fractures, but can't rule them out yet due to the awkward positioning of the patient under the truck combined with his full motorcycle clothing.
We can cut/ remove clothes once freed, again, no bigs...
You're laying down under the truck with the patient holding C-spine, your partner can't access more then the patients legs and left arm, he says you should remove the helmet and place a collar on, and wants the two of you to try to get the patient on the board by yourselves.
Cool, if we can, we'll safely and gently remove it (it's quite simple and given his repetitive questions, better safe than sorry). Also if I have time to kill a quick set of V/S with the freed arm and and IV, again, whilst awaiting fire; moving on...
Do you remove the helmet or keep it on? Since you're holding C-spine and have only your partner and one cop with you at this point in time do you try to move the patient onto a backboard or wait for incoming fire for assistance? What else would you be trying to do or assess in the meantime?
Helmet removal, especially most motorcycle helmets, are fairly straightforward. If we can we will. Too much pain, stop and try once the boys arrive with their "manpower"; not gonna stress over this either. See reply above re: the second part of this question.
BTW, you have your local community hospital 2 miles away....though your local Level II trauma center is 5 miles away....both straight down the freeway in the same direction as traffic flow.
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