Critical Decisions

CONTINUING EDUCATION FROM EMS

This CE activity is approved by EMS Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1.5 CEUs. To earn your credits, go to www.rapidce.com, or to print and mail a copy, download the test here. The deadline to take the test is September 30, 2009.

ARTICLE OBJECTIVES

• Discuss scene size-up at motor vehicle crashes
• Review general patient assessment
• Outline the components of a rapid trauma assessment

INTRODUCTION

As a responder, your actions within the first few moments of arriving on the scene of a motor vehicle crash are crucial to the success of managing the situation. Within these moments, you must size up the situation, mitigate as many hazards as possible, establish incident command, rapidly triage patients and ultimately assess, treat and extricate patients from the scene. In doing so, you must decide when to extricate a patient and what treatment is essential to improve the patient's chances of survival, based on your knowledge, previous experience and a problem-based assessment algorithm.

SCENE SIZE-UP

Assessment of the situation begins from the moment of first dispatch. You must not only consider the information received, but take into account the time of day, traffic, weather, safety issues and potential resources that may be required. Prior to arriving at the scene, put on personal protective equipment, such as body substance isolation, helmets, eyewear, outerwear, safety gloves, boots and reflective vests, as it may be chaotic upon arrival and responders often fail to don appropriate safety equipment as they become distracted with managing the situation.

As you arrive, assess the scene through the windshield of your vehicle to develop an index of suspicion for potential injuries based upon damage to the vehicle and mechanism of injury.¹ Patients involved in front-end collisions may have head, neck, chest, abdominal, pelvic and extremity injuries, whereas a patient from a lateral collision may have injuries localized on the side of impact. Patients involved in rollover crashes may have any number of injuries, especially if they are thrown from the vehicle, which significantly increases their chance of dying.

The "windshield assessment" also allows you to evaluate for scene hazards, such as other traffic, wires, spilled liquids or hazardous materials. Evaluate the scene for any immediate life-threats that would require an emergency rescue and removal of the patient from the vehicle, such as fire or any other environmental threats to the patient and/or responder. Move to an area that is safe for all.

Not only should each responder perform this assessment upon arrival, the incident commander should continually reassess the safety of the operations. Throughout the extent of the operation, the incident commander must weigh the risk of injury and death to his or her providers against the likelihood of being successful and is responsible to pause or terminate operations if they are deemed unsafe. One way to accomplish this is to assign a dedicated safety officer to provide the needed focus to ensure this task is always completed. However, it is everyone's responsibility to continually reassess the scene and situation for safety. If at any point during the operation anyone feels there is a safety issue, they should immediately stop, retreat to a safe area and notify the incident commander. Always be cautious when using the phrase "scene is safe," as it may give a false sense of security when operating at a scene that is vulnerable, such as a motor vehicle crash. Even with the best traffic control, there are still hazards from fire, trips and falls, and vehicles driving around or through traffic control measures. All responders should develop a culture of situational awareness where they use all of their senses to continually evaluate the surrounding scene for safety, planning each and every movement before it is initiated.