NTSB report on the Tracy Morgan crash

[jaysonsd]

Saw the bullet points on a the NTSB report on this accident, here. Makes mention of 'confusion and inexperience among emergency responders led to poor triage and a delay in delivery of patients to a trauma center'. I'm not looking to slam or question decisions made, merely curious what NJ's protocols for responses are or who is expected to respond on this turnpike. There is an excellent response profile here in San Diego, but we're a major city. However, I would think the NJ turnpike would be in a similar situation.

Jayson

 

[DesertMedic66]

A city may have a great response plan for incidents however without proper training and training often that response plan will go to ****.

 

[Flying]

We have all these nice MCI plans and response teams, but they're all for CBRNE attacks.

So all MCIs that don't involve terrorists are chucked to the county EMS coordinator, who you can trust to tell people what to do. You better hope he gets to the scene before the EMTs start doing too much. You also can't forget that NJ's EMS "protocols" are not consistent statewide. Each agency has its own medical director, so your care is partly determined by which ambulance you get.

The first responders that flow in are determined by local dispatch/mutual-aid protocols, a single agency may cover the highway from exit x to exit y. The municipalities have the most control over the initial coordination of resources, but they rarely ever have adequate information, so agencies are usually under or over dispatched.

Relevant training is pretty much nonexistent.

 

[Flying]

Oh yeah. Backboard buses for responses to "The Big One".

I'm still trying to wrap my head around how these were conceived.

 

[DesertMedic66]

Oh yeah. Backboard buses for responses to "The Big One".

I'm still trying to wrap my head around how these were conceived.

In cases of a huge MCI we are able to use city/school buses to transport patients. The problem with city/school buses is they have zero medical gear and other issues from seating. A bus like that makes sense to me (however the likely hood of it being used is hopefully very slim)

 

[DrParasite]

Saw the bullet points on a the NTSB report on this accident, here. Makes mention of 'confusion and inexperience among emergency responders led to poor triage and a delay in delivery of patients to a trauma center'. I'm not looking to slam or question decisions made, merely curious what NJ's protocols for responses are or who is expected to respond on this turnpike. There is an excellent response profile here in San Diego, but we're a major city. However, I would think the NJ turnpike would be in a similar situation.

Since, you asked: http://www.nj.gov/health/ems/guideline.shtml

So all MCIs that don't involve terrorists are chucked to the county EMS coordinator, who you can trust to tell people what to do. You better hope he gets to the scene before the EMTs start doing too much. You also can't forget that NJ's EMS "protocols" are not consistent statewide. Each agency has its own medical director, so your care is partly determined by which ambulance you get.

ummm maybe not in your state of new jersey, but my state of new jersey's trauma protocols are statewide (see the above link from the Dept of Health). Clinical protocols are the same among every BLS agency (and they should have the same medical director, aside from 3 or 4 relatively new items). ALS clinical protocols are given by the state, and modified by the regional medical director (which is more common than a blanket protocol for everyone state wide).

The first responders that flow in are determined by local dispatch/mutual-aid protocols, a single agency may cover the highway from exit x to exit y. The municipalities have the most control over the initial coordination of resources, but they rarely ever have adequate information, so agencies are usually under or over dispatched.

That's typically how limited access roads are covered. it makes more sense to have the nearest agency to the access point have primary response.

According to the article, here was the comment (with all the author's spelling errors left uncorrected by me):

Confusion and inexperience among emergency responders led to poor triage and a delay in delivery of patients to a trauma center, which was 16 miles away. One victim who should have been immobilzed was moved without being secured to a backboard. The NTSB recommended that New Jersey health officials establish minimum training and practice standards fof organizations that provide emergency services on the New Jersey Turnpike.

Without reading the actual report, I'd be skeptical about any comment suggesting the EMS crew messed up due to not immobilizing, considering all the research about how immobilization isn't needed as much as we were originally thought.

Also, IIRC, Tracey Morgan was flown from the scene to RWJUH in New Brunswick (exit 9 of the turnpike), while the others were driven to Trenton Regional Medical Center in Trenton (which was probably 16 miles away). Maybe they didn't want to overwhelm the closest trauma center with all the sick patient's from the MCI?

I'd be curious to read the whole report, and see exactly what they were talking about.

 

[NomadicMedic]

Agreed, I'm very curious about this line:

One victim who should have been immobilzed was moved without being secured to a backboard.

... and why the NTSB believes that they have any authority to relate such a statement.

 

[Flying]

ummm maybe not in your state of new jersey, but my state of new jersey's trauma protocols are statewide (see the above link from the Dept of Health). Clinical protocols are the same among every BLS agency (and they should have the same medical director, aside from 3 or 4 relatively new items). ALS clinical protocols are given by the state, and modified by the regional medical director (which is more common than a blanket protocol for everyone state wide).

As of right now, NJ's EMS model does not resemble the regional systems found in surrounding states. Governor Christie and the First Aid Council made sure of that:
http://www.state.nj.us/governor/news/news/552012/approved/20120109a.html
S-818 vetoed.

At the end of the day, a trauma patient transported by RWJ has a 50/50 chance of being backboarded, while a person transported by MONOC will simply be collared and placed in a position of comfort (unless flown).
https://www.monoc.org/docs/SMRLetter.pdf

For those who are still interested:
http://dms.ntsb.gov/pubdms/search/h...=105&CurrentPage=7&order=1&sort=0&TXTSEARCHT=
The first responder interviews pretty much sum it all up.

 

[Flying]

From the Survival Factors Group Chairman's Factual Report:

The patient report from NorthStar indicated that the patient was delivered to the landing zone by a Cranbury BLS at 1:55 a.m. The patient report noted that at 1:55 a.m., two crewmembers from the Cranbury BLS removed the patient from the BLS. They started walking toward the helicopter with the patient, who was experiencing periods of combativeness, unsecured on a backboard with no cervical collar, no head immobilization, and no oxygen in place. The flight crew stopped the BLS crew, assessed the patient, secured him to the backboard, and put a cervical collar on him; they then moved him to the aircraft. At 2:05 a.m., the patient was loaded into the aircraft, secured, and placed on oxygen. A secondary assessment was begun. At 2:05 a.m., an IV was initiated, and the patient was placed on a cardiac monitor. The helicopter left enroute to RWJUH at 2:05 a.m. At 2:18 a.m., the patient was intubated and noted to be combative and to have a head injury. At 2:22 a.m., the patient was packaged for transfer out of the aircraft. At 2:25 a.m., the patient was removed from the aircraft onto a stretcher and transferred to the care of the trauma team at RWJUH.

Seems like an inference was made from the actions of the paramedics.

 

[triemal04]

The first responder interviews pretty much sum it all up.

Utter failure on the part of everyone on scene, including the paramedics.

I'd say that something was learned and now the various first aid squaddies, fire departments, and EMS agencies came up with an overall plan to guide largeish scale events, train together, and incorporate that training up and down the personell ladder...but I doubt it.