Two Vehicle MVC

[HF-EMS]

Everyone is missing a pretty important point.

Regardless of what 3 rigs equals, be it three medics, and three basics; 6 medics, or 6 Emergency physicians and trauma surgeons, three of them have to drive the ambulances to the hospital. If you put one critical pt and one not so critical pt in the ambulance; then the medic may not be able to adequately care for both patients, especially with pts one and two which will require almost exclusive care. Now you just put in possible jeopardy, the lives of the patients in the ambulances with them; or at least potentially denied them the care they really need.

Now with pt one, she might be responsive to pain right now, but she is suffering from a crush injury. The reason she is altered(other than possible head injury) and that her vitals are falling is because the seat and steering wheel that are pinning her in place are probably the only thing keeping her alive.

This poses two separate problems:

Pt one is an ALS patient, who is going to be a prolonged extrication, and according to the scenario Fire/Rescue hasn't even arrived on scene. You wanna use a bird? What if they are a significant flight time out? Besides, the pilot of the chopper can cancel for any number of reasons, if that happens, you are caught with your pants down around your ankles waiting for and counting on something you're not getting. SO while you wait for the chopper, and fire to come extricate the pt you loose one medic, poof, and (assuming the 3 medic scenario to make the point more dramatic) you are down a third of your ALS to 2 medics which can work up patients. This is a pointless loss when you consider point two.

As soon as you remove the impingement from the pt there is a good chance that she will crash from hypovolemia and exsanguinate. Also much like the application of a tourniquet, there is build up of toxins, and lactic acid on both sides of the impingement, releasing the pressure can cause severe acidosis and toxic shock. Not to mention throwing numerous clots all around the body. Well the argument can be made that the medic had plenty of time to get bilateral 14g IV's. Well all that'll do is replace what was blood with saline and push away whatever clots had formed and were helping to keep her alive.

I'm not saying that saving her is impossible, but not knowing what additional resources you'll be able to get, with 5 other pts, some critical, all with the potential for crashing due to the MOI, attempting to save her is by far not the most appropriate distribution of your resources.

With pt 2, the death of a child is horrific, but you have to remember peds. don't crash till very late, and this kid is crashing, this means irreversible shock, if not knocking at that door, again taking away a medic on one patient when they could be better used.

Please don't mistake my post for callousness or coldness, leaving a child who is not pulse-less with a black tag is something I dread. But you have to appropriate your sources so there is the smallest potential risk for loss of life.

The ability to make those decisions can only come with a lot of experience and the confidence to believe in what you feel is the right thing to do. Don't criticize people like PRPGfirerescuetech for making that call seemingly so easy, it takes a lot to make that call.

Its also easy for us to judge without being there. Lets all keep that in mind.

[temsp40]

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.

Establish EMS command, triage all your patients

#1 -- black tag -- to many resources required (at this time)

#2 -- red tag -- although may deteriorate to black tag if no units in a readonable time

#3 -- green -- can wait

#4 -- red tag -- vitals n/g

#5 -- green -- ankles are not a priority

#6 -- red tag -- Cushings Triad beginning?

You need a total of 5 additional units (air/ground)

Patient 4 or 6 will go with the first air unit -- depending on revaluation of triage with the support units arrival.

Patient 4 or 6 (who ever is left over and is NOT black tagged) will go next

Patient #2 next

Patients 3 & 5 will go together

Patient 1 will be revaluated after either (a) all other patients transported or ( upon completion of extrication.

One theme that is not being explored here is how appropriate the triage is. Unfortunately the trapped driver and the 3 y/o are probably going to die because you do not have the appropriate resources to treat them all immediately, and both seem to be requiring extensive treatments. I, personally, would have a HUGE problem deciding not to work a 3 y/o, but that is the role I have accepted as a medic.

Remember -- The most good for the most people.

