Transcript Cooperation and Coordination of Emergency Services for Traffic

Cooperation and Coordination
of Emergency Services for
Traffic Accidents
Jim Holliman, M.D., F.A.C.E.P.
Professor of Military and Emergency Medicine
Uniformed Services University of the Health Sciences
Bethesda, Maryland, U.S.A.
Objectives of This Session
Explain the rationale for cooperation
among different types of personnel in
dealing with road traffic accidents
Point out specific methods by which
different personnel can help each other
Stimulate interest in obtaining
emergency medical care training for
non-medical personnel
What Different Types of Personnel
May be Involved in Caring for Road
Traffic Accidents ?
Police
Firefighters
Central Dispatchers
Rescue
Military
Medical
–Emergency Medical Technicians
–Paramedics
–Nurses
–Physicians
Who is in Charge of an
Accident Scene ?
Should be pre-determined by local or
regional agreements
Should be one easily identifiable person
Sequence of transfer of command
responsibility to higher level person also
needs to be pre- agreed upon
Off - scene dispatchers also need to
know the command person designation
Who is in Charge of an
Accident Scene ? (cont.)
Specific command person should vary
according to type of accident :
–Gunfire or hostage situation :
ƒ Police
–Fire or hazardous materials spill :
ƒ Fire chief
–Non - entrapped medical or trauma patients :
ƒ Medical personnel
Who is in Charge of an
Accident Scene ? (cont.)
Use of the "Incident Command System"
facilitates scene management
–Single pre-designated Incident Commander
–Establishes Incident Command Post
–All arriving personnel report to Incident
Command Post for duty assignments
–All communications routed thru Incident
Command Post
What is the Role of Dispatchers
for an Accident Scene ?
May provide pre-arrival instructions to
bystanders at the scene
May provide navigation information to
responding units
Ensure the appropriate types of personnel
and vehicles are enroute
Maintain communication to the Incident
Commander in case secondary
responding units are needed
What Pre-Arrival Instructions
Should
be Considered by Dispatchers ?
Environmental safety
–turn engines off
–use fire extinguishers or hose water on
smoking engines
–avoid downed electrical lines
–get uninjured people off the roadway and
away from the scene
–breaking out windows if vehicle full of smoke
What Pre-Arrival Instructions
Should be Considered by
Dispatchers ?
Emergency first aid
–Pressure bandages on active bleeding sites
–airway maneuvers (with cervical spine
precautions) if patient not breathing
–keeping victims warm with blankets if cold
environment and anticipated delayed arrival of
medical personnel
Other Pre-Arrival Instructions
for Dispatchers to Consider
Person to guide responding vehicles to
the scene (if difficult to locate)
Clearing access to scene by removing
other vehicles or obstructing objects
Maintain open phone line to scene
Calling electrical company to turn off
power if downed lines at the scene
Rationale for Medical Training
for Police and Firefighters
May arrive on-scene long before arrival
of medical units
Early emergency medical care ("first
aid") may prevent the patient(s) from
dying before medical crew arrival
If multiple patients, limited number of
responding medical personnel may need
to assign medical tasks to police &
firefighters
The U.S. "First Responder"
Course
Designed for police, firefighters, and vehicle
drivers who may be first to arrive on-scene
40 hours instruction
Covers basic anatomy & medical terms,
interpretation of vital signs, CPR, basic
trauma care, simple extrication & splinting
May also encompass use of Automatic
External Defibrillator (AED)
Advantages of the First
Responder Course
Stimulates interest in medical care by
first responders
Enables better communication between
first responders & medical personnel
("common language")
Enables medical personnel to take care
of greater number of patients in multicasualty situations
Further Advantages of First
Responder Training
Enables first responders to better
understand the needs of the patient and
the priorities for medical care
Allows more accurate and faster triage if
first responders are bringing multiple
patients to a central triage area where
medical personnel are located
Represents cost effective use of limited
training funds
Police Duties to Consider
Coordinating at the Accident
Scene
Stopping or re-routing other vehicle traffic
Crowd control
Scene security
Arresting & removing uncooperative
persons who interfere with the rescue effort
Preserving scene evidence for investigation
Ordering obstructing vehicles to be moved
Firefighter Duties to Consider
Coordinating at the Accident
Scene
Extinguishing vehicle fires
Hosing down spilled fuels
Encasing spilled hazardous materials
Directly rescuing patients from smoke
areas
Stabilizing tilted vehicles
Protection of other personnel and
patients from downed electrical lines
Rescue Duties to Consider
Coordinating at the Accident
Scene
Major vehicle disassembly to get access to
patient or to free patient from entrapment
Extracting patient and / or rescuers up or down
a steep slope
Turning, rolling, or moving a wrecked vehicle
Removal of physical hazards from the scene
(sharp objects, etc.)
