Replies to This Discussion

Permalink Reply by Ric Smith on February 19, 2008 at 2:23pm

Ok, let's talk treatment plans... (I think I'll just stick with the passenger on this one & yes, He/She is alive). Now we all know the range of injuries can vary from "DOA" all the way to "Hey! Can you please undo this seatbelt so I can get outa here!!!" But from the time of dispatch I'm thinking & preparing for TRAUMA, TRAUMA, TRAUMA! until proven otherwise (remember: Your patient should NEVER have to "PROVE TO YOU " that they're sick). Since we really don't have a pt, I'm going to say that from the looks of the picture I'm thinking multi-sys trauma. So with that, let's start with the basics. First: Is the pt awake/alert/what's their GCS? Then: Does the pt have an airway?(If not, get one! & If I have to RSI the pt, I'll need to use Lido to decrease possible ICP). Next, Is the pt breathing? (listen to lung sounds, do I have to dart the chest? Remember to start your O2). Moving on to circulation. Does the pt have a pulse? Gross bleeding? Signs of internal bleeding? Signs of shock? (Get at least 2 large bore IV's started & keep listening to those lung sounds. Do I have to dart the heart?). Now that we have our ABC's done, we can move on to the "Head to Toe" assessment. This is pretty cut & dry as far as... you find it, you fix/stabilize it... if possible (can I give mophine/fentanyl for pain management?). Finally: RE-ASSESS RE-ASSESS RE-ASSESS. Remember to update your receiving facility of pt status and what you've done. Upon completion of extraction, RE-ASSESS AGAIN to verify everything is good. I think that should about do it.......... Again, without a real pt, this is just something off the top of my head. WHO'S NEXT!!! lol

Permalink Reply by Ric Smith on February 19, 2008 at 2:46pm

Well, that's one thing wrong with ya... the other is your accent!!!!!! LOL :-)

Permalink Reply by Ric Smith on February 20, 2008 at 2:29pm

And don't forget to take full spinal precautions!!!!!!

Permalink Reply by Stacy Banderinko on February 20, 2008 at 4:39pm

oh, that's right. well then, question still stands...what kinds of injuries would the passenger have? just from the opposite side of the car. lol from an EMS standpoint, we consider a patient who was in the same car as someone who died to be of top priority. because of the mechanism of injury and the fact that there was a death in the same car, EMS's goal would be to get the remaining patient to the hospital as quickly as possible.

Permalink Reply by lutan1 on February 20, 2008 at 4:51pm

what accent?

Permalink Reply by Micky Blain on February 21, 2008 at 11:44am

The train would be my first concern, scene safetey. How do we make sure the train will not move once we start working on te vehicle?

Permalink Reply by hafley on March 17, 2008 at 5:58pm

ok i agree here with bits and pieces fom everyone mostly William here but from the outside looking in the you are extremly more worried about this screnio and why simply because its involving a train on every MVA you go on you always have potenial haz mat are you guys not worried on the other MVA that you respond to and i have also worked semi-VS-trains and i have not seen that much damage to the train and our biggest concerns were what the truck was hauling not the train and i guess out of all this shit im writing you can be standing in a puddle of gas while working a single vehicle MVA car-VS-tree or something and i think that this "CRIB THE SHIT OUT OF IT" is a thing of the past step chocks are great, fast and they work well.

Permalink Reply by daniel smith on March 25, 2008 at 11:46am

We had a similar call in my district. A train versus anything gets an als ambulance (as we are the providers), our rescue and at least one command. The nearest helicopter is 20 min away. As The ambulance went en route they asked for the line to be shut down. When they got on scene the first ambulance encountered sand on the access and became stuck. Because it was a train and there were unknown injuries or number of victims a second ambulance was dispatched. I was the driver on that ambulane and by the time we arrive in the location our rescue and the personnel off of the first ambulance had made thier way to the car. It was 1 mile from the crossing where the car was struck. The engineer of the locamotive had been asked to move the train as rescue would have been more difficult or impossible. Remeber that you have only somuch time and after stabilization is accomplish you need to get the most direct access to the patient. As it was our patient was moved approx 14 inches into the middle of the vehicle. Extrication took around an hour if memory serves me. Some points I would like to share, is that trains have a "plow" in front of them so more than likely fluid from the locomotive is not going to be a concern, Access is always going to be an issue even at 20 miles an hour a train will push the car quite a distance so be ready to throw stuff into a utility or a bysander pickup to access the scene, A 360 is imparitive on a scene like this because the impact may have thrown occupants out of the car, Usually they train crew will have the locomotive "tied down" wich is a chock for the rail wheels, Lastly if you have this potential in your district get with the railroad and set up a class on locomotives with a tour you will gain good information that you can use on any rail incident, and you will find out what that railroad's emergency procedures are. Up has had a good relationship with hermiston because of classes like this. I you have a question railroad personnel are usually more than happy to get the answer for you and they usually are willing to help in any way they can

Permalink Reply by lutan1 on April 9, 2008 at 8:44pm

from an EMS standpoint, we consider a patient who was in the same car as someone who died to be of top priority. because of the mechanism of injury and the fact that there was a death in the same car
Interesting concept and not a bad one either....

Permalink Reply by felix santos on April 13, 2008 at 10:50am

you must call first the local train station to stop all incoming train in the accident location . coordinate with the local police to cordon the area .Tech.rescue,EMS,Fire immediately may proceed to the area.

Permalink Reply by Brian on May 18, 2008 at 3:42pm

Good points made, but...and I'm just throwing this out there...is there too much assumptions being made? There is nothing wrong with "overcribbing". I would rather "overcrib" than "undercrib". All it takes is one time. The pic isn't able to be blown up to see more detail. It appears to me the passenger side rear wheel is off the ground, above the tracks, only being held up because the automobile is possibly resting on the locomotive. (Again I don't know the details, only by what I can make out). As far as rig placement, we aren't able to see where the closest road/driveway is to this location. I don't know about other departments, but if its only an open field, the best thing we have is a mule (ATV type vehicle), and our 4 wheel drive grass rig. Perhaps we would send an ambulance out depending on the terrain stability, but never an engine. Again, I stress that I am not criticizing, just noticing some other details that might change ones approach. Ideas?

Permalink Reply by Brian on May 18, 2008 at 3:50pm

Looks can be deceiving. As I said before in another post, your a lot better off overcribbing than undercribbing. Its not worth taking the chance, to take an extra 10 to 20 seconds to throw some more cribbing in, even if its only to serve as an extra step of safety. With people hopping in and out of the car, it is possible the vehicle may shift wrongly, and if the transmission is in neutral, it is possible for it to roll. I have seen it done by someone who insisted the car was stable, but in fact, was only stable until responders started extricating the patient.

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