Just Plain Ruff Posted July 18, 2007 Share Posted July 18, 2007 12am in the morning. Small rural county, One ambulance on duty, one crew for backup Major divided highway runs through the county. Closest additional ambulances Town 1 - 30 miles south (5 units avail) Town 2 - 25 miles north (4 units from one service, 2 from 2nd) Town 3 - 34 miles east (2 units) Town 4 - 12 miles north (bls unit only) Helicopters - 4 (all 30-100 miles away) Small volunteer fire department with one set of extrication tools (covers the entire county) Next fire departments are in the above towns with one town having a heavy rescue unit Greytrailbear(name changed to protect the innocent) Bus line with as many as 45 people on board Initial call comes in that the bus has driven between the bridges and gone down into the water. This was at highway speed and we all know that the buses drive 70 miles per hour and not any higher. What do you want to know? Link to comment Share on other sites More sharing options...
flight-lp Posted July 18, 2007 Share Posted July 18, 2007 1st question in my mind would be why these cheap ass people didn't spend a couple extra bucks and fly Southwest?????? LOL That sucks, guess its gonna be one of those nights............... Pull both of your units, both available rescue trucks. Get a heavy duty wrecker out there to pull the silver bullet out of the water or out of the ditch. Senior fire officer is IC, senior medic is medical sector, his partner can start triaging once access to pts. has been made. Start maybe 2-3 mutual aid units and put your helicopters on standby. Have the BLS truck respond to rehab on scene workers and provide extra hands. Contact the local school district, get a bus or two out there to utilize for transport. If it turns out to have a large pt. count, consider any available local military resources. Page out all available personnel for manpower and have a chief officer (someone with a clue on MCI scenes) set up a personnel section and transportation section. Increase or decrease your needed resources as required. Return to service in time to go get a couple of donuts and a cold beer! Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 18, 2007 Author Share Posted July 18, 2007 Dang, you stole the thunder LP Link to comment Share on other sites More sharing options...
EMSGeek Posted July 18, 2007 Share Posted July 18, 2007 Given the potential mechanism and chance for a large number of patients I would request all available ambulances from the surrounding area and get the helicopters in the air. IC would need to find out the receiving numbers for any hospitals in the area, especially trauma and burn centers. LEO would need to be present in force on scene to keep things under control. I'd be concerned about family going to the scene. Additionally put other rescue units on standby should we need multiple extrications. Perhaps get the Red Cross involved since there may be people who don't need a hospital but will have no where to go for a while. The Red Cross will also be able to provide grief counselors and folks of that sort. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 18, 2007 Author Share Posted July 18, 2007 the bus is from 700 miles away from the crash scene so I suspect there would be no family arrive during the incident. There are indeed 42 people on the bus. The bus is imbedded on it's side in the opposite side of the creek it landed in. The bus driver is obviously DOA as he is crushed between the bus and the embankment. you can see massive open head trauma You see about 10 people all crumbled in the front of the bus. There are passenger seats and passengers all muddled together where the bus driver normally sits. Quick assessment of those patients show 5 black, 3 reds and 2 yellows. All the windows are shattered or open or torn off. You can see multiple patients about 15 that were ejected from the windows. Triage teams show these patients as 2 blacks, 5 reds and 5 yellows There are 5 walking wounded with lacerations, bruises, open and closed fractures of the arms and legs. Triage teams show these all as either yellow or green Still even more people are inside the bus still in their seats or on the floor of the bus. You have yet to get inside the bus. There may be people trapped under the bus you won't know until the bus is moved. You place all your available helicopters on air standby Are you sure you want to put the heavy rescue truck on standby or do you want them rolling towards the scene You have requested all the available ambulances to respond to your location. You have effectively taken every available ambulance from 4 surrounding counties thus leaving those counties without ems resources. Are you sure you want to do that? Link to comment Share on other sites More sharing options...
whit72 Posted July 19, 2007 Share Posted July 19, 2007 I would quit After the beers and donuts got their of course. Has the bus already exploded? No ones on standby, get the birds in the air and get the rescues rolling, trust me you are going to need them. Call a private ambulance company if possible they can mobilize quicker, they have much more resources at their disposal such as equipment and manpower. Dont strip the surrounding areas if you don't have to, that just creates another problem. Link to comment Share on other sites More sharing options...
