Scene control

[Jwan]

my first task may be different from other people's. It may be in this FF's protocols to stop and render aid off duty if he is in uniform.

I was simply making a statement about what can be done by a bystander. What should or shouldn't be done is a value statement and has a lot of factors. I was also making a statement that trying to do any sort of assessment (on or off duty) is going to be extremely difficult on this patient until he is somewhere he can be assessed properly.

Agreed, he may be required to render aid, my point is simply that IMO the best type of aid rendered in this situation would be to stand by the patients side and observe/assess what you can from where you are, do your best to controll the crowd and keep them from yanking him out from under the vehicle and leave the rescue to those responding to the call.

On a side note I do appreciate your take on this, this is afterall what a discussion needs to hold value, two or more opposing takes on a situation

 

[LACoGurneyjockey]

Agreed, he may be required to render aid, my point is simply that IMO the best type of aid rendered in this situation would be to stand by the patients side and observe/assess what you can from where you are, do your best to controll the crowd and keep them from yanking him out from under the vehicle and leave the rescue to those responding to the call.

On a side note I do appreciate your take on this, this is afterall what a discussion needs to hold value, two or more opposing takes on a situation

Ok, so let's say you can assess him, even though you can't. What exactly are you going to look for, with him in full gear and a full face helmet, pinned under a car? How would you control this crowd as a one man show?

 

[Jwan]

Ok, so let's say you can assess him, even though you can't. What exactly are you going to look for, with him in full gear and a full face helmet, pinned under a car? How would you control this crowd as a one man show?

Not to be an *** but lets look at it this way. Your not the responding unit, it is THEIR job to do a thorough assesment. You, the bystander, can assess what you CAN prior to them arriving. What do you see? blood? Any evidence of broken bones? Is the patient alert? Can they follow commands? Are they able to move their extremities?

All of these are assesments and although you cannot fully assess the severity of any injuires you can still monitor the pt for significant changes. Has he had LOC?

A simple quick check seeing that the pt is verbal, actively moving arms and legs and groaning/ forming words tells me for the moment, he is stable. Is that subject to change? sure, but right now he's stable.

After observing this, turning to the bystanders and instructing them to leave the pt as it can cause further injury to the pt or themselves if they try to extricate would be my next step. Once the crowd can be controlled continue to monitor the pt THE BEST YOU CAN from where you are untill help arrives.

 

[LACoGurneyjockey]

Yep, those are all assessment findings. But what are you going to do with that? If he wasn't answering questions, or you could see blood soaking thru his (very thick) gear, would you then try and extricate him with the jack? Or would your course of action remain the same? What I'm getting at is that as long as he is under the car, you can assess everything from his respiratory rate to how he matches helmet and jacket. And yet you can't do anything for him. So either you A). Do nothing for the patient and play highway patrol trying to control the scene. Or B). As safely as you can with what's provided attempt to extricate him, so that all those assessment findings can be turned into patient care.
If I show up on scene of this call, I really don't care what you were able to observe on him under the car. Not because I don't trust you, but because he is entirely covered up by his gear (and a car), and because his condition may very well have changed. I'll start my assessment from the beginning either way (after we extricate). So either control the scene and get people back, or try and use the few useful ones to help extricate him so you can actually treat anything that may be wrong with him (which for this scenario is really just CPR and direct pressure).

 

[Mufasa556]

You may have the best command presence in the business, but it still may not be enough to control a crowd of good samaritans. Especially if they feel you're not doing anything and decide they're going to do their own life saving thing anyways.

 

[Jwan]

Yep, those are all assessment findings. But what are you going to do with that? If he wasn't answering questions, or you could see blood soaking thru his (very thick) gear, would you then try and extricate him with the jack? Or would your course of action remain the same? What I'm getting at is that as long as he is under the car, you can assess everything from his respiratory rate to how he matches helmet and jacket. And yet you can't do anything for him. So either you A). Do nothing for the patient and play highway patrol trying to control the scene. Or B). As safely as you can with what's provided attempt to extricate him, so that all those assessment findings can be turned into patient care.
If I show up on scene of this call, I really don't care what you were able to observe on him under the car. Not because I don't trust you, but because he is entirely covered up by his gear (and a car), and because his condition may very well have changed. I'll start my assessment from the beginning either way (after we extricate). So either control the scene and get people back, or try and use the few useful ones to help extricate him so you can actually treat anything that may be wrong with him (which for this scenario is really just CPR and direct pressure).

