By Ferno
Cold and inclement are relative terms. They are defined by what’s normal for your area and how you react to what you consider abnormal conditions.
For instance, 50-degree winter temperatures cause no notice in New York, but would have responders bundling up in New Orleans. Rainy weather is just another day in Seattle, but water on the roads in Santa Fe can lead to disaster. Everyone expects snow in Minneapolis, but what about in Memphis?
However you define them, adverse weather conditions affect how you run calls. Response times, responder comfort and safety, equipment performance, patient presentations and patient care practices are all impacted on some level. Let’s look at how these factors drive what you do in a response to a multipatient motor vehicle crash.
The call
Your EMS unit is dispatched with others to a reported accident involving a van and an SUV on a two-lane rural road. It is daytime, but the heavy cloud cover and rainfall make light conditions and visibility poor. The outside temperature is 42 degrees Fahrenheit.
As road conditions worsen, driving becomes more dangerous, and response times increase. A normal four-minute response can easily double with water, slowed traffic and reduced visibility. En route updates from dispatch about lots of patients only increase responder anxiety and frustration at the slow pace. It’s important to recognize this is happening and maintain a steady emotional state and safe driving speed.
Scene safety
You arrive first on scene to find the van upright but blocking one lane of traffic. Six adults, including the driver, are inside. All appear to be conscious. The SUV has left the road and apparently hit a large tree, and is now wheels-down in the mud about 20 feet from the pavement edge. The slope has the top of the SUV about level with the pavement surface.
Due to the poor weather and visibility conditions, you decide to use multiple responding units to close the roadway. With all the challenges posed by the temperature, wet weather, poor visibility, sheer number of patients and unstable working surfaces, the last thing responders need to worry about is traffic around the scene. Motorists will be obliged to find another route, but responders’ top priority must be the safety and lives of themselves and their patients.
Patient care
Both patients in the SUV are conscious and have patent airways and strong pulses, but both are complaining of multiple injuries. All van occupants have nonspecific “bumps and bruises” types of complaints. You determine the van has no apparent safety issues and is protected inside the closed-off roadway. You decide to shelter those patients in place until more resources arrive and concentrate your initial efforts on the patients in the SUV.
It continues to rain heavily, and responders navigate precariously down the muddy hillside from the pavement to the SUV. The driver presents with abdominal pain, neck pain, chest pain from striking the steering wheel, and left knee pain. Extricating him and his passenger from the truck will be no problem, but getting them up the hill to the ambulance offers challenges due to the weather and slippery conditions.
Exercising concern for the patient and your crew equally, you consider options for how to move the driver, once he’s been extricated and moved to a backboard. Standard procedure is to place the backboard directly onto the ambulance cot. In this scenario that doesn’t look like your best choice. Cots travel well on flat, hard surfaces, but must be carried elsewhere. Empty, they can weigh from 74 to more than 100 pounds. With or without the patient’s weight, that’s a lot to try and move up and down a slippery, muddy slope.
You choose to leave the cot on the pavement and instead take a basket stretcher--a rescue stretcher designed for use in raise/lower operations--down to the patient’s side. This particular model has an all-carbon-steel, MIG-welded frame construction and a tubular top frame and lower rails that are stronger than the flat steel used in other basket stretchers. It has a static capacity threshold of 900 lbs.
You know this regular-size model will easily accommodate the backboard, eliminating the need to transfer the patient and risk further awkward movement and injuries to crew. With carrying points all around, four responders easily bring the man in the basket up the slope, with two more up on the pavement holding tension with a belay line. The basket is secured to the cot, then easily and quickly loaded into the ambulance for further care and transport.
Meanwhile, the SUV passenger is complaining of severe neck and back pain. She is just four weeks post-surgery on her back. You have the same muddy slope dilemma to overcome, plus the added need to protect her neck and fragile back. A suitable option here is a full-body vacuum mattress to extricate and carry the woman up to the roadway. At only 15 pounds, it’s easy to carry down to the SUV, and it allows responders to immobilize her in a secure position that conforms to her shape. Three patient restraints with buckles provide maximum patient security, and six carry handles allow the splint to be used as a stretcher.
Using this, the woman is gently immobilized and removed safely up to the road. In both cases, the specialized equipment, readily available and familiar to well-trained responders, helps avert further injuries to patients and accidental mishaps that can hurt responders. Just as you routinely overcome bad weather by altering clothing and response modes, don’t forget that you have other specialty tools available that, when the weather in your area turns unusual, will help you save the day.
This scenario challenge is for illustrative purposes only. Please check your service’s protocals before employing any patient care.