Providing lighting or electrical power to scene
for rescue
Secondary Police Duties at the
Accident Scene
(these should not interfere with medical
care)
Write damage & accident cause reports
Identify & protect dead bodies
Recover & safeguard property
Notify authorities & families about deaths
Respond to missing person reports
Control entry to area (prevent looting)
Photograph & document scene
Decide on disposition of vehicles
Important Principles for Fire &
Rescue Personnel to
Remember
Extrication of patients from vehicles should utilize
the simplest & fastest method
–Power tools & vehicle disassembly often NOT
needed
–May just unlock door to get access to patient
–If long spine board can get into vehicle, then
usually patient can be removed via open door or
thru removed windshield
–Medical personnel should insist on use of fastest
method
Considerations for Use of
Helicopter Evacuation of
Patients from Vehicle Accidents
Important to pre-decide which personnel have
authority to call for helicopter
–In U.S. some areas empower first responders and
most areas empower medics to call
–Should utilize pre-agreed criteria for dispatch
ƒ May vary somewhat according to traffic or
weather conditions
Helicopter should be able to directly communicate
with on-scene personnel
More Considerations for
Helicopter Evacuation of Patients
from Vehicle Accidents
Safe landing zone must be established
Responsibility for landing zone must be
pre-agreed (usually would be police)
If landing site somewhat distant from
scene, transport of helicopter crew to scene
& back to landing site must be planned
(may ned another vehicle)
Transfer of responsibility for patient from
ground to helicopter crew must be clear
Considerations with Exposure
of Accident Victims to
Hazardous Materials (Toxins)
Requires close cooperation of medical
personnel with fire / hazmat personnel
Best if patient can be decontaminated prior
to entering ambulance
If decontamination incomplete in field, must
communicate this to receiving hospital prior
to arrival there
Police may need to evacuate others from
area
Other Considerations for
Accidents Involving Hazmat
Incidents
Usually fire / hazmat trained personnel
should be in charge of the scene, and
medical personnel should follow their
instructions
Initial patient access and care may need to
be done only by the hazmat personnel who
are wearing special protective equipment
Rescuer safety should always take
precedence
Should a Physician Be in
Charge of the Accident Scene ?
NOT in all cases
If not an emergency physician, and if
unfamiliar with prehospital personnel,
should limit his participation to direct
patient care, and follow advice &
requests by other personnel
Fire, hazmat, and police considerations
may initially take precedence over
patient care
"Debriefing Conferences" : A
Useful Technique to Develop
Cooperation Among Different
Personnel
After a major vehicle accident, may be helpful to
schedule a conference of all the involved
personnel (fire, medical, & police)
–Should be moderated by an administrator or
local government leader
–Should review sequence of events
–Should elicit comments on suggestions for
improvements
–Should not be used to criticize or assign blame
Practice Drills : Another Useful
Technique to Develop Better
Cooperation
Should involve all local services (medical,
fire, rescue, police)
Mid - and upper level administrators from
each service should be present
Should have followup critique session
Another technique is for different
personnel to do "ride-alongs" with the
other services to become familiar with their
daily work
Use of "Cross- Training" of
Personnel to do Different
Duties
This approach has been used in the U.S. in North
Carolina successfully
–Police also trained as firefighters
–Police and firefighters rotate as dispatchers
–All have at least first responder medical training
–Helicopter medics in Maryland are also full time
police officers
Local governments like this approach since they
can hire fewer personnel
Facilitation of Interactions with
Hospital Personnel
Hospitals should provide feedback to prehospital
personnel on patient outcomes
Having fire and police spend observation time in
the emergency department may be useful
–Response vehicles could be based at the E.D.
Hospital may coordinate medical training
sessions or short courses
Hospital personnel could do "ride-alongs" with
prehospital, fire, or police vehicles
Important Principles of
Interaction by Different
Prehospital Services
Main goal should always be trying for the
best outcome for the patient(s)
Unusual situations may require flexibility
in duties and responsibilities by different
personnel
–People should not be rigid but should be
cooperative
When disagreements arise, should make
efforts at quick resolution
Cooperation and Coordination
of Emergency Services for
Traffic Accidents : Summary
Best patient care results when different
services cooperate
Requires pre-established protocols
Drills and review sessions help in
improving interactions
Some degree of "cross-training" may be
useful