Friday, December 03, 2010

MVC's: SOPS for First Responders

By: Lou Angeli

Note: For the purposes of providing a guideline for this segment, the term First Responder refers to members of departments who are not full-fledged Firefighters, Paramedics or EMTs. Many of you are trained in basic level EMS or have taken First Responder courses through the auspices of your local emergency management agency. Now we're taking you to the next step, as we demonstrate how you can best interface with your trained colleagues.

The Goal: Quality Patient Care:

The Fire-Rescue-EMS Services have seen more change in the past twenty years then it did in the first two hundred. Delivery of emergency services has become much more diversified, and as providers, we are required to cross train in a number of disciplines, including Auto Extrication. With the move toward rescue-engines, quick response rescue apparatus and tactical service units, this installment of Rescue US outlines how thos who arrive on the accident scene should operate and interface with other agencies.
"All over the World, a report of an MVA sets into motion a multi agency response that includes Fire, EMS, Rescue and Law Enforcement. And in most jurisdictions the simple fact of the matter is that we respond to many more accidents than we do fires."

The Mission of Fire-EMS-Rescue is to save lives and limit property damage, and that holds true during MVc’s as well. Most serious accidents result in traumatic injury to the driver and passengers, so it’s imperative that fire/rescue personnel free trapped victims, so they can receive definitive hospital care. The goal - to begin advanced treatment within 60 minutes of the onset of life threatening injuries.
The Golden Hour

No, it’s not a religious TV show - it’s the buzz phrase that refers to the time frame from the point of time when an injuriy occurs - to the 60 minute mark. To call this the critical period is an understatement, because the earlier the patient is able to reach surgical intervention of their traumatic injuries, the greater their chances for survival.
Here's a prime international example: In the case of Princess Diana, lost her life following a high-speed tunnel race with paparazzi along the Seine River. Diana's limo was forced into a guardrail, smashing from side to side until it stopped and the paparazzi grabbing one more shot.
Paris has no cetralized emergency response number, so citizens phoned police, after a hile police contacted SAMU (French EMS) who requested heavy fire brigade 20 minutes into the incidenr. From the time of the onset of her injuries, until she was released from her vehicle, one hour, ten and minutes had elpased. Subsequently, as EMS physicians attempted cardiac microsurgery aboard a slow moving ALS unit. They essentially served Diana with her death warrant as she bled out.  

The Process Begins: Rapid Assessment
In most areas of the country, Law Enforcement is often first on the scene of an MVA. After all, they’re already on the road. Trained police personnel can begin the vitally important “size-up” of the accident scene, even before EMS and Fire arrive.
Once Paramedics or EMT’s arrive on the fireground, their first task is to determine the extent of injury through “Rapid Assessment”. During the Primary Survey, First Responder Teams should consider the mechanism of injury, damage to the vehicle and the patient’s position in the vehicle.

Consider the “Collision Factor” - namely the accident itself, the collision of the patient against vehicular compartments, and the collision of the patient’s own organs against internal body components. It’s also important to recognize if the patient has received any “deceleration” injuries. It goes without saying that treatment should be initiated immediately, in order to stabilize life-threatening conditions, and provide transport without delay.

Simultaneous Rescue and Patient Care
And therein lies the rub. Since MVA’s are multi-agency responses, the “rules of the road” are sometimes unclear, with responders often wondering “who’s patient is it anyway?” There are still departments in North America who DO NOT subscribe to the theory of simultaneous rescue and patient care. I’ve found this to be especially true in those areas where fire/rescue is provided by a government, and EMS by a contract provider.

Wake up Gang! Turf Wars were part of the job a hundred years ago, but in this age of micromanagement and communication, responsibilities should be crystal clear. When the battle lines aren’t clearly marked, the only loser is the patient.
Primary or Initial Assessment
Rescue Teams should provide EMS with immediate access to patients by opening compartments and removing glass. The Initial Assessment by EMS and Extrication Efforts by Fire/Rescue MUST OCCUR SIMULTANEOUSLY in order to remove the victim(s) as quickly as possible.

As the assessment takes place, Paramedics and EMT’s can immediately begin management by maintaining airways, controlling bleeding and stabilizing the C-Spine.

Secondary of Focused Assessment
Once Fire/Rescue personnel are able to remove trapped victims, secondary or “focused” assessment can take place. This exposes the patient full body to providers and allows for complete head-to-toe examination to identify other injuries, and reassess any critical findings that were initially suspected.

Risk Management
Chances are that as a First Responder, you may arrive on scene before a heavy rescue or vehicle rescue squad. So consider using some of the basic hand tools that are carried on your first-due rig. In many cases you may be able to provide access to victims using a simple halligan tool or axe. Other first-in tools may include a pry-bar, center punch, porta-power or portable saw.

Following Size-Up, Company members should be instructed to perform duties that will limit risk to victims and rescuers alike, including:

· Initiating scene safety procedures
· Stabilizing the vehicle with airbags or cribbing
· Providing adequate access to the patient
· Deflating tires (check your SOP’s first)
· Removing glass
· Advance a charged inch and ¾ hoseline
· Prepare any additional hydraulic tools
- Install portable scene lighting

Rapid Extrication

Rescue Tools are highly specialized pieces of equipment. You and fellow members should have a thorough working knowledge of these devices, including all appropriate safety precautions and maintenance procedures.

Of course, Rapid Extrication is the key to any successful Vehicle Rescue. Extrication.Com is a wonderful resource for those of you who’d like to learn more about state-of-the-art extrication techniques, especially precautions that should be taken when working with automobile airbags.

I encourage you and your members to review your department’s SOP’s and any local regulations dealing with emergency activities at motor vehicle accidents. Remember, our primary job at any MVA is to deliver quality patient care, and at the same time, keeping our own teams safe.


Photos used to illustrate this article were taken by the author during an MVC with the driver trapped near Wilmington, Delaware. The incident occured on busy I-95 northbound lanes during a holiday rush. Responders included New Castle County Paramedics, BLS crews from Christiana Fire Company and Wilmington Manor Fire Company, along with Rescue-Engines and Heavy Rescue from Christiana Fire Company, Minquas Fire Company, and Wilmington Manor Fire Company.

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