Monday, June 6, 2011

Medical Monday: Scene safety, part 2

Last week I talked about scene safety and what EMTs do when there’s a danger at the location where we might be needed to check a patient. You can find it here. This week I’m going to talk about roadside dangers.

Toxins or explosives on semi-trucks, shipping companies like UPS, USPS, or FedEx, or other chemical dangers.

Traffic hazards

Dangers from the vehicles involved in the incident.

First: Toxins/explosives. Did you know even milk, if it’s in a big enough quantity, is considered a toxin when it spills? And shipping companies carry a whole lot of dangerous stuff in those packages—because people don’t always follow the rules as to what they’re allowed to ship. The big problem with shipping companies like the post office or UPS is that the drivers don’t know what’s in the boxes, so they don’t know if they are carrying toxic chemicals.

On the other hand, a semi-truck driver for a big freight company generally has a list of everything they are carrying, with an MSDS (material safety data sheet) for anything that needs one. But they don’t have to put the MSDS placards on their trucks unless they are carrying a certain volume of a dangerous chemical, so one of the things EMTs are taught is to ask what the truck is carrying, or to stay back if there is any fluid or powder on the road until we can be sure what it is. Considerations: are we upwind, is it going to run downhill to us, if some idiot driving by in another lane tosses their cigarette butt out the window, is it going to cause a fire?

Traffic hazards: Usually law enforcement arrives at the scene before we do, but in cities where they have a paramedic crew at the station all the time, it’s possible the ambulance could arrive before law enforcement. Where I live we have almost no traffic accidents in town (we’re talking one every year or two), but our department covers over 50 miles of freeway (more if the department to the north of us needs extra help), so we get a LOT of single car rollovers, which means we’re parking on the side of high-speed roads a lot. When the ambulance is called out to a traffic accident, so is the fire department extrication truck, and often they send the chief’s suburban as well. The state troopers respond, and most of the time, we get at least one sheriff’s deputy on scene, often more if the reports are bad and it’s daytime.

In addition to their job of getting statements and pictures for their reports, law enforcement puts up cones and directs traffic to the other lane, and helps if we need an extra hand with patients. They provide a safe place for us to park (we like to park on the far side of the fire truck, in case an distracted driver isn’t paying attention, but go where we’re told, and try to pull completely off the road if conditions allow). At night, the fire department also sets up lights at the accident scene so we can see what’s going on.

Accident vehicles: The very first call I responded to when I started running on the ambulance was to a patient who had driven off the road, through a barbed-wire fence, somehow flipped so the car was headed the opposite direction of what it had been going, and ended up the side of an overpass embankment. The fire truck parked on the overpass and ran a chain around the car’s back axle, securing it to the fire truck so the vehicle wouldn’t move while we were taking care of the patient inside.

In addition to extricating the victim—which can vary anywhere from getting the driver’s door to open, to cutting off the top of the vehicle so we can access the patient out the top—the fire department may put chocks in front of the wheels, use their truck to secure the damaged vehicle, or anything else that needs to be done to ensure that we can safely access the patient. Our fire fighters are also trained to deal with chemical hazards and to watch for gas leaks, and other dangers (you know, besides those pesky engine fires—which are pretty rare and hardly ever turn into explosions, in case you still believe Hollywood worries about realism).


If you have any questions about injuries or scenarios that EMTs might respond to, feel free to ask in the comments, or drop me a line at Heather at my first and last name .com and I'll be happy to help you out!

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