Sizing up an MVC

[SpongeDude]

I am still a big new in the game- Most of my calls have been medical- I now am in a system where more and more MVC's are common. We are allowed to respond to scene on non-duty nights to help- The big question I have is when approaching a scene as a first arriving EMT on a multi-vehicle/multi patient crash- What are the priorities or order of doing things?

For example- I arrive to find 2 cars and 4 patients all hurt in some fashion- Do I start evaluating each one for a quick 10 seconds or so to get an initial size up for the responding crew and then do stabilization of some kind??? If I do an initial size up on 4 pts' and find all are not hurt very badly but all have some neck/back pain- What is my next step? Tell them to all remain still and take Cspine on one person??

[hfdff422]

First thing is scene safety. Do you have PPE? Are there fuels on the ground? Do you have powerlines down? Is there anyone who appears suspicious (combative drunks)? Is there any odd smoke or sparks coming form a vehicle? Are there DOT placards on any of the vehicles? What may have caused the accident? These are things to assess prior to exiting your vehicle or an apparatus.

Next is give a brief radio report and ask for any additional resources that may be needed above the standard (tactical or box) response. Tell whether there are any vehicles that are inverted or on their side, how many vehicles, the way the may have collided, etc. Then guesstimate how many patients.

Next, approach the scene in appropriate PPE and triage the patients. If there are no serious injuries or life threats, then instruct the patients on what to do (stay in vehicle, exit the vehicle, stay still, or whatever is appropriate). If there are life threats to one patient (quick interventions can be done while triaging), you treat that patient to the best of your ability after triaging all the others. If there are life threats to multiple patients then, treat the one who you can make the most difference with- refer to START triage/protocols/common sense. If opening an airway is all the intervention they need, then they become the priority, -etc. there are chapters and entire classes on this. Direct the next arriving fire/EMS units to the next most serious patient(s). The walking wounded will have to wait until sufficient resources are available.

Finally- POV's rarely have a place on the scene of an emergency, unless you would have to drive by it to get to your station.

[Scaramedic]

If I do an initial size up on 4 pts' and find all are not hurt very badly but all have some neck/back pain- What is my next step? Tell them to all remain still and take Cspine on one person??

An old school trick is to tape their head to the headrest.

Having said that I am not a fan of off duty response. You need to verify a few things before you respond to calls off duty. Are you covered under insurance, both physically and for medical liability? The good Sam Law only covers you if you have no "duty to respond." If your going on scene under the guise of your department/company that is a duty to respond. If you get hurt on scene are they going to take care of you, or are you on your own? MVA scenes are inherently dangerous, that multiplies when you are on your own without the protection of a big vehicle with emergency lights lights all over it to block oncoming vehicles for you.

Peace,

Marty

:thumbleft:

[SSG G-man]

I agree to some extent with the responding from home to a scene. It is different if you are there when it happens, etc. My department chief has gone as far as to say we can not be in a POV at any scene in our first due. I guess he figures if we are within first due, report it and head to station so we can be there protected and with correct equipment, etc.

Heck, I wish we had more PPE going to MVA. I have been advocating keeping a set of turnout gear in the rig for use in MVA situation.

I always try to give as good a report as I can before leaving vehicle if we are first on scene, or report any changes from earlier reports. Nice thing about our ambulance is that they are big so we are pretty high up and can get a good look at scene.

[hammerpcp]

Your first step should be to skip around in a cirlce singing "No fire, No wire, No gas, No glass." :blob3: After doing this the scene will magically become safe.

[SooC]

(bet ya cant tell hammer was a lifeguard- only the lifeguards in my class knew that little saying lol)...we also included "guy with a gun" as part of our hazard check...might be more useful to our American friends

[Spock]

I respond to calls from home while off duty all the time. I call in with my portable and tell dispatch I'm enroute which covers me for insurance plus my bunker gear and first in bag is in my trunk. I only respond to calls that are priority one and are closer to my home than the station. I mostly drive at space normal speed and obey all traffic laws although there was the one time I followed a state trooper on the interstate at 100+ to a very bad MVC. He was pretty pissed when we pulled up on scene but he laughed when he saw me and I said "Couldn't you go any faster?" It helps to be the only medic in area driving a Mercedes especially since most of the local cops know my car as well.

All of that said, the bottom line is: 1. Give a good windshield report.

2. POV's on scene should be the exception and not the rule.

3. When responding from home whatever you do don't get on scene first!

Live long and prosper.

Spock

[EMT001]

I have been advocating keeping a set of turnout gear in the rig for use in MVA situation.

Woah...You don't keep turnout gear in your rigs? How do you protect yourself from broken glass and other hazards while on scene? What do you wear if you are in a vehicle holding C-Spine during an extrication? We keep three sets of turnout gear in each of our ambulances, safety vests too.

[Dustdevil]

Woah...You don't keep turnout gear in your rigs?

Most non-FD ambulances do not. While I have been in many situations where it might have been nice, I have never been in a situation where it was absolutely necessary. In fact, I've been in many situations where it would have been a hindrance.

Most places I've worked, the firemonkeys took care of all the extrication anyhow.

[SSG G-man]

We are a Fire Based EMS department. We have jumpsuits or what is termed "foul weather gear" to wear on calls. If going in a car during extrication, we have helmets and safety glasses/goggles to wear. Having turnout gear to wear seemed like a no brainer to me, but maybe that is the military Risk Assessment training coming through (Or could it be the uncommon quality called Common Sense).

Sarge