Patient Priorities

How you treat a patient at a crash scene can greatly affect their experience

Fire departments and EMS personnel respond to crashes every day, but do we treat every patient like we should? When the call is over, can we honestly look back on the incident and know that we treated the patient like a family member and not like a mother-in-law? Just kidding!

Proper patient treatment starts long before we go on a call. It starts with our relationship with our EMS provider. Some departments are fortunate because they provide both fire and EMS to their community. This makes it easier to train with the folks who provide medical treatment to patients.

The majority of the country has volunteer EMS or a hospital-based ambulance service, which makes it difficult to train with them—yes, train with them. There are some very important reasons why we should train with them. Most importantly: our safety. We all need to have good communication on rescue calls, and this starts with having a relationship where everyone can talk to each other. Good communication leads to understanding the operational objectives of each agency and rescuer. Butting heads on the rescue scene is unprofessional and unproductive. Discussing issues before they come up will help us avoid this pitfall.

Another issue is personal protective equipment. Many paramedics believe that wearing proper PPE means wearing a pair of medical gloves. But for rescuers, that just doesn’t fly. It sounds like a reality show or game show—crawling around a confined space covered in glass and a biohazard while only wearing medical gloves. Protect yourself. Wear thick coveralls or bunker gear and eye protection. The PPE you wear should protect against glass, raw metal and blood. Officers, demand that your personnel—and everyone operating at the scene—protect themselves when working crash sites. There’s no heroism if someone gets injured for doing something stupid, like not wearing proper PPE.
So how do we take care of a trapped patient? First and foremost, communicate with them and immobilize their cervical spine. International Trauma Life Support—a global organization dedicated to preventing death and disability from trauma through education and emergency trauma care—clearly states that you should hold the patient’s C-spine, then follow your department’s protocol while letting the patient know that you’re there to help them.

Gather as much information as possible before they pass out—you know, the obvious stuff that’s on the top of the medical report. Don’t forget to ask about allergies and note any hazards in the vehicle. You never know, their rattlesnake collection may be in the backseat. Plus, everyone seems to carry a gun nowadays; this would be good to know, especially if the patient becomes irrational and doesn’t listen to reason. Reassure the patient, even if they’re unconscious.

Protect the patient from everything. Hard and soft protection are needed when breaking glass around the patient. Stop the operation if the patient is not protected. Additionally, explain to the patient the sounds they’ll be hearing. It can be scary to hear glass breaking when you’re not expecting it. And engine noise from heavy hydraulic cutters and spreaders can be unnerving, especially when the power unit is 5 feet from the car with 15 feet of hoses coiled next to them. Thus, position the power unit at the front or rear of the vehicle. The hoses will reach around most vehicles.

Attempt to open the doors from the inside of the car to assist the patient. With assistance, slide the seat away from the steering wheel. This should assist with freeing the patient. Next, if possible, tilt the steering wheel. If the patient is wearing shoes or boots, you may want to loosen them. Lower-extremity entrapments are footwear entrapments—especially with boots. Explain every step of the rescue operation (in terms that they can understand) to the patient; it will help them relax in a tense situation.
The bottom line: Remember to treat patients like you would a family member. It’s the right thing to do. Plus, you never know if someone is pointing a video camera at the scene.

Brad Havrilla is a 20-year veteran with Palm Beach County Fire Rescue, where he is currently assigned to the training division. Havrilla is an international extrication judge and the past vice-chairman of the IAFC Transportation Emergency Rescue Committee. He was the recipient of the Harvey Grant Excellence in Rescue Award in 2004.