Vehicle Stabilization by EMS

[Chief 50]

We were recently approached by the FD who responds the rescue truck to auto accidents in our first due. They were concerned about the safety of EMS providers entering an unstable vehicle. We felt this to be a valid concern, so we made step blocks for each ambulance. Many of our members are already trained in stabilization. We are preparing to train those who are not. The FD is now expressing concerns that stabilization is a function of the rescue truck and the ambulance shouldnt be doing it. We were simply trying to address a problem they pointed out. Only trying to perform simple stabilization. Not going into stabilization of vehicles not on their wheels. Ambulance is usually on scene 3-5 minutes before extrication unit. Whats your opinion about how to handle this situation ?
Appreciate any input you may have.

[JimT]

In our county we have 13 stations. Some of these do not have rescue equipment in them. There has been some discussion to train a station that is non-rescue but is in our rescue area in cribbing so that the majority of the stabilization is complete by the time we arrive with rescue tools. I can't help but think that it would be a positive for the patients...to cut 3-5 minutes off of the golden hour. Our station is in discussion on this now...will let you know what we decide. GOD BLESS!!STAY SAFE!!

[Ken Hanks]

Chief50:

The FD expressed concern of your members working on a patient in an unstable car prior to their arrival. Did they expect you to wait until the rescue truck arrives?

I would thank them for pointing out a safety hazard and giving you the chance to improve patient care.

As an officer arriving on scene, I'd double check the stabilization before we started extrication, but I'd be happy to see it done.

My departments SOP is to stabilize every vehicle with a patient prior to their removal.



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Ken Hanks
Naugatuck FD IAFF L1219
CT Fire Academy

[DD]

Tell them to get there first and they can have it stabilized when you arrive. Who is in charge of the scene?

Disclaimer: Code 606

[Aff]

EMS should not enter a vehicle without it being properly stabalized. How is that good for the patient? If the fire department is that delayed, I agree it is a good idea to train the EMS people in basic stabilization. Then provide the proper equipment. Egos don't need to get in the way of patient care. And besides, isn't extrication part of the EMT and medic training requirements? Unless there is some other hazard, IE haz-mat, fuel spill, ect., and fire/rescue is needed for YOUR safety, do what you need to for the patient. Hopefully they will understand you are not "taking their work", but providing the best possible care. I think you are doing it right.

Stay Safe...
Mark

[Ron Shaw]

Thumbs up to the idea, while extrication is concidered part of the fire service by many, every EMT & Medic that I know of learns extrication as a part of there basic training.

Trust me, there are many of departments that do not practice stabilization. It is common knowledge and concidered a standard that you should not enter a vehicle unless it has been properly stabilized.

Placing cribbing or step blocks under a car is not extrication by definition.

To place step blocks under a vehicle as a safety precaution I concider it a reasonable safety precaution and overal just makes good sense.

Is patient treatment to be delayed until the FD arrives and performs stabiliztion? In some remote areas it could be conciderable time before the FD arrives.

Some times we try to split hairs on who's job is what. If an engine company arrives at an accident scene, do they perform patient treatment prior to the arrival of EMS?

Working together will help both services, putting step blocks or cribbing to stabilize a vehicle so the EMT/medics can safely enter and render aid is not unreasonable in my opinion.

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Ron Shaw
http://www.extrication.com

[Ed D]

I think the first thing we have to remember is that Rescue is Patient Care. Without a patient you have no rescue. Rescue (at least Gaining access and stabilization ) is part of the National EMT curriculum. Medic units should have basic cribbing on them - at least 10 4x4 plus 2x4s and wedges just from basic stabilization
I have heard quite a few chiefs say we are coming to the accident to cut the car apart, we don't do any of that EMS stuff.If you are not coming to the accident to treat the patient........

[Spirk]

Chief 50, I personally commend your efforts in dealing with a "Nationwide" problem. In general, EMS providers are more lackadasical in the "Scene safety" area. In my 27 years of fire service I have seen EMS providers who don't necessarily think about safety to themselves.
Firefighters are required to "gear up" for all accident scenes but we continually see EMS with only work uniforms on working in and around the vehicle.
Yes, patient care is of the utmost importance!!! We must remember our training though: "A dead or injured rescuer is no longer a rescuer but a victim." The safer a scene can be made without jepordizing patient care the better for all.
Your approach to providing the training needed to quickly make an unsafe scene become safe is admirable. EMT's are trained in basic stabilization and extrication procedures to obtain their accredidation. It is not a matter of who does the job but that it be done safe and correct.
Personally I like having a vehicle stabilized when we roll up to do an extrication. It is one less thing that we have to do and it is a great time saver. Of course any time this happens, it is checked before we begin operations.
The EMT's that I work around are great people. They are very smart people! (It takes a smart person to pass the requirements that they have.) To "TRAIN" them in how to use step chocks to quickly stabilize a vehicle, make it safe, and save you time when you arrive on scene is a great idea. I hope it works well for you.
As for the people complaining about who- does-what, they should get over it! We are all in this together so lets "Help" make it better for all.
Good Luck Chief.

