MVA Scenario

S

sbp7993

Forum Crew Member
Messages
48
Reaction score
0
Points
0
What would you do in this situation?


You are dispatched to an MVA. Upon arrival you note that 2 cars were involved in a head on. Car 1 has one DOA driver(as is confirmed by the medic) The passenger in the front has no complaints---doesn't realize that the driver is dead, and cannot recall the events. Car 2 has just a driver---no passengers. Car 2 is screaming of lower arm pain and you note a closed, possible fractured radius, or ulna. Initial exam shows nothing further. vitals are stabile. What do you do? You are in a van ambulance, and you were the only unit dispatched, with only the 1 medic.
 
Well this more than you can handle with one rig so your going to have to call in more resources for sure sounds like everyone is getting c-spined do to the fact that the crash was enough kill an occupant from there follow your ABC's O2 PRN control any major bleeding and so on. Contact trauma centers to make sure there is bed space and follow START.
 
Tx the passenger as a major trauma on the gurney, and the second one as a moderate trauma on the bench...
 
exodus said:
Tx the passenger as a major trauma on the gurney, and the second one as a moderate trauma on the bench...
Click to expand...

Um, beg your pardon? Are you implying that you can transport two trauma patients on one ambulance with one EMT in the back? :ph34r:
 
eveningsky339 said:
Um, beg your pardon? Are you implying that you can transport two trauma patients on one ambulance with one EMT in the back? :ph34r:
Click to expand...

Uhm, if we're the only available resource, what am I going to do? Stick around on scene with a thumb up my *** with a major trauma? Grab a firefighter or a cop to ride with us in case somebody codes.
 
eveningsky339 said:
Um, beg your pardon? Are you implying that you can transport two trauma patients on one ambulance with one EMT in the back? :ph34r:
Click to expand...

Where's the problem? Can a medic not take care of more than one patient at a time?

EMT drive, medic in back, or have another responder drive and try to squeeze the EMT in the back too.


Without further details on the 3rd patient, all it seems to be is splint, narcotics and monitor. But the second patient NEEDS to get to a trauma center asap as there is a high suspicion of major injuries, considering another occupant of their vehicle died.
 
I am curious to know what the difference in prehospital treatment for a major and moderate trauma are and how you could possibly make those triage decisions with the information presented?

Did the driver have an MI and code which preceded the impact? Was he/she looking in the back seat? People generally don't just decide to head on somebody.

There could be all kinds of reasons one patient died and the other didn't. Off center hit,body position, unrestrained, preexisting condtions, extremis of age, medications, and/or struck by an object in the car, to name a few.

Likewise the occupant in the 2nd vehicle could have any number of similar comorbidities.
 
Last edited by a moderator:
Was that directed at me or am I reading it wrong?

If directed at me:

Common teachings are if there are multiple people in a car, and one dies and another lives, the living patient needs to be looked at extremely suspiciously for life threatening trauma even if they have no complaints at that time.

Sure, the other car was subjected to the same accident, but a number of circumstances could have lead to the different outcome, a major one being different vehicles. They could have been in a big truck and the other vehicle a small compact car... big truck usually wins.

And I was treating based off the VERY limited and basic info provided... ie "no complaints" and "broken arm but 'stable' "
 
Last edited by a moderator:
partly directed at exodus, the rest for just general consideration of the readers.
 
Ah, okie dokie.


Consider my post an extension to my original :)
 
Red Patch Linuss is quick on the counter-punch! I like :P
 
Without reading the rest of the replies.

Contact dispatch for coroner on confirmed DOA. Fire should be on scene or on their way. If not quite there yet would also ask dispatch for an ETA on fire and police for crowd control/assistance. Medic will go to the patient who cannot remember the accident, EMT goes to the closed possible fx. Fire on scene will assist medic and EMT seperately to board and collar their patient.

Once all patients are boarded and collared as well as the possible fx splinted (if needed). Pt with possible fx goes on bench, pt that cannot remember anything goes on strecher. Transport to nearest trauma center or facility with extensive neuro capabilities. Radio ahead to let the receiving hospital know we're coming in with two patients and to have a bed ready for us outside, additionally request possible trauma room assessment for a patient with suspected head injury involved in an MVA with one DOA occupant. EMT and Medic ride in the back, fire drives us in.

I've done this scenario many many many times at my service. We only run vanbulances and I've taken two patients in many a time.

Edit: Got my patients backwards on who gets loaded where, whoops.
 
Last edited by a moderator:
Also you have plenty of resources for two patients one truck with a medic. Get a firefighter to drive the ambulance in while the medic and basic work in the back.
 
Person most likely to live is the driver in a highspeed.

I'm not going into the rest of the inconsistencies. Good brain exercise.

You can move four laydowns if you have enough litters that fit the ceiling hangers.
 
Last edited by a moderator:
It is quite common for a patient in a MVA not to be able to recall the event. Now confusion, repetitive questioniong or lethargy thats a different story. With the little info provided its tough to say, was there intrusion into their compartment, broken glass, steering wheel deformity or any indicator of potential underlying injury?

Assessment is the key and as it was presented in my opinion they would both go the closest facility. I didnt read anything presented that would require a trauma center, a community hospital with an orthapedic on staff and CT capabilities should be sufficient.

I would never put two people from different vehicles in the same ambulance especially when death resulted. We dont have a resource problem usually so they go in different ambulances.

If resources are a problem and the last resort is to transport these parties together have a firefighter drive if it makes you more comfortable having two people in the back.
 
Prehospital management of a Major versus Minor category injury...you don't.

You examine each pt and decide what's wrong (diagnose, if you will) and treat each pt as needed and in order of what needs addressing first for survival. In a mass casualty situation you might need to start categorizing and allowing that to affect transport and treatment. Categories are administrative, not medical.

"Five is four"...the "Single Combat With Death" scenario. It is how we all come to grips with the fear we'll get swamped someday.
But a good execise and discussion. Thanks for posting, OP!
 
Two pt's in one unit is a common occurance. Opposite drivers are a common occurance. If it is during a busy time in your system, why tie up another unit.

If both pt's are fairly stable, there is no reason a medic cannot treat both. It is done all the time. You have to think outside the box on this job. Be prepared to do what is needed.
 
I would assume it could be very uncomfortable for the parties involved to be in the same vehicle especially if serious injury or death has occured.

Just my opinion.
 
If you search my posts...

I actually was the guy in the back of a Cadillac and we did that! Family members were saying how they'd crush the guy who did it, and he was lying unconscious within inches of their knees.
 
You must log in or register to reply here.
Back
Top