When responding to your assigned alarm ...

[agaudio]

you come across a school bus full of kids that just flipped over. People are screaming that kids are trapped and hurt. Do you take it in, or do you radio it in and have another unit respond to the alarm? Lets say your assigned alarm is an elderly male who fell down a flight of stairs. It can be any situation, the point I am trying to bring out is, are we going to look bad for blowing past the bus for the original assignment or skipping the original assigment to give immediate attention to the kids?

Just looking to hear what others think. I myself would find it hard to pass a school bus with kids trapped.

Thanks.

[mcaldwell]

Way too many what if's and variables in these scenario's, but generally:

1. Follow your dept protocol.

2. If protocol is not specific, senior man makes the call.

Here, closest unit takes the most serious call (at least as percieved by dispatch or apparatus officer), and request an additional unit(s) for the lesser call.

In your scenario; of course we would stop and render aid to the bus, and dispatch a second unit for the original call.

Just like triage, you assign resources where they will do the greatest good.

[nmfire]

A similar situation happened here over the winter. We were dispatched to a very minor non-emergency ems call. About 2 minutes later, there was a high speed roll-over with entrapment and a major priority one patient. The one ambulance crew decided to divert to the MVA and have dispatch tone out for a 2nd crew for the medical. This was the best decision in reality and for the patient in the wreck. However, by protocol, it was the wrong decision. You can't just abandon the patient you were initially dispatched to.

So, this is something that would have be very carefully spelled out in your local and medical control protocols. I think we all know what the right and logical thing to do is. But it might not be what is written.

[Firetacoma1]

I don't think you'll find a soul on here who would advocate not stopping at the bus crash. You're not abandoning the first patient as you haven't had any patient contact yet.

I would notify dispatch that you're on scene at a school bus crash (possibly a MCI?) and either a new engine needs to be dispatched to the first call.

[Paul343]

some one's been watching too much "Rescue Me"

[nozzelvfd]

With the reality that no call should be taken as routine, I think in this situation you need to evaluate the risk factors here. For example if you are responding to a male who fell down a flight of stairs. Sounds to me he is breathing and basically in some pain but should go to the hospital and get checked out ASAP, however you have a bus full of kids who may be trapped. Could have some serious life threatening conditions as a result of the bus rolling over. I am not saying that a fall down a flight of stairs can't produce some serious injuries either, but you go on the information you are given.

Officers should be make this call, if it where me we stop at the bus accident and have dispatch send another truck to the first call. No one is abandoning the first patient because they sent a second truck and not the initial truck on the call.

However I do agree that you must follow local protocol. The safest thing to do is call it in on the radio and ask for direction from an officer on what they wish for you to do.

[fire0099881]

A similar situation happened here over the winter. We were dispatched to a very minor non-emergency ems call. About 2 minutes later, there was a high speed roll-over with entrapment and a major priority one patient. The one ambulance crew decided to divert to the MVA and have dispatch tone out for a 2nd crew for the medical. This was the best decision in reality and for the patient in the wreck.

Had a similar situation that happened here a few yrs. back, got toned out for elderly man that needed just transported to the hosp. responded to the station, no one was responding to the call, after probably 5-6 mins. finally had another EMT sign on that they was responding. Just after leaving the station, got a call on the radio that there was a semi vs. car accident ( wasn't more than an 1/8 of a mile off the road we was traveling on) with possibly 3 trapped. I immediatly contacted M.A. for first call beings it was just a routine transport, and responded to the accident call, while enroute received a call from ems coordinator, instructing us to go on the first call ( He was not responding was several miles away, and no other officer's was responding to first call when we contacted M.A. for the first call, which would put me in charge of the call) after everyone heard the second call, they all came out of the woodwork ( this all took place within 10 mins of us being toned out on the first call) I no sooner got out of the squad and was getting my *** reamed for showing up on that call and not going to the first one, by someone who is not even medically trained let alone an officer, (which is def. not needed on a scene, save that for back at the station), neighboring dept. didn't know what call they was supposed to respond to, after telling dispatch to have them respond to our initial call, after everything was worked out, and all pts. transported to the hosp., chief comes over and yells at me for not responding to the first call, b/c we was toned out for that call, and had the duty to act ( which we had not made any pt. contact what so ever, so it was not pt. abandonement, since we did have a neighboring dept. responding also) The thing that irritated me is, having people not even around telling you what you need to do since they have no clue as to what is going on, yelling at people on the scene ( I ain't talking about the minor yelling either), and people just responding to the glory calls, that's what irks me the most.

[FTMPTB15]

Around here, EMS is allowed to divert their units to more serious calls as needed. If one unit is going on a non-emergency call and there is a more serious call, in which they are the closest unit, they will get diverted to the more serious call and dispatch will re-assign another unit to the non-emergency run. That's the EMS side...

