Cooperation and Coordination of Emergency Services for Traffic Accidents

1. 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.

2. 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

3. 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

4. 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

5. Who is in Charge of an Accident Scene ? (cont.) • Specific command person should vary according to type of accident : • Gunfire or hostage situation : • Police • Fire or hazardous materials spill : • Fire chief • Non - entrapped medical or trauma patients : • Medical personnel

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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 multi-casualty situations

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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 • May vary somewhat according to traffic or weather conditions • Helicopter should be able to directly communicate with on-scene personnel

21. 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

22. 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

23. 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

24. 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

25. "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

26. 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

27. 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

28. 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

29. 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

30. 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