First Responder Procedures at MVA’s
Editor's Note: Although originally developed as entry level instruction,
Amy Steelman's "Rapid Extrication" feature serves as an excellent refresher
for veteran fire-rescue personnel as well.
DatelineUSA: The Fire-Rescue Services have seen more change in the past twenty
years, then it did in the first two hundred. Delivery of emergency services
has become much more diversified, and as providers, we are required to cross
train in a number of disciplines, including Auto Extrication.
All over the World, a report of an MVA sets into motion a multi agency response
that includes Fire, EMS, Rescue and Law Enforcement. And in most jurisdictions
the simple fact of the matter is that we respond to many more accidents than
we do fires.
The Goal: Quality Patient Care:
of Fire-EMS-Rescue is to save lives and limit property damage, and that holds
true during MVA’s as well. Most serious accidents result in traumatic injury
to the driver and passengers, so it’s imperative that fire/rescue personnel
free trapped victims, so they can receive definitive hospital care. The goal
- to begin advanced treatment within 60 minutes of the onset of life threatening
The Golden Hour
No, it’s not a religious TV show - it’s the buzz phrase that refers to the
time frame from the point at which injuries occur - to the 60 minute mark. To
call this the critical period is an understatement, because the earlier the
patient is able to reach surgical intervention of their traumatic injuries,
the greater their chances for survival.
In the case of say Princess Diana, the one hour, ten minute extrication process,
and subsequent attempt at microsurgery aboard a slow moving ALS rig, might have
served as her death warrant. A high visibility incident which nearly brought
the French emergency services to their knees.
The Process Begins: Rapid Assessment
most areas of the country, Law Enforcement is often first on the scene of an
MVA. After all, they’re already on the road, responding from the street. Trained
police personnel can begin the vitally important “size-up” of the accident scene,
even before EMS and Fire arrive.
Once EMT’s arrive on the fireground, their first task is to determine the extent
of injury through “Rapid Assessment”. During the Primary Survey, First Responder
Teams should consider the mechanism of injury, damage to the vehicle and the
patient’s position in the vehicle.
Consider the “Collision Factor” - namely the accident itself, the collision
of the patient against vehicular compartments, and the collision of the patient’s
own organs against internal body components. It’s also important to recognize
if the patient has received any “deceleration” injuries. It goes without saying
that treatment should be initiated immediately, in order to stabilize life threatening
conditions, and provide transport without delay.
Simultaneous Rescue and Patient Care
And therein lies the rub. Since MVA’s are multi-agency responses, the “rules
of the road” are sometimes unclear, with responders often wondering “who’s patient
is it anyway?” There are still departments in North America who DO NOT subscribe
to the theory of simultaneous rescue and patient care. I’ve found this to be
especially true in those areas where fire/rescue is provided by a municipal
agency, and EMS by a contract provider.
Wake up Gang! Turf Wars were part of the job a hundred years ago, but in this
age of communication, responsibilities should be clear. When the battle lines
aren’t clearly marked, the only loser is the patient.
Primary or Initial Assessment
Rescue Teams should provide EMS with immediate access to patients by opening
compartments and removing glass. The Initial Assessment by EMS and Extrication
Efforts by Fire/Rescue MUST OCCUR SIMULTANEOUSLY in order to remove the victim(s)
as quickly as possible.
As the assessment takes place, EMT’s can immediately begin management by maintaining
airways, controlling bleeding and stabilizing the C-Spine.
Secondary of Focused Assessment
Once Fire/Rescue personnel are able to remove trapped victims, secondary or
focused assessment can take place. This exposes the patient to providers and
allows for complete head-to-toe examination to identify other injuries and reassess
any critical findings that were initially suspected.
Chances are that as a First Responder, you may arrive on scene before a heavy
rescue or vehicle rescue squad. So consider using some of the basic handtools
that are carried on your first-due rig. In many cases you may be able to provide
access to victims using a simple halligan tool or axe. Other first-in tools
may include a pry-bar, center punch, porta-power or portable saw.
Following Size-Up, Company members should be instructed to perform duties that
will limit risk to victims and rescuers alike, including:
- Stabilizing the vehicle with airbags or cribbing
- Providing adequate access to the patient
- Deflating tires (check your SOP’s first)
- Removing glass
- Advance a charged handline with a combination nozzle
- Prepare any additional hydraulic tools
- Install portable scene lighting
EMS personnel should be outfitted in modified turnout gear, making sure universal
precautions are assured, including eyewear, gloves and masks.
Placing Hydraulic Tools In Service
Rescue Tools are highly specialized pieces of equipment. You and fellow members
should have a thorough working knowledge of these devices, including all appropriate
safety precautions and maintenance procedures.
Of course, Rapid Extrication is the key to any successful Vehicle Rescue. Extrication.Com
is a wonderful resource for those of you who’d like to learn more about state-of-the-art
extrication techniques, especially precautions that should be taken when working
with automobile airbags.
I encourage you and your members to review your department’s SOP’s and any
local regulations dealing with emergency activities at motor vehicle accidents.
Remember, our primary job at any MVA is to deliver quality patient care, and
at the same time, keeping our own teams safe.