[Scene25]

Ed D,
I completely agree with you. Basic vehicle Rescue is touched in the EMT course. Cribbing, some cutting techniques using various hand tools etc. One thing to remember here. The EMS is in charge of the patient, and the rescue is in charge of gaining entry. But, who designates where entry is to be made??? The EMS does. They are in charge of the patient, therefore they designate which way that patient comes out of the vehicle. And hopefully, all EMS agencies are wearing TOG on these type accidents. So, as far as the EMS cribbing the vehcicle, I see no problem with this. They crib to make the scene safe for themselves, as well as the patient. When the rescue arrives, they then stabilize the vehicle to fit there extrication needs. Work with the EMS, and if something is being done "unsafely", address it and move on. You never know when you will need the EMS to help you. Take this into consideration.... Your involved in a MVA, and the EMS arrive, your trapped, and they dont enter for 10 minutes, because the rescue truck isnt there yet. If it were you, you would want the EMS inside with you. This does not say to just go climbing into a car, thats on its side. Obviously this is a per call basis. If the scene is entirely "unsafe", I hope the EMS would make the right decision. Take care and be safe.



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John Williams
NRFF1/EMT
Clairton Fire Dept (swPA)

[rescue1550]

Things are different here in the Valley of Virginia:
Rescue/EMS does RESCUE and EMS.
Fire does FIRE SUPPRESSION and assists Rescue/EMS when needed.

We have an excellent working relationship amongst departments. It is not uncommon to see a Rescue Officer or EMS Officer as a Safety Officer or Accountability Officer on the scene of a Structure Fire. Likewise, it's not uncommon to see a firefighter assisting an ALS provider with setting up IVs or pulling drugs for them from the drugbox.

I applaud Chief 50s response to the problem. He was confronted with a problem and addressed it--with a very logical, sound solution.

I guess what it all comes down to is that fine line between fire/rescue/EMS. Fire doesn't want EMS helping them. EMS doesn't want fire helping them. And us squadies don't want help from anyone (HA HA), but... WE ALL NEED TO REMEMBER THAT "WE" ARE HERE FOR EACH OTHER AND FOR THE PATIENT. Not for territory, not for glory, not for recognition. WORK TOGETHER for the COMMON GOOD. It seems as though Chief 50 knows that but his counterpart doesn't.

Kudos again chief 50. Keep up the good work.

[DED1645]

Well, In my opinion. At least you took their suggestion serious. If you know what you are doing, then continue to do so. Stabilizing a vehicle is a very simple thing. You by doing that you are reducing time on scene and progressing to getting the patient to where they need to be. My a joint drill is in order for the squad and resque? Exchange knowledge and opinions. If they refuse then they are trying to be controling. Wether resque companies like to hear it or not the patient's care is in your hands and you have to turn them over to the ER staff and give the report to the ER doc. I know first hand that resque companies can attempt to take over a scene and demand you to do things. Resque companies that respect their squads won't do this. They work hand and hand like they're suppose to. Good luck in your future rescues. Remind the resque officers of PHTLS and the golden hour.



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David DeCant
firefighter/NREMT-B
Originally Mantua,NJ
Presently Lindenwold,NJ(I'm not a member of any of this District's dept's.)

[MetalMedic]

Vehicle stabalization is part of your patient care. If you mount an unstable vehicle, you could aggravate an injury to a patient inside the vehicle. Therefore, whoever arrives on the scen first, be it fire or ems, should take steps to stabalize the vehicle(s) as part of the initial scene size-up. I would certainly hope that your local fire service will come to realize that and back off the issue and find something more improtant to concern themselves with.

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Richard Nester
Orrville (OH) Fire Dept.

[guardog]

Hi Chief50
Up here in Midland I would have to ask how often do you really get to the scene first? Next how much stabilizing are you going to do? Generally speaking you aren't dressed for rescue at most your guys wear the blue turnout coat but no helmet or boots. If more is needed than just step blocks you should wait for fire-rescue to arrive. There are many things to look at on the scene and I know you are trained but what about the average person on your squad?