[Surgicalcric]

Not bad guys for your first MVA.

1.) Windshield survey
The purpose of the windshield survey is to identify the type of incident(s) you have, immediate needs that may require assistance from other personnel outside of whats immediately available, any hazards on scene, and call for assistance prior to dismounting your vehicle . It is a basic overview or method of reporting back to command before getting busy with the job at hand.

In this case it should go something along the lines of: 2-vehicle rear-end MVA with major damage to both vehicles; one patient ejected; one vehicle leaking unknown fluid, possible fire/HAZMAT; multi-PT's; no apparent entrapment, start MED EVAC coordinates to follow.

2.) Vehicle safety/stabilization considerations
Anytime you are working in or around vehicles that have been involved in an accident make sure they are in Park and the engine is off. If possible set the parking break. (On a civilian EMS note, never stick your head in the drivers compartment between the driver and steering wheel if the airbag has not deployed. It hurts to get hit by one...trust me).

If a vehicle is on its side or top never crawl in or near the vehicle before it is stabilized to the point it will not move or rollover on you. If the vehicle is on a bank/bridge/cliff tie it off to something stable.

Fire hazard/fluid leaking is another hazard that is very real and needs to be dealt with. If its gas/diesel the patients should be removed ASAP. There should idealy be someone with a fire extinguisher standing by. Be sure to protect any patients from the fluids. This is especially a concern with rollovers. If exposed to fuel be sure to wipe the exposed body part(s) off before placing them on the stretcher/LSB. If left on a LSB lying in fuel for a while a patient can, and in many cases will, develop chemical burns.

3.) Probable injuries based on impact
V1: Patients in vehicles struck in the rear are the more susceptible to c-spine (whiplash) and lumbar spine injuries than any other type of injury. From time to time they will suffer an injury from something flying around in the vehicle but generally speaking I would be worried more about spinal injury than anything else.

As the second vehicle struck the patient's his vehicle will have been placed in forward motion. His upper torso will have flexed rearward, at the hips or some other point along the spine, while his lower body moves forward with the vehicle. Due to the impact area, and lack of spinal support that those inside the vehicle are provided by seating, this young trooper is going to have some serious potential for spinal compromise and secondary head trauma from secondary impact with the weapon as the vehicle comes to a stop.

V2 Driver: Unrestrained drivers of vehicles, without airbags, struck in the front end have a high incidence of blunt chest trauma with pneumothorax (paperbag effect) from striking the steering wheel with the chest; head injury and c-spine injury from striking the windshield with their face; knee injury from striking the dashboard; and ankle/tib-fib fx from the peddles.

Passenger: Somewhat the same as the driver with the exception being a lower incidence of blunt chest trauma (no steering wheel) and a higher incidence for hip and pelvic fracture secondary to the passenger’s legs and torso moving forward and their knees sliding under the dash. This pressure is transferred back thru the femurs to the hip/pelvis area most often fracturing the hip or pelvis. This incident is not as high with the driver due to the steering wheel limiting the forward motion of the hips.

Gunner: Having been ejected there are all types of impact injuries he could suffer. His injuries could range from abrasions to fractures, spinal injuries, internal injuries from secondary impact of the organs inside the body, tension pneumo, head injuries, etc... This patient is also the one who will cause you the most alarm.

4, 5) TX & X-port
Everyone gets spinal immob with collar. Sandbags and 100mph tape for H/BID for critical(s).
V-1: Both driver and passenger Priority 3. Walking wounded.

V-1 Gunner: Priority 1 full spinal precautions, IV and rapid EVAC.

V-2 Driver: Priority 1 if unresponsive/ Priority 2 is no LOC, full spinal and EVAC, other TX according to ABC’s and secondary findings.

V-2 Passenger: Priority 3 as long as no other significant injury noted. Full spinal immobilization with precautions taken to immobilize injured hip.

V-2 Gunner: Priority 1 Immediate EVAC, full spinal immobilization, other TX according to findings.


Good job guys. Let me know if you want another.