Rescue in the EMS System

[VaREMS1]

There's an issue that we're looking at locally, and I wanted to gather some input from other EMS, and/or Rescue providers.

When at the scene of an MVA (Motor Vehicle Accident), who handles extrication? Does your EMS agency cut up the car, or is that the FD's responsibility?

Additionally, if your FD handles it, how is that working for you? What kind of agreement/SOP is in place concerning this, if any?

Also, if YOUR agency handles VehExt, what role does the FD play when on scene, if any?

I realize that the "M" in EMS stands for MEDICAL, not MVA Extricator, and that many of you probably feel that EMS should have nothing to do with it, maybe...and you're probably right. I didn't go to school to cut up cars either.

We're trying to overcome some problems here, and if a FD who is supposed to handle extrication, isn't fullfilling their side of the agreement, ie: sending people untrained in extrication, to the scene of an MVA with the rescue truck, which then means we can not remove the patient, unless somehow, by an act of god, the patient extricates themselves. Something's gotta give.

PS: I noticed that this issue is lightly talked about recently, in the Rural EMS forum...but not enough for my needs, and not vehicle-recue specific...more of an all-encompassing rescue discipline discussion.

[crazyemt5150]

thats really a good subject but I work In bakersfield california for Hall Ambulance Per our ems contract FD is in charge on a rescue response they have the tools and have responsibility over the pt untill the pt is cut out of the car, as soon as the pt is free they hand pt care off to us.

[rdelisle]

IMHO fire should handle the rescue, however the area that I work in is very rural so EMS is often times alone on scene. Also we have members of our Ambulance service that are also Volunteer Firefighters so we tend to do the extrications ourselves, not the best option. If we need Hydraulics(Jaws of life) they have to come in from 35 minutes away and then the crew that brings them uses them. I feel since both fire and EMS have different training they should do what they are trained for and my level of extrication training as a paramedic is basic at best. I'm expected to supervise the rescue and treat the patient, how can I do that and cut a car apart as well? If it's just a matter of pry the door open fine otherwise I call for serious back up.

[CodeBlueEMT]

The fire department responsible for extrication is untrained? That's scary. I'd hate to be on a scene where a patient couldn't be extricated because of incompetence. Assuming your EMS agency doesn't do vehicle extrications, I suggest someone in your department have a meeting with your local emergency management folks and get this issue resolved ASAP. Hopefully, nobody will die while this inexcusable mess is corrected. Without knowing the dynamics of your agency, it's hard to comment on other options. My opinion is, if you're first on scene, be competent and capable of all aspects rescue. I can't imagine what it's like to stand around and wait for someone else to show up. Meanwhile, there's a patient(s) in trouble. Good luck.

Shayne

[Yummymedic05]

Our FD is responsible for extrication. I do feel, this is just my opinion, that it would be nice in medic school to learn about this process. Whenever possible a medical personnel will get into the vehicle with the patient to keep them calm, examine as best they can, etc while being cut out. Since I really know extremely little about extrication I'd rather one of my partners who is on a FD go in (they prefer that anyhow). But seeing I don't know what to expect, minus cutting a car apart, I don't feel like I could explain to my patient in 100% honesty what's happening while we wait inside a vehicle that's being cut apart. I feel it should be the FDs job, because they are 100% trained on this where I am at, and they have all the gear. Our ambulances do not carry heavy duty gloves, turn out gear, helmets, etc for this type of situation.

[Just Plain Ruff]

every service I've worked for has had Fire do the extrication and rescue. Some FD's were expertly trained and worked flawlessly but others were like the keystone firejockeys.

One memorable scene was an entrapment of a patient in an mva. On fires arrival they brought out their shiny extrication tools which were in layman's terms, manual cutters and jaws.

They started to operate them and every time they started to spread some hydraulic fluid leaked out. Unfortunately I was in the car with the patient and I got the hydraulic fluid on me. I at the time did not know what the liquid was that was dripping on my back and scalp but I got the picture pretty quick. (OUCH if you get my drift)

The fire department on scene would not call for assistance from a neighboring scene and after some yelling at the captain and fire crews we got them to call the neighboring department which took 35 minutes to get to us. Meanwhile the patient is crashing and I have no way of getting him out since his lower legs are crushed under the car and the pavement.

Finally the real firemen get there and within 8 minutes the patient is out, loaded on the helicopter and en route to the trauma center.

I am now enroute to my local hospital to be treated for minor burns and chemical exposure.

what a night.

[SSG G-man]

I am member of Volunteer combination department. The FF handle the extrication. Our county will dispatch a rescue squad or rescue engine to all mva's. Many of our FF are also EMT-b's. They know what we want and need. Our leadership will not let the members ride the apparatus until they have been "cut loose" to ride. This requires passing some testing and a decision of some of the senior members.

At least I know the guys jumping off our squad know what the heck they are doing.

[VaREMS1]

I appreciate the responses thus far. The problem here is...once upon a time, there were FF's trained in extrication. Through attrition, and other various reasons, those folks either stepped down from rescue responsibilities, or quit the FD outright, for whatever reason...or were let go, for whatever reason. Since it seems that the EMS agency has more trained extricators than the FD does, and the FD shows no interest, evidently, in training more extricators...currently, EMS might have to begin providing vehicle rescue @ the scenes now.

Who knows where this is going to lead. We shall see.

[SSG G-man]

Well I have seen pictures of ambulances that have extrication equipment on them! Start saving your nickles and dimes to get one of those!!!

[spenac]

I can't give up anymore valuable space for extrication equipment. Let the fire dept do it. Or just require all patients to be self extricated. :twisted: