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Two Vehicle MVC


Rezq304

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Ok, here's the scenario:

Two vehicle MVC, head on collision. Vehicles are a Honda Civic & a RV, older style with the wooden frame.

As you roll up on scene, you notice that the RV has been splintered into a million pieces and your scene looks like a disaster zone. You are the first of three ALS trucks within two minutes to arrive on scene.

Total of six pt's.

Pt 1-Driver of the Civic, 20yo female, shoulder/lap restrained.

Pinned between the seat and the steering wheel. Vital signs fading. Responsive to painful stimuli.

Pt 2-Rear passenger of the Civic, 3yo female, appropriate child safety seat.

Severe trauma to the upper torso, head & neck. AMS, Vitals falling, Child is not responsive to any stimuli just staring into space.

Pt 3-Rear passenger of the Civic, 4yo female, appropriate restraint system.

Obvious deformity to R forearm. Vitals stable. Pt is screaming "bloody murder".

Pt 4-Driver of RV, 40yo male, ejected from the vehicle.

Noticeable road rash on posterior of the body, Vitals are weak, but maintaining for the moment. AMS, incoherent speech. Odor of ETOH suspected.

Pt 5-Front Passenger of RV, 35yo female found seated in passenger seat of RV. Unsure of restraint.

Pt AAOx4 c/o bilateral ankle pain. Obvious deformity to both ankles. Pt c/o no other pain. Vitals stable. Odor of ETOH suspected

Pt 6-Rear Passenger of RV, 41yo male, unsure of restraint. Pt found within rear compartment of RV.

Pt AAO x person & time. Pt. c/o pain all over. Deformities to L thigh & L forearm. ETOH suspected. Pt vitals stable with exception of Hypotension and a narrowing pulse pressure.

Let's see how you'd work it.

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Pt 1-Driver of the Civic, 20yo female, shoulder/lap restrained.

Pinned between the seat and the steering wheel. Vital signs fading. Responsive to painful stimuli.

Pt 2-Rear passenger of the Civic, 3yo female, appropriate child safety seat.

Severe trauma to the upper torso, head & neck. AMS, Vitals falling, Child is not responsive to any stimuli just staring into space.

Pt 3-Rear passenger of the Civic, 4yo female, appropriate restraint system.

Obvious deformity to R forearm. Vitals stable. Pt is screaming "bloody murder".

Pt 4-Driver of RV, 40yo male, ejected from the vehicle.

Noticeable road rash on posterior of the body, Vitals are weak, but maintaining for the moment. AMS, incoherent speech. Odor of ETOH suspected.

Pt 5-Front Passenger of RV, 35yo female found seated in passenger seat of RV. Unsure of restraint.

Pt AAOx4 c/o bilateral ankle pain. Obvious deformity to both ankles. Pt c/o no other pain. Vitals stable. Odor of ETOH suspected

Pt 6-Rear Passenger of RV, 41yo male, unsure of restraint. Pt found within rear compartment of RV.

Pt AAO x person & time. Pt. c/o pain all over. Deformities to L thigh & L forearm. ETOH suspected. Pt vitals stable with exception of Hypotension and a narrowing pulse pressure.

work on getting patient 1 out.

Rapidly remove patient 2 out and put on next in als truck, also put patient 5 in that same als truck

Put patient 3 and 6 in next als truck

get number 1 out, put in your ambulance and put number 4 in your truck.

unfortunately number 1 and 2 are gonna probably die unless they get to the trauma center right away.

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I would give one and two the sheet then run the rest as Ruff placed them. The extrication is going to delay any treatment to them, and you have 4 other patients to look after till help arrives.

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Good call folks.....that's pretty much how it was worked....with the exception that we attempted to code Pt 2 when she crashed. Pt one was extricated post event. Pt 3 & 5 taken to local facilityfor stabilization. The other two were air lifted to Level 1 trauma center.

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I might have put the child screaming bloody murder in with the ETOH smelling one to make them suffer if the etoh person is the driver of the offending vehicle. Make them think about what havoc they caused.

So who was at fault?

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That is a thought. Actually the driver was one of the one's airlifted. And it stops and makes you think because I was the lucky sole that ended up working on the drunk driver. Almost makes you wish that you would've just left him there to die.

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My first thing it depends on how many other rescue persons that i have on scene and/or enroute. I'd at minium have 1 - 2 more units rolling to the scene, als preferable but bls works just as well. Well since we have 3 ALS trucks on scene, first truck takes Pt # 1 that is a priority 1 als with extrication needed. So truck 1 will be starting treatment and standing by with fire for extrication. Truck 2 will be dealing with pt # 2 in the back of the car, another priority 1 als trauma patient, they will be scooping the patient and gone. Here's the tricky part, truck 3 is going to take pt 4, road rash and weak vitals = another p-1 als patient, and also pt number 6 as it sounds likely for internal injuries. Now if i have another truck they get the rest of the patients, all p-2, all can be bls'ed if neccesary due to lack of ALS. If no other trucks available, i'd be looking towards the fire or PD for drivers, and truck 2 would have to take a second patient, pt # 3, get a fire or police driver if possible if not get going to the hospital. That leaves pt 5 to go with another truck if i could get one or if not the pt would either go with truck 1 or if it was extended extrication then we would have a truck cleared from the hospital.

The other situation that we have to looking at is Pt 1 with the extrication, if it's going to be more than 20 minutes on scene I want the bird now. Tough sceniaro, i'm new to this but thats the quickest way i can think of getting everyone to the hospital. Also well the ALS crews are dealing with the pt's fire would be assisting with the minor pt's and assisting the medics with the priority 1 patients.

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Sorry i didnt read all the replies until after my post, but it gave me some better ideas. I just don't know about the sheet and moving on thing, how many of you would be able to put a sheet over a 20 and a 3 year old trauma patient. I don't care how critical they are, 3 trucks and 6 patients there shouldn't be a reason to leave two pediatric patients (20 isnt really pedi but still), but i just wouldn't leave them for dead.

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