Would you put tools to the car in this MVA?

[DrParasite]

Have a question for the community, a "how would you handle it."

Dispatched for an MVA on a major highway, for PD o/s confirming an OT vehicle.

Rescue arrives with 5 FFs, finds the car overturned resting on it's hood, with damage to the roof. Rescue goes to work stablizing the car with step chocks and struts.

Engine arrives with 7 FFs, pulls a line, and assist with patient assessment (by trained EMT personnel) (and have 3 Rescue trained FFs standing around doing nothing). EMS is not on scene yet. Interior crews report the patient is not physically entrapped, but is being held in her seat by the seatbelt, and only has minor injuries

here is the question: would you have removed the doors to make it easier to remove the patient on a backboard (and pull the patient out at a 90 degree angel), or would you leave the doors and work around them (they can only open at a 60 degree angle due to being against the pavement)?

 

[Shishkabob]

Complaining of neck and/or back pain?

 

[Medic Tim]

Complaining of neck and/or back pain?

I was thinking the same thing.

Rule out cspine if vitals are good and no neck/back pain.

 

[STXmedic]

As long as time permitted (read: patient is not about to catch fire), I would probably take the door off either way. Just takes a minute (especially with that many guys on scene) and makes the extrication of the patient that much easier.

 

[Aidey]

"Ma'am, are you having any pain in your neck or back? Any numbness or tingling anywhere? Can you move everything? Ok this is going to be awkward, but we're going to get you out in about 2 minutes."

*snip*

 

[MS Medic]

As I'm not a FF and am not trained in mechanical extrication, I have to say that I would have no placed making a call like that.

 

[exodus]

Lop 'dem doors off! Let the FF's play with their big tools! Vehicles totaled already because it's a rollover. And why not make it easier (read, safer) to extricate by making more room?

 

[Shishkabob]

As I'm not a FF and am not trained in mechanical extrication, I have to say that I would have no placed making a call like that.

Actually, the Paramedic on scene with the rest being EMTs SHOULD have the ultimate decision in ALL things patient care related... that doesn't mean you ignore all other sides, but you're the one with the final say. My protocols say the same: Fire is incident command, but patient care is up to the ambulance Paramedic. In case of conflict, Paramedic has the final say.


The President has never served in the military, but he has the final say in what it does, after he listens to his staff.




If patient is stable, why aren't they using the KED?

 

[MS Medic]

Actually, the Paramedic on scene with the rest being EMTs SHOULD have the ultimate decision in ALL things patient care related... that doesn't mean you ignore all other sides, but you're the one with the final say. My protocols say the same: Fire is incident command, but patient care is up to the ambulance Paramedic. In case of conflict, Paramedic has the final say.

If patient is stable, why aren't they using the KED?

The OP stated this all occured before EMS arrival. All I was saying is that I have no training and I would be making an uninformed decision to say if the FF on scene should or should not have done something, not that it should or should have been done.
When I'm on scene of an MVC that needs mechanical extrication, I talk to FD and say rolling the roof, cutting a post, etc. would be best for extricating the pt. Once we agree on that, I pipe down and let the trained trained personnel do their thing.

By the way, ditto on the K.E.D.

 

[Bullets]

Besides being upside down, what are the pts complaints?

I most likely wouldnt cut the doors unless there was a life threat. I would rather just invert ont a reeves or LBB and slide out the windows. Ked only if indicated

 

[Shishkabob]

Ked only if indicated

KED is indicated for anyone that does not require a rapid extrication.

 

[DesertMedic66]

KED is indicated for anyone that does not require a rapid extrication.

Pretty sure he was saying if indicated as in "if the patient is complaining of back pain/ possible spinal injury".

 

[feldy]

If there is trauma present and pt needs rapid extrication, then stabilize car, see if the doors open (a common mistake) if not decide if it would be easier to go through the windshield or doors. if doors, then cut the doors where necessary, either A and B post or even all ABC posts. Worst case scenario...gonna have to somehow cut through the bottom of the car.

MOI is enough at least in our protocols that we would backboard the pt even if they are not complaining of neck or back pain. We would be questioned by MDs at any hospital as to why they were not boarded and collared.

 

[Craig Alan Evans]

Cut the car. It's totaled anyway and it will make patient removal easier on the patient, and the crews.

 

[Bullets]

Pretty sure he was saying if indicated as in "if the patient is complaining of back pain/ possible spinal injury".

This, i am a huge fan of the KED

MOI is enough at least in our protocols that we would backboard the pt even if they are not complaining of neck or back pain. We would be questioned by MDs at any hospital as to why they were not boarded and collared.

A.) Your protocols need changing if they actually require you to backboard a patient based on MOI

B.)If you have a reasoned explanation that is well documented there shouldnt be any questions.

In this case the patient is restrained, and lets say they have no complaint of neck or back pain, no neuro deficits or AMS, LOC, maybe their only medical complaints are some minor lacs from broken glass, i would see no need to SMR the patient.

 

[Backwoods]

Id take the doors off.......why? Cause I like to play, but in all seriousness if the car is totaled, why make it harder to get the patient out?

 

[abckidsmom]

We just did this a couple of weeks ago. Take the doors off. At the very least the one the patient is coming out of. And with that many guys standing around, take all the doors off and the roof, too, after the wrecker flips it over!

 

[Bullets]

Id take the doors off.......why? Cause I like to play, but in all seriousness if the car is totaled, why make it harder to get the patient out?

Why? just to ruin the FDs day and its an extra time consuming step i dont need to remove the patient from the vehicle.

 

[exodus]

Why? just to ruin the FDs day and its an extra time consuming step i dont need to remove the patient from the vehicle.

How would that ruin the fd's day? They love cut'n'rescues.

 

[Tigger]

Why? just to ruin the FDs day and its an extra time consuming step i dont need to remove the patient from the vehicle.

Wouldn't it take a literal minute to cut the big with a cutter or even more simply to throw a ratchet strap on the door and front bumper and pull the door right open?