14/12/2015

PrintStory:6questionsmedicsshouldaskoneveryautoaccidentsceneEMS1.com

TheArtofEMS
bySteveWhitehead

12/07/2015

6questionsmedicsshouldaskoneveryautoaccidentscene
ThearrivalofEMSisthemomentwhenamotorvehiclecollisionincidentshiftsfromchaostoorder
Thefirstfewminutesofanycomplexscene,especiallyacaraccident,arecritical.Emotionsarehighandtheenvironmentisextremelyunforgiving.Theprioritiesweaddressorfailto
addressinthosefirstfewmomentsguidethedirectionofthesceneforthedurationofthecall.
Some priorities can dramatically impact our safety and the wellbeing of our patients. But what should you do first? It can be
temptingtorushtothefirstinjuredpersonandbeginpatientcare.Insteadofgettinglostintheconfusion,takeadeepbreathand
remembertoaskandanswerthesesixquestions.
1.Doeseveryoneknowthesafeoperatingarea?
Asafirefighter,operatingonanaccidentsceneinaroadwayisoneofthemostdangerousthingsIdo.Imfarmorelikelytobe
struckbyaninattentivemotoristthantobeinjuredonaladderorinsideofaburningbuilding.
Use emergency vehicles to create a safer working area on your scene and make sure everyone is aware of the designated
workingarea.Often,justsayingitoutloudisagoodremindertoeveryonetostayinsidethedesignatedprotectedarea.Walk
facingtrafficwheneverpossibleandwatchoutforyourcrewandcivilians.
If you dont have an assignment, step back and watch the scene. If traffic is erratic or the scene protection is less than ideal,
considerpostingalookouttowatchforoncomingtrafficandyellawarningifacarfailstoyieldforyourwarninglights.
2.CanIaccountforeveryoccupantfromeveryvehicle?
Knowingexactlyhowmanypeoplewereinvolvedintheaccidentshouldbeoneofyourfirstpriorities.Itsalsoataskthatcan
easilygetlostintheinitialchaos.Inmanycases,individualswhomayhavebeenoccupantsaremistakenforbystandersand
witnesses.Worseyet,occupantsthrownfromthevehiclemaynotbeseenatall.Checkoutthisstatetrooper'sdashcamvideoof
asemicollidingwithastoppedvehicle.
Agreatinitialquestionis,"Howmanypeoplewereinthisvehiclewithyouatthetimeofthecrash?"
Iftheanswerisanythingotherthan,"Justme,"askthepatienttoidentifywhoelsewaswiththemandwheretheywereinthe
vehicle.

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Unoccupiedinfantandchildcarseatsareahugeredflag.Evenifapatientstatesthattheywerealoneinthecar,Illpointtothe
emptycarseatandask,"Whereisthechildwhonormallyridesinthatseat?Wherearetheyrightnow?"
Whenpresentedinthatway,weforcethepatienttopondertheactualwhereaboutsoftheirchildinsteadofofferingasimpleyes
orno.Whileitmayseemoverlycautious,Ifindmostparentswelcomemyconcernoverthesafetyoftheirchild.
3.Arethevehiclessecureandstable?
Itseasytogetpulledintopatientcarewithoutexaminingthevehiclefirst.Adoptthehabitoflookingatthevehiclebeforeyougetdrawnintoaninteractionwiththepatient.Bynow,youve
likelyheardplentyaboutmechanismofinjury,compartmentintrusion,skidmarksandotherpotentialinjuryindicators.
Butonethingyoumightnotbecheckingforconsistentlyisthestabilityofthevehicle.Sure,avehicleteeteringinaprecariousspotwillcatchourattention,buthowaboutthecarssittingon
relativelylevelground?
Regardlessoftheapparentpotentialformovement,itsagoodhabittoconfirmthateveryvehicleisinpark,thekeysareremovedfromtheignitionandtheemergencybrakeisactivated.
Intherushandstressimmediatelyfollowinganautoaccident,thesedetailsarefrequentlymissedbythedriverbeforeexitingthevehicle.Beforeyoubeginpatientcare,makesureyou
haveasecureplatformtowork.
4.AmIbetweentheairbagandthepatient?
Deployedairbagsareoftennotedearlyinourscenesizeup,buttheairbagsthatdonotdeployremainahazard.Airbagscanretainachargelongafterthecrashhasoccurredandstill
havethepotentialtodeploywhileyouareinvolvedinpatientcare.
Airbagscanbelocatedinthesteeringcolumn,thedoorpanel,theceilingandtheBpillar.Itsnearlyimpossibletoperformacompletepatientassessmentwithoutplacingyourselfinthe
potentialpathofanundeployedairbag,butyoushouldstillmakeityourhabittoavoidputtingyourbodyinthesepotentialdeploymentzonesforanylongerthanisnecessary.Askthe
firefightersstabilizingthevehicleandextricatingpatientsiftheriskofairbagdeploymenthasbeenmitigated.
5.Aretheirflammableliquidspresent?
Manypotentialhazardsarereadilyapparentwhenweapproachanaccidentscene,however,flammableliquidsarenotalwayssoobvious.Avoidstandingorwalkingingasolineand
otherpetroleumproducts.Notonlydotheyhaveignitionpotential,theywilloffgasinthebackoftheambulance.Amedicunitthatreeksofgasolineisuncomfortableandapossible
respiratoryirritanttothepatient.
Mitigationoffuelspillsonsceneistypicallythejoboffiredepartmentpersonnel.Ifthereisalargevolumeoffuelontheground,considerwaitingforthemtomitigateorhavingthe
firefightersbringthepatienttoyou.
6.Doanyquietpatientsneedattention?
Wetypicallydontmissthenoisypatients.Theycryandscreambeggingforourattention.Whencriticaltreatmentprioritiesgetmissedininitialscenesizeupandpatienttriageitisalmost
alwaysthequiet(orunresponsive)patientthatgetsmissed.Especiallyifthereisanothernoisypatient.
Countlesstimes,Ivewatchedcareprovidersfailtorecognizecriticallyinjuredpatientsbecausetheyweretoofocusedonanoisypatient.Noisypatientstypically(always?)havepatent
airwaysandadequatebreathing.Whileanoisypatientmayhavecriticalinjuries,neverassumethatthequietoccupantsarequietsimplybecausetheyareuninjured.Often,thepatients
whorequireimmediateinterventionareasquietasachurchmouse.Makeityourruletofigureoutwhythequietpatientsarequietbeforeyouexplorewhythenoisypatientsarenoisy.
Thefirstfewminutesofacaraccidentscenecanbechaoticandconfusing.Ourcalmingpresenceaswestepoutoftheambulancecanoftenbethemomentwhenthescenebeginsto
shiftfromchaostoorder.Tobeginwithconfidence,addressthesepriorities.Createasafeworkingarea,checkforfluidsandundeployedairbags,accountforallthepatientsonscene
andcheckonthequietonesfirst.
Ithinkthatyoullfindthatafewminutesspentontheseprioritieswillgetthescenemovingintherightdirection.Leaveacommentandletmeknowhowitworksforyou.