I nead your opinions on a MVA call that I went on.Thankx

[ghurty]

I was on a call the other day, and I was not happy by what happened. The Senior EMT has more field experience then me, but i have more educational experience. So I would like to hear what you folks would do. Ill try to paint a clear picture as possible.

I am a Vol. in a town where BLS is provided by volunteers, and ALS is based out of the hospital. There are different BLS squads covering the town, each one has its own area, but for MVA's or when one squad cant respond, it goes mutual aid to the other squads. Also, for MVA's and other "serious" incidents, ALS is automatically dispatched, but we can cancel them if necessary.

A call went out for an MVA in my area, no details on the amount/types of injuries. The call automatically went out Mutual Aid. I responded with another EMT in one rig, while a few minutes later another squad put in service another rig, as well as a rescue truck (Extrication, etc..). Upon arrival on scene, it turns out there was two vehchles involved, there were no passengers, just the drivers of the vehichles. One of them was up and about, no problem, his vehichle didnt have any damage. The other vehichle had smashed into a light pole. The airbag had deployed, and there as a starburst crack on the windshield. The drivers side door was messed up, so it would not open. The Patient had a laceration on her forehead from striking the windshield. There was a passerby (a vol. emt from a diffrent town) was in the vehichle maintaing manual c-spine stabilization. The patient was alert and responsive, she remebered getting into the car and driving, but she did not remember the exact details of the accident. The only thing she was complaining about was head pain.

So the drivers door could not be opened (without extrication equipment), but all the other doors could. Also between the drivers side, and the passengers, there was a non removable center console, about four inches higher then the drivers seat.

Responding to the call you currently have one BLS unit on scene, one BLS and Rescue unit responding (about 5 - 8 minutes away), and one ALS unit responding (Unknown distance).

Please tell me what you would do in such a case, and then I will respond by what happened, and why I did not like it. If you have any questions about the scenario, just ask.

Thank You

[Timmy]

I don’t know what your getting at, you’ve got an ambulance on scene with backup and rescue on there way??, what’s the problem? Does it really matter which service gets there first, as long as someone arrives on scene?

Well you’ve got that EMT maintaining C-spince, which is a good start. I’d make sure scene is safe, control bleeding, collar, 02, maybe some pain relief wait for rescue to arrive then extract the pt. Make sure the pt who’s up and about gets checked out (is there something your not telling us about this patient?)

Other wise it seems like a relatively normal call from the information you’ve given us.

Spill the beans what happened?

[ghurty]

Make sure the pt who’s up and about gets checked out (is there something your not telling us about this patient?)

No, my question is focused on the patient that is still in the car.

Spill the beans what happened?

I'll wait a drop longer to see the other responses

[afd216]

I'm guessing the patient was taken out the passenger side across the console instead of waiting on rescue to take the driver's door.

[canuckEMT]

The airbag had deployed, and there as a starburst crack on the windshield. The drivers side door was messed up, so it would not open. The Patient had a laceration on her forehead from striking the windshield. There was a passerby (a vol. emt from a diffrent town) was in the vehichle maintaing manual c-spine stabilization. The patient was alert and responsive, she remebered getting into the car and driving, but she did not remember the exact details of the accident. The only thing she was complaining about was head pain.

So the drivers door could not be opened (without extrication equipment), but all the other doors could. Also between the drivers side, and the passengers, there was a non removable center console, about four inches higher then the drivers seat.

Responding to the call you currently have one BLS unit on scene, one BLS and Rescue unit responding (about 5 - 8 minutes away), and one ALS unit responding (Unknown distance).

If she is alert and maintaining her own airway, I would keep the EMT doing manual c-spine and apply a NC, do a rapid trauma assessment, apply a c-collar.

Depending on the pain and vitals, I might consider some pain control. When rescue arrives, get them to do a roof flap and extricate via KED ( as she is stable and no indication of rapid extrication required). Still the possiblility of a TBI so reassess LOC often during the extrication. Hand off to ALS to transport and ready the unit for another call.

[alpha23958]

I don’t know what your getting at?

You see, in the US, if it isn't done by the book-or the way the patient seen it on TV, and it hurts the patient more, they sue your ass. Long as she isn't doing too bad, slow your ass down, and wait for the rescue. We don't load and go very often, best to be careful and not aggrevate hidden injuries.

I'd collar her, maybe some O2, don't go overboard on the class room stuff; KED the patient, and wait for rescue to pop the door. Then put the board under her bottom, and slide her a bit. Have a guy control the legs, and move her onto the board.

Or.. you can try popping the door w/ a haligar bar or a wreck bar.. what ever you carry on your rig.

[AZCEP]

Did the patient come out of the car with the same number of parts that she went into the car with?

Were all of said parts still functioning upon removal from the vehicle, and arrival at the hospital?

If you didn't like how the rescue was performed, why didn't you stop it while it was happening?

Why don't you ask the people that were there and saw what was happening, why they did what they did?

We don't know anything about how this scene was managed, and you are going to get some opinions you won't like. This thread will continue forever, because someone, somewhere will have another take an what should have happened.

[ghurty]

If you didn't like how the rescue was performed, why didn't you stop it while it was happening?

I attempted to, but his attitude is "my way or the highway", and there was nothing I could do about it (as he is senior). I thought perhaps I was the one making the mistake, so I decided to post here to see other opinions.

Why don't you ask the people that were there and saw what was happening, why they did what they did?

He was the one making the decisions, I went over to the other EMT (the bystander) he agreed with me.

We don't know anything about how this scene was managed, and you are going to get some opinions you won't like. This thread will continue forever, because someone, somewhere will have another take an what should have happened.

There are no opinions that I "wont like", like i said; I have allot of knowledge, but it is mostly classroom knowledge. I know that things are different in the field, so thats why I asked here, to hear other people opinions based on the voice of experience.

[akflightmedic]

Ok this would go a lot easier if you would tell the story, witholding you opnions, let us insert ours and then you can tell us yours instead of this guessing game because it will lead to nothing but confusion.

[ghurty]

Ok here is what happened.

Upon arrival on scene, and sizing up the situation, he got on the radio and confirmed that we had one BLS injury, and one ALS. He then canceled the rescue truck. He told be that he was going to get the PT out was as follows: Stick the board in from the passenger side over the console. When I expressed doubt about doing that, due to the possibility of a C-spine injury, he turned and asked the PT if her back hurt her, when she responded "no", he then stuck the board in, over the console, he then asked for her to lift herself up by standing up a little (This is while the other EMT was holding C-spine stabilization), so that he could stick the bored under her. We then collard her, rotated her on the bored, adjusted her, put on headblocks. The medics arrived as we were loading her into the rig. They assessed her, and released her to us. End of story.

My issue is that based on on the situation, there was no need for a rapid extrication. (she was completely alert and oriented). The Rescue truck was rolling already, and the door could have been popped very easily. We had a high index of suspicion that she could have had a c-spine injury (starburst on windshield, laceration on forehead) enough that the EMT started manual stabilization. I thought that we should have gone by the book; popped the door, put a collar on, put a KED on, then put her on the bored. We were anyways waiting on scene for ALS to arrive, and it would have only been a few more minutes until the rescue rig would have pulled up. Also, I don't think that asking a PT if her back hurts her is a good way of assessing for spinal injury.

And if for some reason there was a need for a rapid extrication, a different EMT should have gone into the car, and lifted her in a sitting position rather then asking her to lift herself up a little.

Please let me know if you agree with this, or if you have a different opinion, let me know why I was wrong in my thinking. I am always willing to learn.

Thankx