Case Study: MVC Trauma Victim

This first Case Study involves a female, approximately 40 years old, involved in a motor vehicle collision. The initial dispatch advised the collision took place between a truck and a vehicle, and that the patient was pinned inside the vehicle. Upon arrival rescue workers noted that the patient was trapped in the driver side compartment due to a severe impact on the driver side door. The local fire department on scene began patient care and extrication. The fire department held in line stabilization of the patients C-spine and focused the majority of their attention on removing the driver side door from the vehicle. When Paramedics and EMTs arrived on scene it was observed that the van had a sliding rear door on the passenger side of the vehicle. Paramedics determined that the patient could be quickly extricated by placing the patients seat in a recumbent position and sliding her out onto a backboard. When told of the new extrication plan the local fire department was not willing to follow this new plan and proceeded with attempting to remove the patient's door. By this time approximately 15 minutes had taken place and the patient's was only half way removed. EMS workers on scene proceeded to remove the patient from the rear sliding door with little assistance from the fire department. EMS workers were able to remove the patient by this method in under five minutes. By the time the patient was removed the driver side door was still attached to the vehicle.

Upon extrication the patient was moved by EMS workers to a county paramedic ambulance. Paramedics on scene advised that the patients injuries were minimal. No IVs were started on scene; no medications were administered. Paramedics left the scene and transported the patient to the local hospital.

Approximately three hours later EMS was dispatched to an unresponsive patient. Central advised that the patient was a female in her forties who was involved in a motor vehicle collision earlier in the day. Upon arrival it was discovered that the patient was the same involved in the MVC discussed above. The patient advised she was feeling week and dizzy, and she was very pale. The family members advised that the patient had become unresponsive and had a glazed look in her eyes as she essentially stared off into space. They were unable to advise on whether or not the patient lost total consciousness. Paramedics on scene did not take a blood pressure or perform any basic physical assessment of the patient. The paramedics advised the patient that it was the pain medication given to her by the hospital that caused her to "lose touch with reality." Paramedics transported patient to the same hospital they took her to earlier that day. It was later learned that did not do a CAT-scan on the patient after the MVC.

Analysis:


1.) The local fire department on scene responded inappropriately to the extrication of the patient from the vehicle. There is nothing wrong with the fact that they chose to remove the door from the driver side of the vehicle. However, when shown a second option for extrication that would allow EMS to quickly remove the patient from the vehicle, the fire department chose to ignore this and proceed with the removal of the door. The Chief of the fire department advised that this was a good learning experience for his fire fighters to become acquainted with the tools. The Chief was noticeably disturbed when EMS workers removed the patient from the back side of the vehicle.

2.) Across the country every EMS agency differs in protocol when it comes to the use of a helicopter. In this particular event the use of a helicopter to transport the patient to a hospital that specialized in trauma would not have been out of the question. In the prehospital setting it is impossible to know the full extent of internal injuries. Although the patient may appear to be visibly fine, they could have suffered internal injuries that could be fatal.

3.) During the second encounter with the patient later that night paramedics responded inappropriately during their treatment of the patient. The paramedics should have at least taken a set of basic vitals and not assumed that the patients symptoms were caused by her medication. Worst case scenario, the patient could have suffered a minor skull fracture from the accident and had some internal hemorrhaging.