1. #1
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    Question Truck Vs Utility. What Would You Do?

    All right Grasshoppers! You asked for it- so here it is!

    Another "What Would You Do?" scenario. This one is obviously a utility vs milk truck. Have a go at it to start with and as it progresses, I'll post additional pictures.

    Has anyone seen any Billy's or 101's? I'm sure they'll have plenty to say about this one! Here billy, billy, billy. 101? 101? Anyone seen 101?

    Once again, I wasn't at this one. So I can't give you any info other than what the pictures tells you. I'll attempt to get more info and pass it on....
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    Exclamation Right Hand Drive

    Just a little reminder Aussie pictures Driver entrapment.
    Looks as though the Utility roof might be a good place to start cutting.

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    Just a bit of background for readers. The patient (4wd) came over crest in the road and found tanker turning in front of him. Patient slammed on the brakes and as a result the 4wd chassis went under the truck chassis, peeling the 4wd metal and engine compartment back onto the patient. Lutan will hopefully show that internal cabin picture soon. The patient was unconscious, non breathing, but still with a pulse by the time the first Ambulance arrived (an intensive care unit). A helicopter was also dispatched as the closest trauma centre was 1 hr flying time from the scene (2 1/2 hr drive). Access to the patient was extremely limited, with IPPV 100% O2 being performed through a small rear window. No access was available to intubate. IV access was also established as BP was ?? 60. fluid push was performed without success of raising BP. Pulse was 50 palpation, confirmed with ECG monitor showing sinus bradycardia. SPO2 monitor did not register. Significant head and chest injuries were noted (A/E good bilaterally initially), but no access below chest level was possible at the initial stage due to damage and very limited access into the 4wd. Within 5 minutes of Ambulance arriving on scene, the patient tensioned and chest decompression was sucessfully performed. Rescue arrived some 10 minuts after the first Ambulance, the patient still alive at this point.

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    Really need a 360 but based on what I can see,I'd block the wheels on the side opposite the casualty.Crib and airbag the other side as close to the pickup as I could get.Lift enough to release tension on the utility.Swing(via winch)the rear of the utility in an arc away from the tanker.When you post more pics I may modify this plan,but this is my starting point.Patient is critical priority high 2 or even 1 so a timely release is called for.With the utility "levered"out from under the tanker extrication would be much faster and easier.

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    To us this is a load and go, so we would lift the truck with bottle jacks, airbags, spreaders, or whatever, then chain to our engine, next hook winch cable from rescue pumper to passenger vehicle and pull away from the truck, now we have room to take the roof and door and get the patient out. No time to worry about moving the patient a little bit.

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    also can't tell from the pic but check to see if the milk truck is leaking if so call out a haz mat team and if that is a ultility truck what is it carrying. example if it's a plumber's truck it can have mag welding rods, an oxy-actylene tank system and so on...

    but aside from that it looks like a simple 18 wheeler vs smaller vehicle that we all love so well. i agree with everyone else on extrication of patient from vehicle.

    do like the people standing on the engine block with no bunker gear.
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    if the milk truck is leaking if so call out a haz mat team
    It's milk. Why a HAZMAT team for milk? Either divert the leak away from the scene so as it's not a slip hazard or try and stop the leak if it's that critical...

    do like the people standing on the engine block with no bunker gear
    This is pretty normal for the Ambulance Service over here. They're not supplied bunker gear. The uniform you see in the pictures is what has been in use for a LONG time. Only recently, they've issued overalls to wear as another option....

    Here's another pic. (More to come as the thread eveolves) Keep the thoughts coming. Now has anyone seen Ron? Ron, where are you? What's your thoughts?
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    Strout,did you look CAREFULLY at the picture?Do you know where your driver is?I sure wouldn't want to work the utility "where is".The driver is under the frt. bumper and tire or both.As Lutan post. updates I may modify my plan a bit but it calls for lift and snatch.The patient is going south fast,no time for fancies just trash and go.43's right on target.Keep coming along grasshopper your perceptions are improving.T.C.

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    Luke,you lil' weasel why didn't you post 5 min earlier.Single axle CO hoss,easy pick as earlier indicated still requires a lever swing to the passenger side.That's gotta hurt though.T.C.

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    101, I could say that I was using my incredible ESP powers and knew that you would be posting whilst I was putting the picture together- but I'd be full of crap!!!!

    Just to remind everyone, SESDTL pointed out that this is an Aussie vehicle, so the driver of the utility is on the right hand side, closest to the truck's cabin.

    As 101 said, It's gotta hurt! For the medical literate and those that understand it, EMTEC has given a good run down on the casualties condition- he'd know- he was there! Hopefully as this post evolves, he'll tell us more, without telling us how the extrication was actually completed!
    Last edited by lutan1; 08-21-2002 at 06:59 PM.
    Luke

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    lutan, about two weeks ago i would've agreed with ya. one of the neighboring depts ran an 18 wheeler accident that spilt milk all over a highway. apparently milk will absorb the oxygen in water and it kills organisms in the water. thus here a hazmat team is needed for the clean up. i agree that milk doesn't pose that much of a immediate life threatening emergency but left uncontained it can pose a hazard to the environment.

    i don't know if 2% milk is different then half n half or regular milk.
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    Originally posted by RyanEMVFD
    apparently milk will absorb the oxygen in water and it kills organisms in the water.
    huh!

    interesting

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    apparently milk will absorb the oxygen in water and it kills organisms in the water. thus here a hazmat team is needed for the clean up
    You guys obviously work a bit different to us- if that's the case then we'd call for the E.P.A. They in turn would activate their disaster plans and personnel and respond to the scene.

