Triage scenario

[paramedicmike]

So I have the medic go to the unconscious dude with the OP and the EMT or medic partner check the dead guy because they aren't really dead until someone higher on scene than a first responder says so in my olde system. You gotta get a strip on the dead guy. So that's the reason for splitting the crew.

I get what you're saying, Mike. I think I misinterpreted your original comments. But my concerns about splitting a crew still stands even if there is valid reason for doing so (as there sometimes is).

I don't split crews if they are going to be far apart but if there are two cars in a wreck, they are probalby close to gether. I was assuming they were close.

That's the scenario as what I mentioned above. We were sent for a 2 car MVC. I took one car my partner went to the other. I still have no idea how it was that we couldn't see or contact each other.

Let me ask this mike

Let's say you are the first crew there. Do you and your partner go to the first car together and then to the 2nd car or do you stay split up and tackle one patent for each of you? That would be splitting up wouldn't it?

Before that incident I'd go to one car my partner would go to the other. Now, we both go to one then both go to the other.

[Bieber]

Let's say you are the first crew there. Do you and your partner go to the first car together and then to the 2nd car or do you stay split up and tackle one patent for each of you? That would be splitting up wouldn't it?

Not directed toward me, but I'll answer from the perspective of my system. We're very "ops heavy", and I don't think we can really wrap our heads around the notion that other systems of equal size may not be just like us. We also must have a lieutenant or acting lieutenant on every truck who is in charge of operational issues. In my system, in a multi-patient scenario like this, it would fall upon the lieutenant or acting lieutenant to sit in the truck and coordinate resources while the paramedic went and tended to patient care.

That said, with only two patients we'd both probably be on scene, but my lieutenant would probably step away after I gave my initial triage and focus on the radio for a moment while I worked on getting the second patient "packaged" with the help of fire crews.

It's not uncommon for us to split crews, and in fact there have been several times where I would be on scene tending to multiple patients while my partner sat in the truck and coordinated additional incoming units. In our system, this would continue until either we disbanded "medical branch" or until one of our supervisors showed up and "assumed" medical branch command.

Not saying it's the best system, and in fact I have a lot of beef with the ops heavy nature of our system, but just something to think about for people who are saying that both EMS personnel should go on scene.

Addendum: Also, the reason for the lieutenant to stay in the truck is because we frequently utilize scene specific channels to avoid flooding our primary EMS channel. Since we each only carry one radio on our persons, the lieutenant will scan both scene and primary channels using his portable radio and the on board radio.

[Asysin2leads]

This entire scenario rests on whether patient #1 is indeed pulseless and apneic. Detecting respirations and pulse outside, in a car, in varying weather conditions is rather difficult. Unless there is obvious signs of death, I'd prefer an assessment under controlled conditions and an EKG strip before I start throwing around the toe tags.

[Bernhard]

Regarding splitting up crews: been there, done that. Regularly.

Usually I'm the one taking command if #providers < #patients, since I've got the training and regularly do supervisor/commander shifts. Even, if I'm the higher leveled medic.

So, when arriving on a scene, I let my partner carry the medical stuff (jumpag, oxygene, cervical collar), I only take a notepad and a pen (plus a flashlight, if it's dark).

We both go to the first patient and check, if he/she's in critical condition. If not, we give tips to bystanders/firefighters for first aid and both move onwards to the next patient. On the first patient needing acute intervention, we split up - my partner starts treatment (even if he's only BLS licensed, but in almost every case my partners can handle at least basic issues including first steps in extrication scenarios pretty well) and I go to the next patient alone.

Often the first critical patient is laying beside others (i.e. one damaged car with several people in it), then my partner has to care for all of them somehow and I'd move on to the next bunch of patients.

From that on I won't treat other patients personally, only order bystanders or firefighters to render basic first aid. I would count patients (notepad is useful!) and get back to the ambulance giving report (we don't carry portable radios, yet). On my way back I usually check my partner's work and may update him on the scenario and maybe assigning him to another spot where his care is needed more (rarely).

After giving report it get's a bit tricky: with one eye I have to look at my partner, with the other eye check the bystanders/firefighters aid and with the third I look out for arriving other ambulances.

Those additional crews will NOT be split anymore, but assigned to critical patients, then to those my partner is working on (which are critical as well, see first step) and then to the remaining ones.

I use this if I'm the first EMS ambulance or in my first responder service. Works pretty well and organized. It gives a scene overview as fast as possible and does as much medical help as possible for the moment - including advising for first aid. But it has to be said, that we have additional ambulances only 10-15 minutes away and can call multiple helicopters within in a 15-20 minutes radius.

Only one incident I can recall where this went a bit strange was when I had a very new EMT on board (just his first day from EMS school). A byciclist hit by a VW bus, which flipped over (don't ask me how) and blocking the direct sight line between ambulance and patient plus a helicopter who needed constant radio contact because simply not understanding where to fly until he finally hovered directly over me (don't ask me why - had to explain our location in all possible and impossible ways). The bus' driver was uninjured so it was only one patient, happened to have a "standard injury" (broken leg, nothing more) and the new EMT did very good - but since I didn't know him and was supposed to supervise him I instantly grew grey hair not beeing able even to watch what happens.

[DFIB]

We split our crew frequently because there is usually no backup. We have to get it done with what we have even if it means one of us is on the road and the other is off in the bushes somewhere.

[Just Plain Ruff]

Yeah, my last service, we usualy split crews. We had one ambulance initially. If we needed a 2nd ambulance it was at least 10-30 minutes away.

So we had to split up. So one crew member went to one car and the other went to the other car or other area of the scene.

So we normally split the crews.

For services that have more than enough resources not splitting up crews it's not that big an issue.

But I do see everyone's points on splitting crews. The pro's and the con's.