How Does an Emergency
Care System Work?
The following scenario highlights the interaction of the essential components of an emergency care system in managing a single, critical incident. The organizational structure of EMS, as well as who provides and finances the services, varies significantly from community to community. Prehospital services can be volunteer organizations, hospital based, or provided by commercial or public safety companies; but the components of an EMS system always remain the same.
So far the day could not have been more perfect, Wendy Cooper thought. She was enjoying a very nice, scenic drive to a nearby community to attend her son’s soccer game. It was almost 4 pm on Friday, and if she maintained the same pace, she and her children would get there by 6:00 at the latest. Even 10-year-old Brian, in the back seat and excited about the game, had calmed down and was reading a comic book. Suddenly, a pickup truck emerged from an almost hidden intersection, moving toward the path of the Cooper’s car. Wendy swerved to avoid the pick-up; drove off the road and over a steep embankment to a creek bed below. That was the last thing she remembered.
Jill was also driving this road and she saw the crash ahead of her. She pulled her car safely off the road, stopped and immediately called 9-1-1 on her cell phone. As she went down to the smashed car, she saw Wendy trying to get out and heard her daughter crying in the front seat. As she began to calm and reassure them, she saw the young boy in the back seat; he did not have on his safety belt. He was not moving and did not appear to be breathing. Fortunately, Jill had recently completed a course in bystander care for the injured and was able to recognize that this was a life threatening situation. Jill reached into the car and safely changed Brian’s position so that he could breathe again. This simple action very likely saved his life.
Debra was on duty that Friday afternoon at the county 9-1-1 center. She is a trained, certified Emergency Medical Dispatcher. As Jill described the situation to Debra, she calmly and efficiently asked Jill questions so that she could send the appropriate units to the scene. After reviewing the dispatch procedures, Debra immediately dispatched a quick response unit and a fire department with rescue equipment from a community only one-half mile from the crash scene and a BLS ambulance that was 15 minutes from the scene. Recognizing that there was a potentially life-threatening situation, Debra also alerted the closest hospital and an Advanced Life Support (ALS) helicopter from its base at a hospital 30 minutes away. In the meantime, she gave Jill simple step-by-step instructions on what to do before help arrived.
Within minutes, the nearest law enforcement unit arrives as well as the local quick response unit (QRU) and a fire truck with rescue equipment. While all responders of these units have received over 40 hours of formal training as EMT-First Responders, law enforcement makes the scene safe; the fire fighters stabilize the wrecked vehicle; and QRU members began assessing and treating the Cooper family. While Wendy Cooper and her daughter appear to only have minor injuries, the QRU responders immediately start to assess and treat Brian.
Tom and Valerie, EMT-Basics on the first ambulance to arrive, find that the QRU crew has arrived about 20 minutes before them. The EMT-First Responders have already immobilized Brian for possible head and neck injuries. Tom and Valerie are able to further stabilize Brian and continue monitoring him as they transport him to the rural critical access hospital (CAH) only a few miles from the crash scene. Because the ambulance report to the CAH alerts them that Brian’s condition is critical, the CAH alerts the regional trauma center and an advanced life support helicopter is launched soon after and is en route even as the patient is still being transported to the CAH.
Even before Brian arrived, Dr. Murphy has talked to the ambulance crew by radio. She knows the severity of Brian’s injuries and that he will probably need more optimal care at the regional trauma center, which has special equipment and a staff highly trained to treat trauma patients. When Brian arrives by ambulance at the critical access hospital, the CAH trauma team immediately assesses his condition and further stabilizes him. Dr. Murphy consults with the trauma surgeon at the trauma center, and because of the distance, it is decided to transfer Brian by the helicopter which is only minutes away from landing at the CAH helipad.
Fred and Lisa, the nurse and paramedic on the helicopter crew that will transport Brian to the trauma center, have additional training in the care of critically injured patients. Much of that training included the treatment of pediatric patients such as Brian. The helicopter is specially equipped and Brian is in good hands as he is flown to the regional trauma center almost 80 miles away. Via radio, Fred talks frequently with the surgeons at the trauma center, updating them on Brian’s condition.
Upon arrival at the trauma center, Brian was met by the trauma team led by Dr. Thomas, a board-certified trauma surgeon. Protocols and training guides the team as it rapidly assesses and diagnoses Brian’s condition. The trauma team works quickly, getting X-rays and CT scans and performing other diagnostic tests to determine his injuries and guide treatment. The trauma team treating Brian is optimistic about his prognosis.
During his first few days at the trauma center, Brian was evaluated by Melissa, a physical therapist, as well as other specialists from speech therapy and social work. They were part of the trauma team and worked daily with Brian and his parents throughout his stay. The trauma team also consulted with his teachers to ensure Brian’s safe return to school.
Tom, the lead paramedic who responded to the Coopers’ crash, was concerned that the Cooper’s accident was the fourth crash to which his crew had responded at the same location. After discussing their concerns and visiting the intersection, Tom and members of his ambulance crew thought that a partially obscured stop sign might be the cause of these crashes. They contacted staff from the State Highway Safety Office to get more visible road signs erected and a guardrail was installed.
The Coopers were concerned that their son had unbuckled his safety belt. After talking with Brian, they decided to try to do something positive. They contacted several public safety and EMS organizations to see what they could do to emphasize the importance of wearing safety belts at all times. Brian appeared in several public service announcements, and his parents were asked to speak to groups about buckling up. Because of the Coopers, the message about wearing safety belts is now being taken seriously by many more people.