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Responding to a Motor Vehicle Crash
Intensive Care Paramedic and CRANAplus Remote Emergency Care course Facilitator Casey Hayes provides advice on how to respond to a motor vehicle crash while working in a remote setting. Casey’s advice is aimed at remote area nurses with limited experience in pre-hospital emergency care but may be of interest to all readers.
1. Remember your own safety
“Sometimes we get so overwhelmed with emotions, adrenaline, excitement – we forget our own safety,” Casey says.
Arriving on the scene to find an agitated caller and a confronting scene, practitioners can easily overlook risks such as being near the road, fuel leaks, and shattered glass.
“However, it’s often the nuanced risks such as airbags that may be missed,” Casey says.
“If the airbags haven’t gone off, and the car is fitted with them, they can spontaneously go off – something to be mindful of if you’re treating a patient who is still in the car.”
“In an urban environment, the fire service would hopefully be responding as well, and would potentially arrive before the ambulance crew. Their responsibility would be to make things safe, disconnect the battery, stabilise the vehicle and deal with any fuel leaks, for example. In a remote environment, this isn’t often the case.
“Also consider vehicle stability. Often when we find vehicles, they don’t have all four wheels sitting on the ground. They’re on their side or their roof… It’s important not to rush into a scene.”
2. Allow sufficient time to prepare
“The moment people hear the word ‘crash’, they picture the worst,” Casey says.
“We’re dealing with high speeds, long distances, big trucks on these rural roads. But it’s important to not let the emotion take over; to take your time and not rush.
“Before leaving, make sure you have the necessary equipment on hand. Some centres have well-equipped vehicles, but in many places, there is a troop carrier with an oxygen bottle and a stretcher in the back. Equipment or bags may be grabbed from the shelf [on departure].”
The distances, which are typically longer, may influence what you need to bring.
“If you have transferred your trauma bag to the troop carrier, it is important to ask questions such as: does it contain enough analgesia to provide pain relief for that patient for potentially two hours of driving – spent not in a hospital bed, but on a bumpy outback road?
“[Also], if it takes you an hour and a half to arrive and that patient has been sitting in the sun, what started out with just a broken arm could now involve a patient that is potentially dehydrated. Have you got enough fluid?”
Establishing a detailed understanding of the situation before departure will help you to make informed decisions about what equipment to bring. This may be time-consuming, and although the speed of the response is important, it is necessary to balance this against arriving well-prepared, Casey says.
Be aware that locations may be mis-communicated by callers who are unfamiliar with the area. Communication is at the crux of preparedness – both before you head out and while you’re on the road.
“Do you have satellite phones or radios?” Casey asks. “Do you know how to use them? Are they charged?”
3. Assess the most appropriate location to deliver treatment
“It’s important to understand when to be urgent and when not to,” Casey says.
He poses the example of a patient with major chest trauma, and potential cardio-vascular and respiratory problems. In such a setting, first responders will rightly consider C‑spine precautions.
“We also need to remember, it can take an hour and a half to get a patient out of the vehicle and keep their spine perfectly in alignment,” Casey says.
“[The question then becomes] – if they have major chest trauma and are struggling to breathe, and we’re an hour and a half from the nearest clinic or airstrip… Is it better we get this patient out quicker and transport them to a more appropriate setting?
“You need to be assessing your patient – undertaking a good quality primary survey – and making that clinical decision.”
Casey encourages practitioners to ask themselves: “What needs clinical intervention now… and what’s better off being dealt with back in the clinic in a cleaner, sterile, calmer environment?”
4. Assess and communicate the extent and nature of the trauma
Understanding the mechanism of injury helps practitioners to appreciate potential injuries and anticipate the potential for deterioration.
“You may have a patient who is presenting quite well,” Casey says.
“But, for example, if you know that it was a high-speed incident and the vehicle has rolled, this tells you this body has bounced around and had major forces exerted on it.
“If there’s two people in a car and they hit a tree, it may happen that one person has severe neck pain, a broken leg, or multiple fractures in different spots, while the second person appears to have no injuries.
“Sometimes that’s the case, but what we teach is that both of those people are in the same car, their bodies have been through the same trauma – as a general rule.
“If one person in a car is very sick, assume everyone in the car at least has the potential to become that sick. It’s always important to find a means of getting that patient back to the clinic, where you can continue to monitor them.”
A practitioner’s attention can also be misdirected by ‘distracting injuries’, a concept Casey often discusses with new students and paramedics. Such injuries draw attention away from more serious risks to the same patient, or from a higher-risk patient in a multiple-patient scenario.
To this end, it’s vital to perform effective primary and secondary surveys, and to continue to reassess throughout the treatment period.
The mechanism of injury and extent of trauma also need to be effectively communicated during handover, while following the ISBAR process.
“If you say the words ‘motor vehicle crash’ to 100 people, everyone will picture 100 different things,” Casey says.
“We want to clearly relay the mechanism of injury and the extent of trauma, so the [amount of trauma isn’t underestimated] and the patient isn’t undertreated.
“During handover, aim to communicate a clear picture of the scene – how damaged the car was, intrusions, how many times it might have rolled, the estimated speeds, how far debris was spread up the road.”
Lead with the most concerning details, rather than those of secondary importance, and if possible, take photos of the crash to show those you are handing over to.
5. Know what resources are in your area
Resources are less likely to be available in remote Australia. Therefore, recommendations that are appropriate for well-equipped urban settings may not apply.
For example, jaws of life – and thefirefighters or emergency rescue personnel trained in their use – will not typically be available to attend a crash and extract patients in remote Australia.
“Every situation is going to be different, but the more people you’ve got there to help you, the better,” Casey says.
“If you’re lucky enough to have a volunteer fire service, I’d encourage you to go out and meet them, find out what they’re capable of.”
“If not, ask yourself and those who have worked there before: what other resources do we have available locally? Farmers who can help, orderlies, drivers on call, police? Where’s the nearest clinic? Is there someone in the community – a volunteer in the school for example – who can come out and pick RFDS up from the airstrip and drive them out to the scene? Does the local school have a bus we can use to get [multiple] patients to the clinic or airstrip?
“If you can answer as many of these questions in a calm environment, and a day comes when there’s a crash, knowing answers to these questions will prepare you to respond.”
Click for information on CRANAplus Remote Emergency Care course. This course teaches knowledge and skills to respond with confidence to emergency situations faced in the remote setting, including safely approaching a motor vehicle crash and how to systematically identify and manage any life-threatening injuries.