Blood through the thick gear and still responsive like he was? I'm still not touching him as whatever is bleeding could potentially be aggrivated by extricating him and without the ability to start a line for fluids/blood products then what?

Extricating the pt no matter what his condition results in a "then what" scenario, no matter what his problem is you cant do anything and you might of further caused injury and theres nothing you can do about it until help arrives so why not leave the pt where he is since he is for lack of a better term "fine" (other than the fact that hes trapped under a car). Bottom line is even if you have the ability to extricate once you do there is nothing you can do for the pt post extrication untill help arrives (other than CPR and direct pressure, which where would you apply direct pressure since you cant see the source of the bleed? are you then going to remove garments and further dig yourself a hole?)

So with this reasoning, you arrive on scene and I relay to you that the pt was A&Ox3 and respirations were around 24, the pt had full movement of legs and arms, however 2min prior to you arriving the pt had LOC. This assesment is useless?

Theres nothing wrong with gathering any information you can and monitoring the pt once the scene is controlled. If theres NSTR then so be it but a recent LOC, how long the pts been down, and the Pts abilities to move extremities are some good peices of information to pass along regardless if your doing anything with them or not, one cannot assume the paramedic on scene will "find it out on his own". The only situation in which extrication would be absoultely nescessary IMO would be if the pt is not breathing or any other signs point to cardiac arrest or a comprimised airway in which case by all means pull him out because seconds count and if your willing to risk yourself (which we have all agreed we are by the type of work we do) then go for it.

 

[escapedcaliFF]

Having pulled up to an accident in a type 6 engine by myself when I worked for FD I will tell you that bystandards can be a pain. However once I have expressed my command presence they tend to back off. I once had a guy push me aside and attempt to pull a PT from a vehicle. I was stabilizing the PT cause his leg was pinned. He literally threw me out of the way. I went off on him big time and a couple of the bystandards stepped in and got him back. Luckily PD showed up pretty quick after that. Off duty I don't stop if there's already people stopped just to much of a pain and odds are EMS got called. No reason to add to the confusion in dispatch with probably 10 callers already on the line. Also the more people stopping just makes it more unsafe. Why do you think they park the type 1 engine at the rear of the all the stopped EMS vehicle's? It's so if somebody hits it at least it won't turn into a missile killing the EMS personal. If your off duty and other people already stopped then stopping on a high speed road is just stupid. Plenty of cops, fireman, and EMS have been killed already cause of secondary crashes.

 

[Tigger]

You may have the best command presence in the business, but it still may not be enough to control a crowd of good samaritans. Especially if they feel you're not doing anything and decide they're going to do their own life saving thing anyways.

Pretty much this. The OP talks about how the scene should be managed as if it were that easy, it's just not. I think that's the message here. I have stepped off the ambulance and struggled to control large groups of bystanders despite being in uniform, with equipment, and a big truck with flashy lights. People in panic are unpredictable.

 

[escapedcaliFF]

Pretty much this. The OP talks about how the scene should be managed as if it were that easy, it's just not. I think that's the message here. I have stepped off the ambulance and struggled to control large groups of bystanders despite being in uniform, with equipment, and a big truck with flashy lights. People in panic are unpredictable.

I'm going to deffiently agree with you. Especially if someone in the crowd knows the PT.

 

[epipusher]

Its ok, hes ok. He gonna be alright.....

 

[Jwan]

You may have the best command presence in the business, but it still may not be enough to control a crowd of good samaritans. Especially if they feel you're not doing anything and decide they're going to do their own life saving thing anyways.

Pretty much this. The OP talks about how the scene should be managed as if it were that easy, it's just not. I think that's the message here. I have stepped off the ambulance and struggled to control large groups of bystanders despite being in uniform, with equipment, and a big truck with flashy lights. People in panic are unpredictable.

You're right, it is not easy to control large groups of bystanders and I agree that sometimes you just can't get a handle on the crowd. However IMO and again it's just my opinion, if placed in this same situation, after noticing the pt had no immediately apparent life threatening injuries and having no standard equipment or qualified supportive personell nearby, turning your focus to the crowd who is currently attempting to yank the pt out from under the vehicle and attempting to establish some form of control and reasoning as to why the pt should remain where he is untill help arrives would of been the best course of action.

Who knows, maybe they wouldn't of listened, maybe they would of, either way it was a free-for-all and could of been a much worse situation had that lone jack been knocked out or if the pt had more severe yet non noticable injuries causing him to hemorrhage and they are now faced with controlling bleeding untill EMS does eventually arrive.