Extricate or not extricate?

[pokeyfd12]

Greetings brothers and sisters, I have a question I was hoping to get some feedback on.

Recently my vollie rescue company responded to a request for extrication at a three car MVA. Upon arriving, the BLS ambulance crew informed me (the OIC) that there were two people trapped in the rear seat of a small four-door vehicle (Volkswagen Fox). The VW had been t-boned in the rear passenger door at approximately 40 MPH, spun around and was t-boned in the rear drivers door by vehicle No. 3. Both rear seat passengers were squeezed together, almost sitting on top of each other and were covered in glass with some lacerations from the shattered rear windshield. The PT's were alert and oriented. We began door removal on both sides simultaneously, as per the EMT's request, when the ALS (seperate agency in a fly car, vol ambulances in my area are BLS) arrived. They spoke to the PT's and stopped all extrication. At that point, the two "trapped occupants" climbed over the front seats and out the undamaged front drivers doors.

We packed up our toys and went home and were happy that the PT's were not seriously injured but would any of you agree with the medic's assumption of no injuries and ask a PT to climb out of a severely damaged vehicle???

[FFMike9]

THAT'S NUTS. WHAT DID THE ALS CREW HAVE, XRAY VISION TO DETERMINE NO INJURIES.

FROM THE DESCRIPTION OF THE ACCIDENT THE POTENTIAL WAS DEFINATELY THERE FOR SERIOUS INJURIES.

IN OUR DISTRICT, OUR FD RUNS WITH BLS EMT'S AND WE DO THE EXTRICATION. ONCE THE VICTIMS ARE EXTRICATED THEN THE ALS PEOPLE GET THEM, BUT WE NEVER MAKE ANY ONE GET OUT ON THEIR OWN UNLESS THEY REFUSE TREATMENT AND SIGN OFF ON THE PCR.

SOUNDS LIKE THOSE ALS PEOPLE YOU'VE GOT THERE NEED A REFRESHER CLASS ON THE MECHANISM OF INJURY.

REMEMBER IN A CASE LIKE THAT TO DOCUMENT EVERYTHING SO THAT IT DOES'NT COME BACK TO HAUNT YOU LATER ON (CYA).

STAY SAFE.

MIKE PIEKIELNIAK
REMSEN FD
EMS OFFICER

[This message has been edited by FFMike9 (edited October 31, 2000).]

[Mr. Freeze]

Wow. Just like Mike said, document that kinda stuff. Who knows what could happen in court later?

[MetalMedic]

No, I don't agree with it... but the bottom line (at least in this State) is that the highest trained medical person on the scene (that assumes responsibility) is in charge of patient care. Part of that care is extrication, so if the medic decides to extricate by means of the patient's own power, so be it.

In our EMS protocals, we can rule out the need for full immobilization based upon lack of pain and deformity. Based upon that, you could reasonably allow a patient to do what you described.

DOCUMENT what happend and WHO was in charge that made the call... file your report and go back home and get back to bed. May not make you happy, but you will be able to say it wasn't your fault if the victims end up paralized. Unfortunately, you can't win that battle on the scene. That one has to be won through proper channels.

I might suggest a group drill sometime with the BLS and ALS unit to critique some of your calls.. and slip this one in to get your opinions on the table and learn from everyone's prospective.


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Richard Nester
Orrville (OH) Fire Dept.

[Lewiston2Capt]

That ALS medic also need to review his NYS EMS Protocol. It states that unless the patient is critical or unstable perform rapid extrication. But if the pt. is potentially unstable or stable, as it sounds like these people were, a stay and play approach in mandated. I have been to a few MVA's where the pt has "self-extricated" and upon a secondary assessment had diminished response in their legs, which later was diagnosed as a fractured vertebrae. My FD has the policy if at an MVA and pt trapped cut them out. Then board and collar them unless they refuse and are willing to sign a statement to that effect on both the PCR and Pt refusal form.

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Shawn M. Cecula
Captain
Lewiston Fire Co. No. 2

[Hamy91]

Where was the IC during this? Yes the ranking medic has pt command but he does not have scene command. Did the fly car medics have bunker gear on? We had a wreck once were a critical care emt was in the vehicle upon arrival. When my crew chief got off the truck he took command and asked the medic what he was doing. The medic did not have bunkers so my a/c told him to get out of the hot zone and back by his ambulance until we extricated the pt.

Back on the original subject if you guys had already started extrication why in Gods name would any sane medic have you stop. If a pt has not done self rescue before your arrival then you extricate them. That does not mean you have to cut everytime but it sounds like you guys needed to cut.

It is the IC's scene and it does not matter if the ranking medic is a flight doc. If something is unsafe for the pt then the IC has the ability to override the medic.

Document document document.................

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Hamy91

FIrefighters are the chosen people.
_________________________

My views do not reflect that of my department or the United States Air Force

[pokeyfd12]

Thanks for the responses. I should elaborate a little further on the incident. Although I was the OIC in charge of the extrication, I was not in command. The Chief was there and had that covered. He just shrugged his shoulders at the medics decision and said that it was out of our hands.

Hamy91: No, the medics did not have any t/o gear on. Nor did they get in the car, they did a visual assessment from outside the car by interviewing the victims.

I should also point out that I am an NYS EMT, I ride with the same ambulance corps. that was on the scene and knew the medic personally. However, I was personally shocked at the decision to let them climb out considering the MOI and was also concerned that the decision to override BLS' decision to extricate after the EMT did an initial assessment. Both rear seat PT's signed the RMA and a third patient (from vehicle No. 1), which was walking around when we got there, passed out on scene and was Tx.

