Car Accident W/ Entrapment

[fakingpatience]

Ok, so sounds like I am going to ask fire to take spinal precautions on all patients when extricating them. I'd let them decide who it is safest to extricate first, while telling them I would like the driver of the truck ASAP.

Gonna need both other BLS units, and the ALS back up. So far I see no reason why we have a time out listed for the burn center, none should need to go there above the level 1 trauma center, which is probably where we are gonna be headed.

For the woman in the truck: even if she smells of ETOH, I can't assume her inability to respond properly is due to the ETOH, since she likely has a head injury also. I'd also be concerned about a chest injury on her from the bent steering wheel.

[Timmy]

Control bleeding.

Cervical Collars all round.

Oxygen all round.

Methoxyflurance (inhaled analgesia, easy and effective to use for trapped pts) to who ever requires it.

Chopper can start moving based on MOI.

Any risk of crush injury?

Baseline vitals if we can.

Just BLS until we can remove patients from vehicles.

Remove patients with spinal precautions/KED.

Depending on how long extraction is going to be will depend on if I’m going to jump into the car, get lines in, get monitors on ect ect.

Until we can get these people free from the car and onto the stretcher it’s hard to examine the patients and get a good picture.

[scubanurse]

They might live at the accident location, had gotten into the car from inside the house, but hadn't yet opened the garage door, or started the engine.

now that's just crap luck.

[uglyEMT]

All very good points!

I listed burn center only because it was in my head LOL sorry about that. I know in my area the regional burn center also has a trauma unit so its a secondary site to send patients. My line of thinking was 3 patients, 3 traumas, one hospital may divert so want all my options available.

OK FD has no problem doing spinal precautions. FD Cheif agrees to take Patient 1 (truck driver) out first. The cut away the door, you have full access to the female now.

Patient 1

Upon entery RTA you notice:

There is blood in the left ear Right is clear

Pupils are dialating but are not reacting equally

There is blood in her mouth by it is clearing on its own due to head position

Palpation of the upper chest makes her moan but you feel nothing remarkable

Palpation of the abdomen revels rigid ULQ URQ

Pelvis is intact and stable

A compound leg fracture on the right leg of the tib and fib

Lower left leg is impaled on the emergency brake

Verbal is still unintelegable

Patient 2 and 3 are still being extricated during this time.

Patient 2

You are near the patient and speaking with him.

He is complaining of severe pain everywhere

Due to his position (foward and twords passengerside) he is also complaining of difficulty breathing

Keeps asking about his wife

Bleeding from the head is on the left side inside the hairline

No other bleeding is evident

Hard for you to really see the patient due to position

Patient 3

You are near the patient and speaking to her

She is complaining of arm pain you visually see deformity above the elbow below the shoulder noncompound

Shoulder is not in correct position

Also says she is numb everywhere else "feels like pins and needles"

Keeps saying she is sorry

No visable blood

Breathing is labored, rapid, shallow

Again they are still trying to get into the red car.

[Chief1C]

Even without basing any decision on Mechanism or colorful hours. Fly 1 & 2 to a level 1; and 3 to the Burn unit's level 2.. B/c it's going to be a b*tch to get them out, extensive extrication time. In my protocols, they would be flown based on the information posted.

Although, patient 3, assuming it's the car's passenger, is going to be the last out. Thinking from a rescue point of view, you wouldn't want to work from both sides, eg cut stuff open on both doors... Something will collapse.

[uglyEMT]

smart call on getting all 3 in the air. This will be a prolong extrication especially for Patient 3 the female red car passenger. Looks like she will actually need to be brought out from the drivers side. Even with cribbing the risk of collapse would be too great in my estimation. (I have no FD expereince so extrication is not in my SOP, just thinking it in general)

I will wait till a few more chime in. I think i have given enough information to begin to think about treatment. Vitals will come next and also what the trauma naked reveals. You all most already be thinking what might be under those cloths.