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EMT protocol at the scene of a car accident
When the ambulance arrives at the scene of a car accident, is it not required that the EMTs' in the ambulance check if the individuals involved in the crash are well?
I have recently heard of a situation where an ambulance showed up at an accident, looked around and did not administer any tests to see if one of the individuals in the crash were hurt. Instead, the EMT only looks at this person (who is at least 6ft away from the EMT during the "diagnosis") and asks, "Are you hurt?" and the individual responds with a confused, "I don't think so, I think I'm fine."
There's a problem here, and this could be a scenario where the person in the accident may be injured and not know it, like a very mild concussion or something else. These EMT's should have performed some sort of test to verify that the person was ok.
My question to you: Is there a law or protocol that is enforced by the state or federal governments which EMTs' must adhere to when dealing with people in car accidents? If so, where can you find this information.
I have recently heard of a situation where an ambulance showed up at an accident, looked around and did not administer any tests to see if one of the individuals in the crash were hurt. Instead, the EMT only looks at this person (who is at least 6ft away from the EMT during the "diagnosis") and asks, "Are you hurt?" and the individual responds with a confused, "I don't think so, I think I'm fine."
There's a problem here, and this could be a scenario where the person in the accident may be injured and not know it, like a very mild concussion or something else. These EMT's should have performed some sort of test to verify that the person was ok.
My question to you: Is there a law or protocol that is enforced by the state or federal governments which EMTs' must adhere to when dealing with people in car accidents? If so, where can you find this information.
Replies to This Discussion
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Permalink Reply by James on
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it's kinda a gray area, and depends on you local protocols.
if the person is alert and oriented, and has no complaints. there not a patient in the first place it's property damage only
obviously it all depends on index of suspision, and damage on the vehicle and such, (I.E minor damage might only get a "are you okay" while a overturn gets a full assessment and the RMA protocol)
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Permalink Reply by Joe Stoltz on
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Assuming that the ambulance was called to the scene of the accident, and therefore had a legal duty to act, then I would say this is the work of a piss-poor medic. "I think I'm OK, I think I'm fine" leaves room for doubt, and any doubt must be removed either by a full assessment or a trip to the ER.
Unless someone says "Nope, not hurt at all" then they should be checked out IF the patient allows the crew to do so. As Todd said, you need a conscious person's consent in order to treat them.
Having said this, I have seen patients "checked out" in this manner. In the case I am referring to, the ambulance had a paramedic on board and were headed to a serious crash when they happened across a minor vehicle crash with everyone walking around. They did a quick eyeball on the participants, then sped on to the more serious crash which wound up being a fatality.
This raised some hollering about signing people off without any vitals being taken, but it was also kind of a rolling triage situation.
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Hey, Bildo and Anthony -
Are you guys on here just trying to stir up trouble? Do either of you guys have any experience in Fire or EMS? Not according to your profiles...
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Permalink Reply by CJ on
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It's our Duty to Act that holds us to provide care to the patients. It's the emt/paramedics responsibility to provide the best care possible to those patients. It may be considered nonfeasance if there was a lack of treatment that was obviously required. However in this situation, the emergency personnel did an assessment, though it may not have been as detailed as you would have liked. Just walking up to someone and asking them how they're feeling can tell you alot about the patient's condition. It gives you a general impression of the patient: if they're in distress, their ABC's, LOC, respiratory rate, ect. I've ridden with departments that would drive by the accident, ask their partner "anyone look hurt?" and then keep going, telling dispatch no patient was found! With some busier departments this is an accepted practice. It depends on your department but even more so it depends on you. We're responsible for providing the absolute best care possible to each patient with no prejudice.
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Permalink Reply by Cafryrmn on
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I agree with the comments of Fireforever and Joe. You perform an assessment on each individual involved in the accident. If it is a MCI then you assess each patient accordingly. But in the everday type of situation, you assess each patient whether it is 3 to 5 people or 8 people. As EMTs you have a duty to act. Anything less is negliegence. All it takes is one deposition with a group of lawyers and the above mentioned EMTs would soon realize the error of their ways due to their failure to act. I have worked on calls where we have had over 50 patients and I was the lead paramedic. If these EMTs watched someone else do it, then I suggest that they "watch a different medical television program". Not a good practice to follow.
