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SUBJECT: Patient Accountability at Crash Scenes
TOPIC: Thermal Imaging Camera Use for Patient Accountability
OBJECTIVE: Given a scenario of a crash-damaged vehicle and unoccupied seats, the rescue team will be proficient at techniques to determine if all occupants of the vehicle are accounted for.
TASK: The rescue team shall conduct a skills practice session using a thermal imaging camera to observe the heat signature of a vehicle seat under various conditions
A s fire department responders, it is not uncommon to find no occupants inside a crash-damaged vehicle when we arrive at a scene. Occupants may be uninjured and ambulatory at the scene. That would be the best scenario. On the other hand, we may find an empty seat with an open door or window, or worse yet, a blood-stained, empty seat. Depending on the situation, one or more occupants of the vehicle may have gotten out or were ejected during the collision, especially if they were not wearing their seatbelt. These vehicle occupants need to be accurately accounted for by fire, rescue and medical personnel.
Evidence of personal items that don’t appear to belong to the occupant is one telltale sign that someone may be missing. For example, a diaper bag in the back seat, child’s clothing scattered around and an empty booster seat should immediately raise our suspicions that a small child may be missing and must be accounted for.
Our first effort to determine if everyone is accounted for typically begins with questioning the known occupants of the damaged vehicle. We may ask our patient during our initial assessment questions such as, “Who else was riding with you?” or, “Were you the only person in the vehicle?” If the answer is that our patient was the only occupant and physical evidence seems to reinforce that, then we can be more confident that all patients are accounted for.
We may, however, find that our initial patient has an altered mental state or may be unconscious. Without the ability to question our patient, we can resort to other methods. One possible source of information may be quick questioning of civilians at the incident scene. You may ask a witness, “Did you see anyone else in this vehicle?” Or, “Did you anyone get out of this vehicle?” If they were witnesses to the collision or arrived just after the crash occurred, they might have seen something or someone or they may be able to verify that all occupants are present and accounted for.
When the initial patients cannot offer up any solid information and there are no witnesses, we can resort to some basic open-area search procedures. This is where some good detective work, physical searching of the surrounding area, and being alert to any indications of ejected persons will come in handy. Beginning at the vehicle, crews systematically begin searching the area around the incident scene in all directions.
Blood stains on the roadway, debris thrown in a certain direction by the crash and articles of clothing found a distance away from the vehicle are all good indicators that someone who was originally inside the damaged vehicle might have been ejected during the crash toward this direction. You need to search this area intently for a possible missing patient.
Back at the vehicle itself, a piece of firefighting equipment may prove itself to be very valuable as well. It may be possible to use your thermal imaging camera (TIC) and scan each empty seat of the damaged vehicle. In most cases, if a person was seated there prior to the collision, the seat back and bottom cushion will have a heat signature from that person’s body heat. Even with a heavy winter coat on, the bottom seat cushion may reveal a very distinct body-heat pattern.
If you use your TIC to carefully scan an empty seat and there is no heat on the seat back or cushion, then the probability that the seat was occupied at the time of the crash is slim. If, however, you scan the seat and see the distinct heat signature of a human form, then you most likely have a missing person. Initiate efforts immediately to account for at least this one missing patient. This same TIC technique can be used to determine if an injured motorcyclist was alone or had a passenger riding with them.