EMT- Trauma

You arrive on scene to a roll over car accident where a passenger has been thrown from the car and the driver is trapped.  The fire department has not yet arrived on scene, but the police are on scene.  People are starting to gather around both victims.  How should you handle the scene and who is a priority to take care of first?  Also respond to 2 other students posts.

In the case of a trauma such as this one given, I would wait until the scene and call for additional resources/back up while waiting for the scene to be safe and the crowd has been managed. I would be aware of traffic, ensure the ambulance is parked in the safest location, be observant of any glass, debris, broken power lines, spilled/leaking gasoline or fluids, etc. for the sake of me and my crew’s safety. My first priority is to ensure my safety and my next priority would be the patient evicted from the vehicle. I would make sure I have the appropriate  BSI worn properly (usually a helmet and vest). Then I would do a scene size-up as I mentioned earlier which would include determining whether or not the scene is safe, determining the MOI/NOI from the dispatcher and the observations made when pulling up to the scene, determining the number of patients (in this case two) which would then call for additional resources, ALS/EMS assistance, and bring the backboard for C-spine precautions (which are very much needed in this case, obviously.) I would medically tend to the patient evicted from the car while the firefighters are assisting the other patient/driver trapped in the car. For my primary survey, I would get a general impression of the patient and determine their alertness/ responsiveness. Since they were thrown out of the car, I would assume they are probably unconscious. At the same time I would do my ABCs and begin my Head to Toe body examination. First, cutting off the patient’s clothes then begin my Trauma Examination: Rapid Trauma Exam. While doing my trauma examination then I would be looking for DCAPBTLS (Deformities, contusions/bruises, abrasions/scraped skin, penetration/punctures, burns, tenderness, lacerations/cuts, and swelling). I would feel the head, check airway and ears patency, palpate trachea, chest palpitation down the center of the chest with my hands in the shape of a knife, check sides by pushing in to see if ribs are fractured, palpate the four quadrants of the stomach checking for distension and rigidity, place pals on inner hips while using my body weight to rotate the hips (aka: “open and close the book” motion), check broken bones by palpating with alternating pressure down the arms and legs, checking pulses both palmer and radial, turn on back while stabilizing spine with EMT partner to check for any step-offs, chepidice (not sure if I spelt it right, but it’s bone on bone), and palpating/inspecting the thorax, lumbar, and buttocks areas. , etc. Since the patient is unconscious, then I’d check for any medical/sample history by checking their wallet, pockets, and/or purse or bags (essentially any available resources) to see if the patient has any allergies, essential medical history that could be valuable when treating them, etc. I’d check for vital signs and tend to any wounds or secondary injuries properly while stabilizing the patient. I would choose to load and go while reassessing my patient every five minutes. The patient should be on oxygen and cared for appropriately with whatever their condition is at that time. As for the patient who was the driver, the firefighters would hopefully be trying to get the patient from out of the car to a safer area on scene. That would allow myself, my partner, or any other back up team to medically tend to that patient. I would assist them in the same procedure (Rapid Trauma Exam most likely) like I had with the patient evicted from the vehicle. If the scene was safe enough for me to help the patient in any way I could while they were trapped in the car, then I would, but only if it was safe enough. There are several things to consider when approaching a tumbled car like leaking fluid, possible random explosion, fire, etc. that would all need to be taken into account to ensure my safety. It would be desirable that the scene is safe enough to medically service the patient and do everything I could, while ensuring the safety of myself, my crew, and others, to help the patient medically and emotionally.