The fire side... I doubt you'll find too many souls who'll drive past a bad wreck like that. Everyone is different, but if it was me.. I'd stop, radio dispatch and advise them of the situation and that we need more units dispatched both to the (MCI) wreck and also need to send another unit on the EMS run. I couldn't see the admin. here getting mad over that.. there are more important things for them to be worrying about, like shorts or what their members are reading.

[nmfire]

You're not abandoning the first patient as you haven't had any patient contact yet.

That isn't how it works. The ability to abandon the patient starts when you are notified of the incident and assigned to respond. Deciding to go somewhere else is abandoning the patient.

[mikeyboy411]

How I'd do it......

Personally, I would stay onscene of the bus accident...... upgrade the assignment to an M.C.I....... give my size-up and don the appropriate PPEs....... then start another unit to the original call...... once my crew was ready I would assign triage and then establish command.
However, both of my Departments have S.O.P.s that state that I can do this. If you don't have this luxury then it is a judgement call. When Management came and read me the riot act I would ask with all do respect, where are they basing their actions from......... and stand firm with my decision. The worst thing you can do is flip-flop and allow them to convince you that the decision you made was wrong.
I saw in a training facility for the Army one time a picture on the wall that said something to the extent of Leadership........ Base your decision on what is moral and legal, then stand-by your decision. Not sure if that was exactly how it was worded, but I hope you get the meaning.
I would be more frustrated with the person who couldn't make a decision and did nothing........ we all make mistakes and if the choice you make is wrong then so what, as long as you learned from the mistake.

[cozmosis]

War Story

My life isn't anything like Rescue Me, so I can't speak for flipped busses and the like. However, I know that earlier this year, we (the only engine company in town) were dispatched for an elderly person at a retirement home that had fallen. As we approached the scene, we were paged out for an infant not breathing. We have no written SOP on what to do, so it's officer's decision... But I think you have to take the higher priority call. If your protocols say otherwise, it's time to change your protocols.

With that said, we had to provide some assistance to our first patient because we knew the ambulance would be diverted away from that call. (Ambulance authority responds to highest priority call with the closest unit.) So, we made decisions on the fly. First, we dumped a firefighter, an AED and a jump kit off at the retirement home. The second call was on the other side of our station, so we stopped in front of the station and had our other firefighter get another rig equipped with an AED & jump kit and we responded with two units to the pediatric. Because we were split up between apparatus, we then paged our volunteers for additional staffing.

As it turns out, the kid was heavily congested -- but breathing -- when we arrived. We had people scattered in multiple apparatus on both ends of the city, but we gave the citizens the best care they could expect in the process.

[DeputyChiefGonzo]

This is a no brainer.

Have fire alarm send another unit to cover the medical call you were going to.

Assess the situation, call for the MCI and start triaging!

[WebFire]

That isn't how it works. The ability to abandon the patient starts when you are notified of the incident and assigned to respond. Deciding to go somewhere else is abandoning the patient.

Not rendering aid at the school bus is also abandonment and trumps the original call. You cannot leave a patient unless care has been handed over to a person with at least the same skill as yourself. With the original call, you have not yet rendered aid.

Now, I guess you could argue that you drive past it and never stop. But I don't think that argument would get far.

[MaddogDFD5]

you are right... stay with the school bus...... the other medical can be re-dispatched...

[the1141man]

That isn't how it works. The ability to abandon the patient starts when you are notified of the incident and assigned to respond. Deciding to go somewhere else is abandoning the patient.

From a very specific point of view, you're correct. The specific POV being that if you are assigned a call and decide that "somewhere else" is Starbucks, Burger King, etc, then yes you're "abandoning the patient" via nonresponse.

However, in the case presented, it would not at all be abandonment because you were responding "in good faith", but the lower-priority medical aid got trumped by a higher-priority call.

Let's put this in a different light, borrowing a theme from another thread:
You're at the grocery store with your HUGE red truck, yes, it's ok, you're allowed to go in-service for whatever as long as you remain in your first-due. You get a call, priority three (code 2/cold response) medical aid, stubbed toe. As you're walking out to your rig, a guy in the checkout aisle collapses, and you hear someone say "He's not breathing!"

So, by your logic, you go ahead and respond the stubbed toe medical aid (because that's your assigned call) and leave the unresponsive possible non-breather for the next-due unit, which may be 5-10 mins or more away?

Just a note for those of you who have no knowledge of the EMS side of the house, but Priority Medical Dispatch is the nationwide "standard of care" with respect to assigning units to calls. However agencies choose to do that is up to them, but there should be a way of classifying and "triaging" calls, and responding units appropriately...not doing so in the EMS world is simply not meeting the modern standard of care.
If you were an EMS crew instead of a fire crew, you'd be expected to "drop" the lower priority call and advise dispatch you're out on an unresponsive poss nonbreather, it would then be on the dispatcher to assign another unit to the "stubbed-toe" medical aid.