1. #1
    Forum Member

    Join Date
    Oct 2002
    Location
    Sewell, NJ, USA
    Posts
    19

    Question Motorvehicle Crash Involving a School Bus -=- Please read and respond

    Scenario:
    Your ambulance is dispatched for a commercial motorvehicle crash involving a passenger car and a school bus that is full of high school aged children. You arrive to find two injuries in the car and no obvious injuries on the bus. You have an un-dispatched engine coming from your station just because extra people showed up. No other resources en-route.

    Questions:
    1. Do all the children on the bus need to go to the hospital when they are obviously uninjured and have no complaints?
    2. If yes how do you handle their transport?
    3. If no from whom can you obtain refusals?
    4. What additional resources to you request off the bat?

    I know some of these answers might sound obvious but I am just trying to clear up some things with my company. Thanks in advance for your replies.

  2. #2
    MembersZone Subscriber

    Join Date
    Jul 1999
    Location
    Flanders, NJ
    Posts
    13,537

    Default

    Questions:
    1. Do all the children on the bus need to go to the hospital when they are obviously uninjured and have no complaints?
    2. If yes how do you handle their transport?
    3. If no from whom can you obtain refusals?
    4. What additional resources to you request off the bat?
    1. No, but school personnel must activate their emergency plan (don't have one...get one) and get parents and children together for pick up.
    2. N/A
    3. If people are not injured and did not call EMS, why do you need a refusal?
    4. Traffic control and a tow truck

  3. #3
    MembersZone Subscriber

    Join Date
    May 2000
    Location
    Wheaton IL
    Posts
    1,765

    Default

    This is something that must be addressed by the local EMS system. In Good Samaritan EMSS, Illinois Region 8. We have a school bus MVC policy.

    1st how bad is the incident, ours is broken into 3 categories No to minor damage to the bus and no obvious injuries, minor injuries and minor damage to bus, and obvious injuries and moderate damage to bus.

    If it is the 1st 2 categories we can sign off children and release them to a representitive of the school ie principal.

    So in your senerio we have a category 1 bus accident, we contact medical control and the school and sign off the lot of them.

    Again set this up with the system, school and their lawyers.

  4. #4
    MembersZone Subscriber
    CFD Hazards's Avatar
    Join Date
    Apr 2002
    Location
    Cranston, RI, USA
    Posts
    381

    Default

    If you want to take the responsibility of saying that none of the kids on the bus have any injuries and they are all fine then that is your choice. It is not one that I would make nor would any hospital in this state. We have had this same situation and the hospital/med-control has had us transport everyone. If two people were injured in the car, I would assume that there was some sort of jarring to the people on the bus. By RI EMS Protocol, anyone 16 and over is considered adult and able to refuse treatment on their own. With that in mind:


    1. All of those that are not 16 and the parent is not on the scene.
    2. Call as many rescues as necessary.
    3. Anyone 16 or older.
    4. Enough rescues for transport.

    We have also had situations where the bus was allowed to continue to school and all of those on the bus were brought into the cafeteria and the parents called. The parents then showed up and determined if the child should go to the hospital. Some parents were unable to make it to the school and when told that the child was in an MVA, wanted the child to go to the hospital.

  5. #5
    Forum Member

    Join Date
    Apr 2000
    Posts
    770

    Default

    Originally posted by cfdeng3
    We have had this same situation and the hospital/med-control has had us transport everyone.
    Which probably explains why in my brother's school bus bus fender-bender, he and his friend (both 10 at the time) were walked off the bus, into the rig, and THEN C-collared and boarded. Another bus rider who'd struck his head was allowed to lave with a parent.

  6. #6
    MembersZone Subscriber

    Join Date
    Jul 1999
    Location
    Flanders, NJ
    Posts
    13,537

    Default

    If you want to take the responsibility of saying that none of the kids on the bus have any injuries and they are all fine then that is your choice. It is not one that I would make nor would any hospital in this state. We have had this same situation and the hospital/med-control has had us transport everyone. If two people were injured in the car, I would assume that there was some sort of jarring to the people on the bus. By RI EMS Protocol, anyone 16 and over is considered adult and able to refuse treatment on their own.
    So every time a kid falls down, we should board and collar them? If they are not hurt, leave them alone.

    We have also had situations where the bus was allowed to continue to school and all of those on the bus were brought into the cafeteria and the parents called. The parents then showed up and determined if the child should go to the hospital. Some parents were unable to make it to the school and when told that the child was in an MVA, wanted the child to go to the hospital.
    A much more sensible approach. This is the way I would expect my child to be treated if he obviously was not hurt.

  7. #7
    MembersZone Subscriber
    CFD Hazards's Avatar
    Join Date
    Apr 2002
    Location
    Cranston, RI, USA
    Posts
    381

    Default

    "So every time a kid falls down, we should board and collar them?"