    Interesting info- food for thought! (Mind the pun )
    Luke

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    Ryan,Yeah 2% is different.Takes more to color yer coffee!Absolutely correct about not letting it into lakes and streams,many floating fish.Due to tanker construction and strike zone,I doubt highly that product loss was a issue here.Kristen,I have no problems with protecting my rescuers,but here that can be done rapidly and still quickly shift the heavy portion of your crew to patient issues.As I'm dragging you along,I'm trying to get you to look at heavy truck vs anything different than a car for several reasons.The average car weighs around 25-3500# and will move in any direction quite easily.The average TT weigs from 22000# to 120000# and doesn't move anywhere but down worth a damn!The ONLY CHANCE this patient has is to get the crushing weight of this truck off him.Look at how the utility is corkscrewed up,this is putting additional crushing forces on the driver area.Part of my education to you is to try to get you to RAPIDLY evaluate conditions on arrival.With cars you MAY have a little time to make/change decisions.With heavy vehicles that window often is diminished.You still need to do things safely,but you need to be able to QUICKLY devise a plan and to have alternate plans available to use RIGHT NOW if plan A doesn't work out.I'm not too medically inclined so I defer to others on those issues.Car rescue I'm pretty good at but still learning,Heavy truck are my forte!Still learning here as well,but in working around,on,and towing these everyday I am accustomed to how they,and some of their DA drivers react.We pass these gleanings to you.I like your perspectives,but as you work more around these vehicles,I will lead you to the "dark side".T.C.

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    I'm game for lifting and blocking the 'prime mover' (thought I'd throw in some of that Aussie-speak ) and then moving the passenger vehicle away to gain access.

    How stable is that vehicle going to be once it isn't resting on the milk truck? Should we hook a chain to the right side (driver's side)of the vehicle and run the chain over it to a pumper to keep it from falling over?

    We're going to need a nice box crib, and I'd start the extrication by removing the roof for patient access and further evaluation.

    As for the milk/hazmat thing--I wouldn't worry about the milk (even if it was leaking) unless it posed a direct hazard to my rescuers. The EPA can deal with it later after the patient is taken care of.
    Bryan Beall
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    How stable is that vehicle going to be once it isn't resting on the milk truck? Should we hook a chain to the right side (driver's side)of the vehicle and run the chain over it to a pumper to keep it from falling over?
    Here's another thought...with the vehicle so deformed, could a reverse dash push be feasible? Instead of pushing the dash away from victim, how about pushing the whole back of truck away? Use gravity and the raised end of the truck to assist with the spread. If you cut back side of passenger compartment and then spread, would that give enough room to remove patient? Don't know, just looking at different options.

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    Default Hmmm.........

    Good one Lutan!!

    I would start by calling a large wrecker from the local garage. While they are enroute, I would crib the patients vehicle to the hilt and prepare to lift the truck off the patients vehicle with the wrecker. Once the truck is lifted, (depending on the type of wrecker)I would move it as short a distance as possible off of the patients vehicle. Possibly removing the trailer first if feasable.

    Once this is done, rapid extrication to give the patient to EMS.
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    Default Why Rapid Extricate?

    A helicopter was also dispatched as the closest trauma centre was 1 hr flying time from the scene (2 1/2 hr drive).
    A few people seem pretty hell bent on doing a "load and go" on this one...

    Why?

    Emtec said earlier that the nearest trauma centre is 1 hour flying time and 2.5 hour drive from scene.

    Why not slow the whole extrication down and take it easy for the patients benefit?

    Make every technique and procedure that we do, count.

    Slow and easy wins the race!

    If we did a rapid extrication and had him out in 20 minutes, what have we achieved if we may have done something detrimental to his health in the long run? We can't take him anywhere because we're waiting for the chopper. (By the way, emtec didn't say this, but from the time the chopper is called and arrives on scene is about 45 minutes...)
    Luke

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    Alright Luke,I missed that one.But the read I get on emtec's post would put this patients viability "window" at >20min. without intervention which means I still want to get those two vehicles seperated in short order.Call me crazy(I am) but I don't want to be on the slow end of the stick getting those two seperated.What med does after that is their thing.What next? T.C.

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    To me this patient is still in line for rapid extrication, his condition as described by emtec, is to say the least pis$ poor, so we can either rapidly extricate a viable patient, or slow down and recover a body.

    They can not intubate this patient where he is, no airway no patient, also fluids have not brought bp up, may need to do m.a.s.t., also the crushing force needs to be alleviated as soon as possible.

    I still say maintain what c-spine that you can, raise the prime mover, pull pickup out from under, and rapidly extricate patient to give the medics a shot at saving him.

    If the chopper is responding from the trauma center, then once you extricate the patient you can always load the patient in the ambo and head towards the trauma center, meeting the chopper somewhere near the middle, this may shave several minutes off the trip to the trauma center.

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    If you don't have an airway, it doesn't matter what else you do. Remove the truck, Rapid extrication.
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    Here's another view....
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    WOW!! I can hardly see the patient in that photo for all the debris!!

    From that view it may be possible to remove the roof and roll the dash....... Has the truck been removed??? It kinda looks like it.
    I.A.C.O.J. Charter Member
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    1835, the truck is still in place, the casualty is still in there...
    Luke

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    I would definately utilize a wrecker to lift the truck off the patients vehicle.

    Heck of a mess in any case.
    I.A.C.O.J. Charter Member
    "Chet, get an inch and a half on that!"

    "Not for fame or reward,Not for place or rank. Not lured by ambition or goaded by necessity. But in simple obedience to duty as they understood it. These men suffered,sacrificed,dared all, and died. Let us never forget our fallen friends."

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