I documented everything on our fire run report, including the PCR#'s and medics names and card numbers.

It was pointed out to me that the medic in question has a personal problem with volunteer FF and thinks we have no idea what we are doing. Her statement as she walked to the curb with the PT's was: "now you can play with your toys if you want."

Thanks again for the responses.

Rescue Lt. Kevin C. (aka Pokey)



[This message has been edited by pokeyfd12 (edited November 01, 2000).]

[Lewiston2Capt]

This is a little off topic, ok a lot off topic.
That opens a whole different set of issues that I think need to be addressed in a civilized conversation. We all should be professionals and should not allow any differences that we have to interfere with what is best for the people we are called to assist. I hasve continually witnessed and heard of paid professional emergency services personel considering the volunteers substandard because we dont get paid. To my knowledge every EMT/Medic in NY has to go through the same course. Some volunteers even run more calls than the paid personel. I think since we are al working toward the same goal, public safety, we shuld al be on the same team.
I will now get off of my soap box and attempt to stay on topic from now on. I do not intend to start any arguements over who is better.
This is just my opinion and does not necessarily reflect the opinion of my fire department.



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Shawn M. Cecula
Captain
Lewiston Fire Co. No. 2

[MetalMedic]

[QUOTE]Originally posted by pokeyfd12:
[B]It was pointed out to me that the medic in question has a personal problem with volunteer FF and thinks we have no idea what we are doing. Her statement as she walked to the curb with the PT's was: "now you can play with your toys if you want."

Yep.. you folks do need to get together and have a group discussion. And your Chief needs to talk to HER Chief about such a statement. Especially if she made such a statement in front of "civilians". That deserves some discipline for conduct unbecoming of an official. I am sure you were less than happy on the scene, but hopefully you kept your cool (I doubt if I could have done so to be honest!).

Sorry you have to work with such people... You say you knew her personally and work on the same squad. I feel for you brother!

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Richard Nester
Orrville (OH) Fire Dept.

[Lt Fenstermaker]

Well sir, I would agree with your company's actions. Even though the patients may claim that they are ok, they could be in shock. I was always to treat every injury as if it were the most critical possible. I would commend your department for taking extra caution. As was previously stated, the fd has sontrol over the remove, the ems has patient control. It is the fd's job to free the patient, and then the ems may have their moment of control. And as in the other post, this is my own personal opinion, and in no way reflects the view of my fd.
Eric Fenstermaker
Scipio Fire

[This message has been edited by Lt Fenstermaker (edited November 02, 2000).]

[FFMike9]

POKEY,
SOUNDS LIKE MAYBE A PHONE CALL FOLLOWED BY A LETTER SHOULD BE SENT TO YOUR LOCAL EMS COUNCIL CONCERNING THE ALS PROVIDERS PP (**** POOR) ATTITUDE TOWARD FIREFIGHTER/EMT'S AND ABOUT HER OBVIOUS LACK OF PROFESSIONALISM!

MIKE

[JAMESBENNETT]

Well this is not off the topic, but a call that we made only a couple of weeks ago. I am not a medic nor do I want to be; just wanted to say this before I start. Major accident auto-vs-tree, Driver pinned in small pick-up. When we arrived on scene the passenger had extricated himself and was laying on the ground next to the truck. Ems packaged both pt's and air lifted them to a local hospital. The passenger that pulled himself from the vehicle and was saying he was not hurt, now has a broken back and may never walk again. Wacky-Tobacky can do some strange things to poeple. Come to find out the kid was stoned and couldn't feel anything. Sometimes the pt's don't allways know how bad they are hurt and I can't believe that they would make such a call just by an interview.

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SERVING FOR PRIDE
PROUD TO SERVE!

[Squad33]

pokeyfd12, I was just curious if you had any info on the outcome of the patient? I'm not trying to say "gee, the pt is fine whats the big deal." I would agree with just about everyone on cutting them out. Those medics boo-booed. I just hope the patients didn't suffer because of attitudes.

Stay low, Stay safe

Steve

[Looper]

Sounds like you need to have some written SOPs between the FD and the EMS service(s). We have an excellent working relationship with the EMS service in our area. Senior FD officer assumes command, EMS handles patient care, and FD extricates.

I disagree with the idea that the EMS should stand off to the side while the FD is working on extrication. Does the patient get no care until the FD gets him out?

In our system, EMS triages the Pts, and unless the car is really crumpled up bad, one of the medics will stay with the Pt while extication is in progress. We even conduct an extrication demo for each new EMT class done by the EMS service -- the students sit inside the car while we work on it -- so they know what to expect.

Yes, we have stopped extrication at the request of EMS, so that they could start an IV, administer meds, or evauluate the Pt. It is up to them to decide on the Pt's stability -- this can affect the techniques and/or time available for extrication.

You need to build a good relationship with the EMS service -- ours comes from working side by side for 25 years. We have many people who are members of both organizations.

As far as patient care goes, its up to the senior EMS person on the scene. If they say that person does not need mechanical extrication, its thier call to make. There is a very large municpal Fire & EMS service just south of here that routinely has Pts from MVAs walk to the ambulance, then puts them on a backboard with full c-spine imobilization.

[smokeyben1]

I have done mva extrication for about 10 years as firie and I lost count of the number times I have encountered this, unfortunately we are required under our 'Act 'to work to the directions of the Ambulance staff. It is scary to see the things the 'ambo's 'do to get people out of cars so they can get going rather than wait a few minutes for extrication. The Ambulance service is a separate gov'department to the Fire department here. This is my view not the NSWFB.