    Well unless you drive around looking for things to do, someone thought that fall was bad enough to call 911 and get you there. If you feel confident enough to let a 6 year old make the determination that he doesn't need medical attention than good for you. If there is a parent or responsible party there willing to refuse for that child than that is fine. If there is no one there willing to do so our protocol says we must transport.

  8. #8
    Senior Member

    Join Date
    Apr 2002
    Location
    Vermont
    Posts
    93

    Default

    In VT if you are under 18 you will be transported if you are involved in an MVA and Fire/Rescue and/or an ambulance is on route. Our department responds as two entities for the most part, one being fire, and one being rescue. If the rescue was dispatched then an ambulance has been dispatched as well. We decided that we won't do patient refusals anymore so the ambulance will continue to the scene despite whether they are needed or not to sign off patients. This ambulance company does not like liability so if the patient is under 18 and no parents/guardians are present then that patient gets a trip to the hospital. So in turn a bus accident would more then likely require a lot of ambulances to transport all of the minors on board.
    This statements made above do not represent the agency i belong to in any shape or form. So if i say something stupid its just me.

  9. #9
    MembersZone Subscriber

    Join Date
    Apr 2001
    Location
    Port Jefferson, NY
    Posts
    146

    Default

    We had a bus accident happen right in front of the school and we were told by the principal that in NYS any child involed in a bus accident is to be transported and released to the parent at the hospital. It makes sense really. Parents will not have to look for children and the parent will be the one to refuse care. Also with the spread of news these days the last thing we need is 30 frantic parents heading to the scene. This was a very minor accident, each child was assesed and none needed care so they were not boarded and collared, but all were transported by abulance to the hospital.
    B Holmes

  10. #10
    MembersZone Subscriber

    Join Date
    Jul 1999
    Location
    Flanders, NJ
    Posts
    13,537

    Default

    Well unless you drive around looking for things to do, someone thought that fall was bad enough to call 911 and get you there. If you feel confident enough to let a 6 year old make the determination that he doesn't need medical attention than good for you.
    That's the point. The 6 YOA does not make the decision...I do. That is what I was trained to do. I was trained to apply science and critical thinking to a situation and make a decision. Why even bother going through EMT school or PALS if all you are going to do is blindly transport like a machine?

    You guys who are talking about State laws about transporting kids, I am not doubting you were told that, but it would be interesting to see if there actually is a state law. Both of your posts have the common thread of someone looking to cut their liability.

  11. #11
    MembersZone Subscriber
    CFD Hazards's Avatar
    Join Date
    Apr 2002
    Location
    Cranston, RI, USA
    Posts
    381

    Default

    That's it exactly. Liability. I am not going to lose my license, my job and get sued because I let a kid go with no obvious signs of injury, only to have him become paralyzed two days later. Who do you think is the first ones the lawyers are coming after? What would be my defense, I don't think that the "he seemed fine to me" would suffice. I have no idea what state law says, I am just going by the RI Pre-Hospital EMS Protocols. It has become painfully obvious to everyone that some of the laws in this state aren't the greatest in the world.
    What age do the protocols in NJ say a person can refuse on their own? How would you defend yourself if it is written in B&W that no one under the age of 16 can refuse without consent of an adult but you decided that the child seemed fine and decided not to transport?

  12. #12
    Forum Member
    DeputyChiefGonzo's Avatar
    Join Date
    Aug 2000
    Location
    Somewhere between genius and insanity!
    Posts
    13,584

    Default

    We recently had a situation with a school bus vs. car. The driver of the car backed out of his driveway and struck the bus at the front wheel/bumper area. The was litle damage to the bus, other than a small dent and a little paint scraped off the bumper area. The bus was dropping off kids after school. One child complained of "bumping his head" on the window. He lived on the next street over, so I asked him his address and requested that one of the police officers on scene get the child's mom and have her come to the scene. Mom came, the kid was fine, and the bus was allowed to continue on its route. Mom, Dad and the kid came to the firehouse the following night with 2 dozen homemade chocolate chip and oatmeal raisin cookies as a thank you.

    I think we have to do a size up and look at the severity of the incident before making the decisions, otherwise, we will create a MCI every time we get a call for a school bus.
    ‎"The education of a firefighter and the continued education of a firefighter is what makes "real" firefighters. Continuous skill development is the core of progressive firefighting. We learn by doing and doing it again and again, both on the training ground and the fireground."
    Lt. Ray McCormack, FDNY

  13. #13
    MembersZone Subscriber

    Join Date
    Jul 1999
    Location
    Flanders, NJ
    Posts
    13,537

    Default

    What age do the protocols in NJ say a person can refuse on their own? How would you defend yourself if it is written in B&W that no one under the age of 16 can refuse without consent of an adult but you decided that the child seemed fine and decided not to transport?
    It doesn't matter if the kid is not hurt in the first place! You didn't just say he seemed fine. You did a complete patient assessment, based on RI protocols, exactly as you were trained to do. They didn't give you all that training not to use it wisely. You can only be held liable up to your level of training. Otherwise, every single patient would be taken to the ED no matter what findings the pre-hospital provider has.