P40

[Ace844]

[Mikeyg]

call for backup.

pt#1 rapid extrication, pt has possible shock? lots of trauma?? air lift

pt#2 rapid extrication. pt has severe trauma. by the sounds of it, there is severe neuro trauma. i would request air lift as well as pt 3 go along.

pt#3 has minor damages out of other pts in the vehicle. child is screaming because they are scared. calm pt as much as possible.

pt#4 air lift. no questions

pt#5 ground transp

pt#6 ground transp

I don't know any other information.

Sounds like a bunch of drunk old men gone fishing and drinking ended the night short. Little to say, looks like they tore apart a family.

[brock8024]

Ok I was not going to post on this but after reading what others have wrote I figured why not.

1st everyone is assuming that the people with the smell of ETOH is at fault. I do not believe it was ever said who was at fault, but I do not think it really matters. We are not judges we are professionals who chose a awesome line of work. We are there to help people no matter what. Let me give everyone a possibility and see if that changes things. Lets say that the drive that smelled of ETOH was not drinking but had been at a party and was the designated driver. Someone spills beer or what ever on him. He can smell of ETOH but does that mean he had been drinking. NOPE. 2ND I do not have kids but have seen some parents turn around to the back seat and give their baby something or try to calm them down while driving. So lets say this is what the mother was doing and went into the other lane and hit the other people. Is this possible YES. If this is how it happened would that change how you treated the Pt's. I would hope not. Like I said we are there to treat people not to let our emotions take over and things. This is how I would send the Pt's to the hospital.

Pt #1 blk tag. Like others have said she needs a lot of treatments and resources are limited. so if she is still breathing when others are taken then treat her then.

Pt #2 Blk tag. Think about it, this kid is bout to code which is going to take at least two members to work her to the hospital. And if I am coding a kid I personally would not want any other Pt's in the truck. Plus she has trunk, neck and facial trauma, she is going to be hard to get a airway on and are her injuries compatible with life?

Pt #3 she has a broke arm so she can go with Pt #5 with the broken ankles. both need to go code 3 L&S.

Pt #4 he had a lot of road rash which I have been taught to treat like a burn. He now has a very increased risk of infections, Fluid loss.

Pt #6 he is another that I would worry transporting with another pt in the back. It sounds like he has either a tension pneumo or cardiac tamp.

If there was a chopper then i would send Pt #6 and Pt #4 due to the road rash.

Patients # 3 and 5 are going to go by ground code 3

Patients 1 & 2 are going to go either to the morgue or code 3 depending on how they are after the others are off the scene or are leaving the scene.

Now please do not get mad at me for any of this but by reading what others have wrote it seemed that a lot was assuming what had happened and who was at fault. It really does not matter or should not matter to us who is. We are there to help people not judge them. I would hate to ever have to make the choice to blk tag a child. but I guess we have to trust in God or what ever you believe in to guide you to do the right thing. I read our code of ethics and no where does it say that we are to judge before we treat but to do no harm.

[Rezq304]

Ok I was not going to post on this but after reading what others have wrote I figured why not.

1st everyone is assuming that the people with the smell of ETOH is at fault.

As a follow-up, multiple eye witnesses stated the RV veared into on-coming traffic. Also, multiple eye witnesses placed the vehicle just prior to the event swerving almost causing two wrecks prior to the one listed here.

[brock8024]

i guess my point as that not always are they going to be at fault and it does not matter. we are there to treat patients not found out who is at fault or to judge them.

[Rezq304]

i guess my point as that not always are they going to be at fault and it does not matter. we are there to treat patients not found out who is at fault or to judge them.

I never said that you should pass judgement. I'm just saying that it's kind of disheartening knowing that the person that you're attempting to save, just took two other lives.

[brock8024]

I know what u mean that would be hard to do. I guess it was just peoples judgment with out knowing who was at fault and just assuming. but i fully understand. I think it would be very hard esp when a kid in involved.

[Asysin2leads]

Fuck it, call for two more ALS buses, treat the 20 year old, 4 year old, and 3 year old. Let the guy from the RV die. He's old and he shouldn't have let his friend drive. Lose certification, go home, sleep soundly, apply for job at Denny's.