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Permalink Reply by Kathy Miller on
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First of all, our calls are not categorized car acccident, fire, etc. All of our calls are emergencies and we respond to them equally. Where I volunteer - when coming onto any emergency scene - we are required by our corp, not the state , to assess each individual if not fully then at least to get a set of baseline vitals and make sure the patient is alert and oriented. If the patient refuses medical attention or tells us he's ok (and he really isn't) we will have them sign a waiver of medical attention after explaining that if they feel worse later or symptoms start to appear to go to their local emergency room or dial 911. That way if he comes back later and says we didn't take him to the hospital, we have his signature of refusal. To answer your question- the protocols vary according to state and they do not have individual protocols for each emergency.
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DOH! I got off track on my original post... I forgot to mention about the protocols.
As Kathy said, in our state there aren't any protocols specific to MVAs. On the local level, our medical director and regional EMS council have written a comprehensive set of protocols that include refusing medical treatment. This is also called RMA or AMA in other areas. Two sets of vital signs to establish a trend, and signing the refusal section of our care report and that's it for people who are shaken up or don't know if they're all right.
I can see where some agencies would condone a drive-by interview, particularly in urban areas where call volumes and demand for services are high with ambulances in short supply. You wouldn't want to spend 15 minutes assessing a walking, talking patient who is shaken up but apparently fine, knowing there's a cardiac patient just a couple of miles away who obviously needs immediate treatment.
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Permalink Reply by Kimberly A Bownas on
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Joe and the others who are in this field are correct. We have protocols to follow and we follow them. If someone doesn't then they better have a good reason. I get so tired of people who don't know anything about what we do making statements that are so incorrect and making us sound like we don't do the job correctly. If you are looking for answers to a question that I have no plroblem with and any Paramedic or EMT will gladly try to answer the question or at least tell you where to look for the information. There are a lot of variables because each state is different with their protocols.
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Permalink Reply by Brian Dumser on
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Joe brings up a good question, I was wondering the same thing!
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Permalink Reply by Moose on
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Im kind of shocked that so far, with all of the combined experience in this thread both fire and EMS, that not a single one of you discussed "Scene Safety"......
I dont know about you guys and gals, but If Im in the bus that day, without turnouts or charged hoseline, cribbing in place and vehicle stabilized, and confirmation there are no power lines touching the vehicle....Its just not safe to go and start my assessment. Creating 2 more victims for our Fire/EMS bretheren to worry about on top of the original patients just is not kosher no matter how you look at it. Maybe these EMT's in question saw a hazard that you did not and they were doing their job by maintaining safe distance, and talking to the patients to keep communications going and establish a few things for their assessments until FD arrives and stabilizes. I know that in my assessment a whole BUNCH can be ascertained from that one simple question "are you OK?".......Like if they answer you in a clear complete sentence they A) Have an open and stable airway B ) Have no difficulty breathing and C) Obviously are concious, AOX3.
Scene Safety is Paramount in everyones case....granted, if the car is on fire and they are trapped or otherwise incapacitated I will go and do what I can....but if there is no threat to life or limb, the patients are concious and talking, then there is no need to rush in balls to the wall and get yourself and your partner hurt or killed in a gasoline flash fire, or when the car starts to roll because its still in gear, or when the Loaded Bumper goes off and takes off your legs, or if there is a delayed deployment of the airbags while you are taking a BP and get knocked on your gluteous Maximus or my personal favorite, the new Hybrid Vehicles with the 36 volt battery system in the rear of the cars...Anyone here completely comfortable working in those monsters??.....the list goes on folks. Scene safety, let the FD stabilize the situation, than move in and care for the patients.
On top of that, like mentioned already, the topic starter has no experience in the Fire/EMS field and how do we know the accuracy of this allegation??
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You're completely correct in pointing out the scene safety considerations, Moose, but... my underlying assumption in this discussion has been treatment of the "walking wounded" who have self-extricated and are either standing nearby or are in a passerby or police vehicle.
In my area, the majority of vehicle crashes nowadays result with "everyone out and walking around" reports received while enroute. This is great to hear but it doesn't let us off the hook insofar as evaluating those involved to make sure they are indeed not injured.
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Jinx - almost
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