Part 1:

You and your EMT partner are dispatched to a multi-vehicle collision on Interstate 10 at milepost 86. Dispatch states that there are at least two vehicles involved, one being a semi. Approximately two miles from the scene you note that the eastbound traffic is at a complete standstill. You continue traveling towards the scene by way of the median.

As you are approaching the scene, you find an 18-wheeler semitrailer truck on its side. Off to the side of the road you see a passenger van that appears to have rolled over and is now sitting upright.

1.         What is your first step on this scene?

2.         What safety issues should you be considering?

Part 2:

You call for immediate backup. You notify dispatch that you will be assuming incident command until further notice. Prior to exiting the ambulance, you and your partner survey the scene for any signs of a hazardous materials spill. You see a red placard on the semitrailer with the numbers 1202 on it. You look up information on this placard in the Emergency Response Guidebook and find that it is a classification for diesel fuel. You see no leakage and decide to exit the ambulance and complete a scene size-up.

3.         How can you verify what the tanker actually contains?

4.         What is your first step in patient care?

Part 3:

You send your partner to check on the occupants in the passenger van while you see to the driver of the semi. The driver is conscious, alert, and oriented. He states that he is in no major pain but is just a bit shook up. The driver verifies that he is hauling diesel fuel. You double-check the freight bill to confirm. Your partner notifies you that there are six passengers in the van and that he needs your assistance.

Due to the fact that this is considered a mass-casualty incident and triage must be initiated, you ask the driver to lie on the ground and remain still. You quickly explain why you are leaving him there. You ensure the patient's airway, breathing, and circulation are patent. With the current condition of your patient, you assign him a green tag.

5.         What do the colors on a triage tag signify?

Part 4:

As you are heading toward the van, you notify dispatch that you have initiated triage and ask for an estimated time of arrival (ETA) for your backup. The responding units have a 3-minute ETA. In the van you find six patients, all restrained. The driver-side airbag was deployed and there is approximately 10 inches of roof intrusion.

Your partner tells you that all patients are conscious, alert, and oriented. He has checked the ABCs on all patients. Together you verify the injuries of all patients and assign the appropriate triage tags. The fire engine arrives. Your partner remains with the patients in the van while you give the report to the captain on the engine. You transfer incident command to the captain and assist with patient care.

6.         What types of injuries or medical conditions would fit into each of the four triage color categories?

7.         Who would you provide treatment to first?

Summary:

As with any scene, safety should always be your number one priority. You are of no help as a rescuer if you yourself become a victim. Call for backup anytime you feel it may be needed. It is better to find out that additional resources are not needed and have them return to the station than to not call them at all or to call them too late. Attempt to identify any hazardous materials before you exit the ambulance. Remember that any time the number of patients outnumbers your resources, consider the scene a mass-casualty incident and react accordingly.

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