EMSGeek Posted July 19, 2007 Share Posted July 19, 2007 Given the new information I will have the rescue trucks respond to the scene as well as getting the helicopters in the air. I am going to continue the ambulances to the scene. I feel the needs of these patients outweigh the possibility of a call in the surrounding area. I'm not sure if it is common practice but in my area the dispatchers will have begun tracking available resources and will stage ambulances from further areas in the areas which no longer have ambulances available. Request any available military helicopters with or without medical personnel but with the ability of transporting patients to be readied and I will pull medics from some of the ambulances as needed. Have the IC start relaying initial casualty numbers to receiving hospitals so they can prepare themselves. Once arriving on scene and seeing that this truly is a MCI I would "declare" a level 1 MCI which puts certain protocols into effect (this may be specific to my area). Request that the FD stabilize the bus enough to get those people inside out. I think we need to get them out before we can tend to those that may be under the bus. Ensure trauma centers in the area know they will be receiving multiple critical patients thereby giving them time to bring in extra hands. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 19, 2007 Author Share Posted July 19, 2007 Given the new information I will have the rescue trucks respond to the scene as well as getting the helicopters in the air. I am going to continue the ambulances to the scene. I feel the needs of these patients outweigh the possibility of a call in the surrounding area. I'm not sure if it is common practice but in my area the dispatchers will have begun tracking available resources and will stage ambulances from further areas in the areas which no longer have ambulances available. Request any available military helicopters with or without medical personnel but with the ability of transporting patients to be readied and I will pull medics from some of the ambulances as needed. Have the IC start relaying initial casualty numbers to receiving hospitals so they can prepare themselves. Once arriving on scene and seeing that this truly is a MCI I would "declare" a level 1 MCI which puts certain protocols into effect (this may be specific to my area). Request that the FD stabilize the bus enough to get those people inside out. I think we need to get them out before we can tend to those that may be under the bus. Ensure trauma centers in the area know they will be receiving multiple critical patients thereby giving them time to bring in extra hands. ok, you have no military helicopters within 150 miles You have 6 trauma centers 50 -75 miles away You have 2 trauma centers 75 -85 miles away The surrounding counties know where their ambulances are and what they have available You get a total of 9 ambulances responding You have 4 helicopters coming Heavy rescue is on the way What else do you want to know or what are you gonna do? Do you want to know anything about the nearest hospitals and what they can take? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 19, 2007 Author Share Posted July 19, 2007 ems geek I didn't see one of your items the closest hospital 12 miles away is a small community hospital with a 8 bed Ed and a 4 bed ICU. 2 beds in the ICU are occupied There is a small outpatient clinic attached to the hospital which has 5 beds. They operate on a shoestring of a staff that includes 1 nurse and physician in the ER sometimes 2 nurses They ahve 4 nurses on the floor and 1 nurse in the ICU. At the time of the call they have one patient in the er. There are 4 community physicians in town who can come into the er as needed for coverage. There are 20-25 nurses and techs who live in town that can assist if needed. The trauma centers have been alerted and all 8 trauma centers say that they can handle whatever red patients you want to send them. there are 3 hospitals within a 30 mile to 50 mile radius and are all able to handle what you want to send them. So here is what you have responding You have 2 ambulances coming from the east which are hospital based ambulances You have 2 ambulances coming the town from the north and a hospital in the town they are from You have 4 ambulances coming from the south with a 18 bed ER in the same town You have a bls ambulance from a town between yours and the city to the north. You have 2 ambulances already on scene with a total of 4 paramedics on board You have called in all the available resources you have for EMS and that includes 3 additional ems crews with 3 ambulances. So you actually have a total of 12 ambulances responding with varying ETA's. Link to comment Share on other sites More sharing options...
EMSGeek Posted July 19, 2007 Share Posted July 19, 2007 Definitely need to know what the hospitals can take. Any hospitals in the area which are not trauma centers also need to be notified of the possible numbers which they might receive. Treat/package the patients. Stop the bleeding. Prevent shock as possible. Limit exposure to the elements. If an MCI trailer exists have it brought to the scene. The IC will be tracking where patients are going so now the only thing to do is to save as many lives as possible and get everyone to the hospitals which will best serve them. Link to comment Share on other sites More sharing options...
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