“Ladies and gentlemen: the story you are about to hear is true. Only the names have been changed to protect the innocent.” Sergeant Joe Friday, LAPD (ret.).

Motor Vehicle Accident October 2009

Jerry Barrett – PARAMEDIC

At approximately 1500 hrs I received a call alerting me to an MVA on Carnarvon Road South approximately 20 kms South of the MESA A Camp. A member of the public was at the Gatehouse where she had alerted security to the accident.

I requested that Tamara [HWC] be called to accompany me to the incident in order to assist me if needed, I also requested that Dave be recalled from the Rove on the MRT so that he could “back me up.”

While I was organizing the Pod vehicle and Medical equipment security called again informing me of the type of injuries that had been sustained. I requested that the bystander who reported the incident stay at security in order to direct me to the scene of the incident because I was not aware of the local area topography.

Tamara arrived promptly but I elected to drive the Pod vehicle, as we were to be traveling under emergency conditions.  I felt it was prudent that I drive, being trained and experienced with emergency vehicles under priority conditions. We arrived at the scene approximately 10-15 minutes after departing MESA A camp.

High Speed Damage from MVA Down Under

Aftermath of Australian Outback MVA

Upon arrival I was faced with the following scenario:

A bystander at the scene had given first aid and erected shelter. The driver, Patient A, appeared to be in his 50’s and was seated at the rear of the vehicle, under some ad-hoc shade. He was alert but slightly confused with a GCS 14/15. Patient A was complaining of chest pain and was anxious.

The Front passenger was Patient B.  Patient B appeared calm and coherent with a GCS 15/15, although was worried about pediatric Patient C who was laying in the rear of the vehicle and screaming at that moment.

Pediatric Patient C was in the rear of the vehicle, supine, anxious and in pain from injuries to his right arm and right leg. Patient C was a known status epileptic. Patient B informed me that the condition was well controlled.

I asked Tamara to stay in the vehicle with Patient C to reassure.  I conducted a primary survey on all three patients and determined that Patient A needed a secondary survey first. The vehicle had been traveling at over 130 kph. Unconfirmed reports had indicated that Patient A had been thrown from the vehicle. The accident had initially happened at approx. 1300 hrs. Two hours prior to our arrival to the scene.

Patient A had no recollection of the accident [?LOC] or events leading up to the accident, OE: PEARL, superficial blood from a torn LEFT ear lobe and swelling to LEFT mandible below the ear. SaO2 98%, pulse 75 reg and warm to the touch with good skin color. Good air entry bilateral, c/o severe chest pain. ECG = NSR @72 bps. No pain on springing chest, clavicle OK but c/o pain ++ to RIGHT wrist, covered with bandage & dressing.  Pelvis and Abdomen seemed fine and lower extremities devoid of pain.

ECG and monitoring was commenced, STIFFNECK applied, Oxygen given at 8-10 lpm. 300 mg aspirin given at 1520 hrs and a 16 G IV access initiated in LEFT Cephalic vein with 1 litter Ringers Lactate 500 ml STAT dose. As Patient A was experiencing severe Chest pain and injuries on both wrists I gave 5 mg MORPHINE IV, with good results.

During this time the ERT support arrived. I liaised with Mick from ERT regarding scene assessment etc. I left Patient A under the care of the ERT member while I moved on to Patient C. I liaised again with Mick regarding extracting Patient A as I intended to package Patient A as a spinal/cardiac patient as soon as time allowed. Mick continued to prepare for the patient extraction from his seated position.

I returned to Patient C in the rear of the vehicle.  Access to the rear of the vehicle was limited due to the deformed bodywork. Tamara was doing a great job reassuring Patient C, and Patient B was also of great assistance in helping to reassure the anxious and traumatized pediatric patient.

Upon gaining access to the front of the vehicle I conducted a secondary survey of the child.  I ascertained that the patient had been lying across the back seats, restrained by just one seat restraint when the accident occurred. Patient C was very anxious, was about to have a fit, and was very scared. I initially gave patient C 3 ml Methoxyflurane but had to coax on how to use properly. Once Patient C developed the technique the analgesia seemed sufficient to relax the child enough to enable a secondary survey.

Patient C was c/o pain in his neck, RIGHT arm and RIGHT leg. STIFFNECK applied. PEARL, no obvious scalp wound or structural injury to skull, good and bilateral air entry to chest, soft abdomen, no # pelvis, LEFT upper and lower limbs structurally sound, RIGHT arm misshapen and painful [covered with ad-hoc dressing, and RIGHT leg painful and covered with dressing/ splint. 2 unsuccessful attempts to gain IV access were made and the child was not totally compliant with the attempts. Patient C was alert and coherent but in pain, previous analgesia was wearing off. 3 mg Morphine IM given at 1600 hrs in RIGHT upper thigh (LEFT limb unavailable due to posture).

At this time Dave PRIME Paramedic arrived in the back-up ambulance. I gave Dave a brief assessment of the situation, and then gave a quick handover of Patient A, delivering him into his care for the extraction onto LSB and evacuation.

Patient C was somewhat calmer now but I could not properly assess his RIGHT arm and he was still in pain. After conferring with Dave, I proceeded to give Patient C a further 2 mg Morphine IM. After removing the dressing the child’s RIGHT arm was tender to touch and severely misshapen Ulna/Radius. This was splinted with a padded wooden splint and crepes bandage. There was good distal sensation and capillary refill was less than 2 secs.

At this time the Nurse and Driver from Pannawonica arrived and assisted me with the removal of the splint/dressing on RIGHT leg. RIGHT ankle swollen and misshapen, painful to touch with no motor function. Pillow dressing/ splint applied by Nurse to RIGHT ankle.

I liaised with ERT regarding extrication from vehicle. Scoop stretcher was employed and ERT/Medical team extracted patient from vehicle and onto Ferno stretcher without incident. Patient loaded into Ambulance, Patient B accompanied on route to Karratha hospital.

There was outstanding professionalism from both the ERT and Pannawonica medical team.

Share →
Buffer

Leave a Reply