Scoop and Run Is Not Always The Best Procedure

Your rig rounds the corner and there's the car accident you're looking for. Nothing new at this point. You've been to car accidents before...to extricate and clean up. The difference this time is that the initial medical responsibilities are yours. EMS has expanded into your corner of the fire service. Don't forget to park your rig in a defensive spot to protect your crew members while they work a patient.

Photo Courtesy Phoenix Fire Department You and your crew have carefully put the victim on a backboard and strapped her down with head and neck lined up correctly. She is on high-flow oxygen by mask. One firefighter is regularly recording her vitals. As the captain, you are responsible for the safety of your crew. Take note: The rig is spotted defensively. Your crew is wearing safety vests and infection control equipment including masks, eye protection and exam gloves. The amount of protection worn is relative to the potential for exposure. There are no hard rules at this time. It's your judgment call. In Phoenix, we wear gloves on every medical call, even if it is a broken limb. The more bodily fluids involved, the more we wear masks, face shields, hoods, protective sleeves, shoe covers and gowns.

There are two cars involved. Now open your eyes and pay attention. What you see as you approach could tell you a lot about the patients inside the cars. How was each vehicle hit or how did it hit something? That observation can give you clues as to what kinds of injuries may exist. This is referred to as the "mechanism of injury."

There is one patient in each car. The Camaro was T-boned on the driver's side by the Accord. What does that tell you about the patient in the Camaro? Hard impact on the left side of his body. Left arm, left rib cage, left hip, left leg. The head may have snapped in this direction. What does it tell you about the patient in the Accord? Possible chest injuries against the steering wheel. The head snapped forward.

Let's assume there is no extrication necessary at this accident. You're able to get right to the patients. Who's first? The guy in the Camaro is talking, moving around. The woman in the Accord is still, seemingly unconscious, with her head kicked back. You know he's got a clear airway, he's breathing and his heart is beating (the ABCs).

Divide your crew with two checking on the man and you and your other crew members moving on to the woman. Even though, at this point, the woman seems most in need of help, you need visual, up-close evaluation of everything and everyone. You don't know but there may be a small child jammed up under the seat where the man is screaming or maybe he's going to go into cardiac arrest or some sort of seizure at any time.

The cops are encouraging you and your crew to hurry with this one. Traffic is backing up fast. "Load and go," one of the officers is suggesting. You know better.

On your side of chaos, your first responsibility is to check the ABCs of the woman; clear Airway, Breathing and blood Circulation (the heart is pumping). You've got to be careful with C-spine injuries. The chances are good she's got some. Take note she does not have a seat belt on. You put your ear by her nose. Yes, you can hear and feel her breathing even though it is somewhat crackly. You check her carotid artery in the neck. There is a pulse. You don't have to do CPR.

Now you're going to get the vitals and take notes for the medics who will be showing up soon. You are also going to take C-spine precautions. Have your crew member hold her head steady and straight while you put on the rigid C-spine collar.

Now the vitals. There are five: heart rate (pulse), respirations (breathing rate), pupil reaction, skin condition (temperature, color, etc.) and blood pressure. Record everything on your patient encounter form. Continue to take vitals every five minutes and record them. Her blood pressure is a little high at 152 over 94. Her pulse is fast at 136. Her respirations were fast and shallow. Remember, you heard a rattling sound when you checked her breathing. What should that have told you? Flail chest. It makes sense. She wasn't wearing a seat belt and her mechanism of injury was that she hit that other car head on and slammed into her steering wheel.

You and your crew carefully get her onto a backboard and strap her down with head and neck lined up correctly. Now you have to get that flail chest to stay in place. You don't bind, strap or tape the injured section; you only want to keep it in place.

Locate the edges of the flailed section by gently feeling the site on the chest with your fingers. Put a thick pad of dressing, bandages or even a small pillow on the site to keep the loose bones in place. Use large strips of tape to hold all in place. Administer a high concentration of oxygen and treat for shock, i.e., elevate the legs slightly.

The medics arrive on scene. You've got your patient packaged and ready for transport and a history of vitals. This patient needs to be transported as quickly as possible. And that's one of the reasons your department started running EMS calls.

Decker Williams, a Firehouse® contributing editor, is a 27-year veteran of the Phoenix Fire Department currently serving as a battalion chief. One of Arizona's original paramedics, he teaches the incident management system at medical incidents for firefighter safety and is a staunch supporter of the dual role of fire service first responders. Tim Simmons has been with the Phoenix Fire Department for 12 years and currently is assigned to the Division of Corporate Communications. He is also a volunteer captain in the Nogales, Mexico, Fire Department.