vehicle accident with fire

[Gooch26]

I have been a firefighter for over 10 years and an E.M.T. for over 4. I responded as a paid E.M.T. to a two vehicle accident at an intersection of a four lane divided highway. Upon arrival we found a fullsize pickup truck that had been struck on the passenger side just behind the passenger door by a full size sedan. The right rear tire of the pickup was thrown approximately 300 feet so speed was at least the posted 55 m.ph. We arrived prior to the F.D. to find the truck on the far shoulder of the roadway. The pickup had been on fire due to a ruptured gas tank and had been extinguished by a F.F. arriving on scene with a dry chemical extinguisher. The vehicle was still smoking at this time. We found the passenger door partially opened (we believe it was opened by one of the bystanders). Upon forcing the door fully open we found a male unrestrained patient, lying face down along the front edge of the bench seat wedged between the seat and the dash. His head was facing the passenger door and was over the rocker panel. We did not believe the patient was breathing at that time and decided to rapidly extricate the patient due to this fact and the risk of re-ignition. The patient was placed onto a long spine board with manual c-spine stabilization as best we could. We strapped the patient to the board, applied a c-collar and C.I.D.s. The patient was then loaded into the ambulance and subsequently intubated and rapidly transported to the hospital five miles away. He was then flown by medical helicopter to the closest trauma center. At which time we were informed that the patient had a C1 and C2 cervical spinal fracture and displacement. His injuries were unfortunately fatal. With the information that I have been able to provide, what thoughts do you have on this incident? Did we do right or was there something more or different that we could have done for this patient? I personally believe we did the best possible care we could have for this patient but with the outcome I can't help but have some doubts. Any serious suggestions will be greatly appreciated.
Sincerely Gooch26

[LtStick]

I personaly think that you did the right thing. I am not an EMT but I have been a Firefighter for twelve years and have seen many accidents over the years. I don't think that there is much else you could do. Don't second guess yourself I think you did a fine job.

[Steamer]

You had a real potential for re-ignition with you, your crew, and your patient in the middle of the fire. You say you thought your patient wasn't breathing, so you had to get him out as quickly as possible. Either of these reasons is justification for rapid extrication, not to mention both. I've been a medic for a long time (since 1977) and I don't see where you could have done anything differently. Don't beat yourself up. You did a good job.


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Steve Gallagher
Chillicothe (Ohio) Fire Department

[pokeyfd12]

Gooch, as an EMT and firefighter, you did the best you could. Without the benefit of firefighting protection, your first objective was to remove the patient from the hazard zone as quickly as possible. Wouldn't that be the same thing as pulling a lifeless person from a burning building and then starting CPR outside where there is no further danger to either yourself or your patient???
What was the alternative, to wait for the FD and hope the scene doesn't erupt in a ball of flames again. What would have been your chances then??? I think your patient had a better chance being removed from the vehicle, no matter what his injuries. Sure, we can argue mechanism of injury and C-spine precautions all day but that's what "rapid extrication" is all about.
Our county Medical Examiner gives a class here every year or so and discusses causes of death and shows some graphic pictures of injuries and things to look for. Mostly he has told us that some of the bodies he autopsied from MVA's had some kind of c-spine damage and some had severed cervical vertebrae. Does that mean we stop putting collars on MVA patients, NO. We follow protocol to the best of our ability and if the situation presents as unique, we must deal with it the best way we can. That patient of yours was better off that you were there than he would be if you weren't. At least the family has the knowledge that somebody tried their best for that person.

Rescue Lt. Kevin C. (aka Pokey)

[LadderCapp]

It sounds as if all went as well as could be expected. As unfortunate as any incident causing a fatality is, they are indeed sh** happens incidents. I'm not trying to sound callous mind you, but you need to remember that as ems responders, and FF alike, there is only so much that we can do. You and yours can rest assured that you did all that was possible in the worst possible situation as far as re-ignition, and hazardous conditions are concerned. "One can never dwell on the things one cannot change"

[N2DFire]

Gooch,

Add me to the list of people who think you did an outstanding job.

Just as everyone else has pointed out,
You had an unstable scene with life hazards to your self, your crew & your Pt.
You had a Pt. whom you thought was not breathing & due to the Pt's position & location you could not adequately treat that condition.

Based on your account of the incident, I see no good course of action other than to perform a Rapid-Ex.

Self evaluation is a good teaching tool, always ask what could I do differently/better next time - but don't beat yourself up over the answers you come up with.

Just like LadderCapp, I'm not trying to sound uncaring or insensitive but the 2 "hard and fast" rules I tell every new member are:
Rule 1 - We are not God - we can't save everybody.
Rule 2 - No matter how hard we try nor how good we are - we will never change Rule 1.

Just let me wrap this up by restating the fact that you did an excellent job.

Take Care - Stay Safe
Stephen
FF/Paramedic

[Lewiston2Capt]

Mark me down as agreeing that you did all you could with the situation you were presented with. I too feel that personal review is a good thing, as is learning from your experiences, but dont beat your self up over it. You wont be any god to anyone if you are so busy second guessing yourself that you cant move.
Everyone has given good advice, listen to it and keep up the good work.


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

[CAPTAIN WHO]

I'm going to agree with everyone else here. Job well done! I've gone through a couple of these and you can't help but second guess yourself. You run the scene over and over in your head. You fall asleep wondering: What if?

I recently responded to head on highway collision. 1 vehicle fully involved. We got the kids out of the back of the car but due to heavy winds we had a heck of a time knocking the fire down. Front doors were crushed shut. We didn't stand a chance. Mom burned to death. It was god awful. We called a Proffessional debriefing team along with everyone involved. Police, Fire, EMS, and the private citizens that we had gotten the names from at the scene that tried to help before we got there. 25 people talked it out. Feelings, What ifs, concerns, tactics.

It was the BEST 4 hours we ever spent. Talk to the others find if they have issues. Contact your CIDT (Critical Incident Debriefing Team) These people are professonally trained and usually be reached via your local goverment agencies.

Again for what its worth, You did what you were trained to do. You relied on your knowlege and 10 years of experience and training. You did what your were called upon to do. It just doesn't always work out the way we want it to. A life faded away this time, But think of all those who are alive who wouldn't be, because of your training.

[JohnM]

I agree 100%. You did a great job.

[cfr3504]

I was going to type a reply to this, but after everything that all the others have said, there's just not any more that I can come up with to add to it. Count me in with was the others have said.

[Malahat27]

Even as a "junior guy" on the block, considering the turn of events, I think you did the right thing. Fortunately for me, I have not yet run into your situation, but I have had good advise from my "senior guys": sometimes, no matter what you do, if you do what you think is right, it is right, even if once in a while it doesn't go well." The point here is that you did what you were trained to do and did it well and to the best of your abilities. That is the part that counts! Don't dispare, sometime in the near future someone will come to you and say: "thank you", and that is all that counts in the end. Cheers from Malahat, and remember: play safe!

[Gooch26]

Sorry it's taken so long, but I would just like to thank everyone who posted a reply for their kind words. When I posted this I really didn't think there was anything else that we could have done for our patient. I really just wanted to know if anyone one thought we had missed anything. And believe me, hearing it from fellow fire and ems personnel that we didn't screw the pooch really helps lol. Anyway, thanks again, and stay safe and look out for each other.
Randall Guntrum ff/emt
"Gooch26"
"If lights, sirens and air horns do not attract the attention of a driver, he or she is too drunk to be assisted by a paint scheme!"