    As usual, I agree with our esteemed El Presidente.

  14. #14
    MembersZone Subscriber
    CFD Hazards's Avatar
    Join Date
    Apr 2002
    Location
    Cranston, RI, USA
    Posts
    381

    Default

    Again, how do you positively know that the kid isn't hurt. We don't carry X-ray machines, we can't do CAT scans to check for internal bleeding nor can we do blood tests(except for blood sugar). I can do the most thorough survey I have been taught but it isn't the same as the one he would get at the hospital.
    From what I gather, you are a cop. I don't know what the legal Blood Alcohol limit is in NJ but here it is .08. Can you have someone blow a .08 and pass a field sobriety test? I would tend to believe so but by law, you would be forced to arrest them for DWI because that is what the law says. We have some 300 pound professional drinkers that are not impaired by a case of beer let alone the two beers it takes to blow .08, but they are legally drunk. They may seem fine but they are still drunk, things aren't always as they appear. I may feel the child is all right but my protocol says I still must transport.

  15. #15
    Senior Member

    Join Date
    Apr 2002
    Location
    Vermont
    Posts
    93

    Default

    FYI-We do carry x-rays, MRI, DNA testing equipment, Blood testing equipment, a sphygmomanometer (very useful tool), some bandages, and some other useful equipment in our jump bags on our rescue and we still won't release minors too anyone but parents/guardians or maybe police i'm not sure.
    This statements made above do not represent the agency i belong to in any shape or form. So if i say something stupid its just me.

  16. #16
    55 Years & Still Rolling
    hwoods's Avatar
    Join Date
    Jun 2002
    Location
    Glenn Dale Md, Heart of the P.G. County Fire Belt....
    Posts
    10,739

    Talking Wow.................

    Before we get to the questions posed in the opening post of this thread, I have one of my own. Who in the hell decided to dispatch a single ambulance and no other help when the crash involved a school bus?? Fire that person and move on. A big round of applause for the people who took an engine out behind the ambulance on their own initiative. Those folks we need, the "let the ambulance get there and see what they need" kind of idiots have no place in our line of work. Next question? Our school system has people who respond quickly to all incidents to make a determination of what will be done for that particular incident. We work closely (and very well) with these folks, some of whom are members of area VFDs. Our first arriving units do a triage as fast as possible and make informed decisions on what will be needed for that incident. We routinely send kids to the hospital in a replacement bus, letting the hospital work out the details with the school system and parents. Our school system has a policy of sending everyone to the hospital from a crash, and letting the medical folks figure out who to send home and when. The hospitals in the area are OK with this and we have drills from time to time to keep skill levels up. Back to the beginning. We send 4 BLS Ambulances, 2 ALS Ambulances, 2 Engines, 2 Heavy Rescue Squads, EMS Supervisor, Battalion Chief on all accidents involving Mass Transit type vehicles. (school buses included) There are always extra people going along, (Volunteer Chief Officers and extra apparatus staffed by people who are in the station along with the "on duty" crews. This translates to having a 45 - 50 victim crash that meets a ratio of 1 EMT for each patient within about 10 minutes after dispatch. We wouldn't settle for anything less. "Overkill"? Maybe. We prefer to start a lot of help all the time, and, anything that is not needed can be cancelled when a determination is made that adequate resources are on the scene or enroute. Stay Safe....
    Never use Force! Get a Bigger Hammer.
    In memory of
    Chief Earle W. Woods, 1912 - 1997
    Asst. Chief John R. Woods Sr. 1937 - 2006

    IACOJ Budget Analyst

    I Refuse to be a Spectator. If I come to the Game, I'm Playing.

    www.gdvfd18.com

  17. #17
    MembersZone Subscriber

    Join Date
    Jul 1999
    Location
    Flanders, NJ
    Posts
    13,537

    Default

    I'm not going to prolong this debate. BA limits have nothing to do with this discussion. With the screening tools you are advocating, it leads me to believe that you have been subjected to EMT training of the worst kind. Training that teaches you to be a robot and not to have any critical thinking or independence. My experience with children, as both patients and as a parent, leads me to a different opinion.

    I may feel the child is all right but my protocol says I still must transport.
    You didn't say that before. Your scenario paints the picture that you actually have discretion here. If your protocols say to dress the child in an orange sack, click your heels together three times and transport in reverse, you do it. That is called discipline and that is a good thing.

  18. #18
    Senior Member

    Join Date
    Apr 2002
    Location
    Vermont
    Posts
    93

    Default

    The main reason i can respond to this post and say transport unless something close to a act of congress is in line is because i am not a parent but I would think that if I were I would prefer that my child was taken to the hospital, thats until i recieved the bill and went after the stupid medical person who demanded transport(myself).
    This statements made above do not represent the agency i belong to in any shape or form. So if i say something stupid its just me.

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Log in

Click here to log in or register