would be interested in your responses to this scenario

This scenario was given to Firefighters working alongside a HART team. The person that gave this scenario was a watch commander in the fire brigade :

Cyclist knocked off and run over.

Not just a clip but a run over and dragged job, and the car is on top of the cas with his torso and body still under but his head exposed..is a bad one but this is based on a real incident we had a few months earlier that prompted the chinwag.

The scenario was we get there before you do, its one of those days (although it doesnt happen often) when your ETA is at least 10 mins.

We have realised the car is bearing down on the Casualty and obviously causing breathing probs. We were all in agreement that we would stabilise the car to at least stop it crushing the cas any lower, and administering O2 and performing a primary survey although...
...you would not need to be an A&E Consultant to realise the injuries are severe and life threatening...major internal injuries, multi fractures etc.

We would then put in place our high pressure lifting bags and get everything ready for when you turn up.

This is were it goes 2 ways.
1 camp want to start lifting the car totally off the cas for better access to see if anything can be done Trauma wise.
My camp want to leave it more or less as is because I said that if we take all the weight off him and he has suffered internal bleeding then the cars weight is infact helping to compress the bleeding and he could bleed out.

Obviously when you are there you can detect if there is bleeding with BP/pulse monitors and put lines in to try and stabilise etc but we could not do anything other than watch him die if we raised the car and he did have a bleed.

how would you as combat medic / Nurse etc dealt with the scenario...
Isn't there also an issue with how long he's been crushed? Can't remember what its called but the toxins build up in the distal tissues and can cause problems when the weight is lifted as they all flood into the circulating blood?

editted...i think its actually called 'crush syndrome' and its about 15 mins time scale
Bigbird, what you refer to is a reperfusion injury , however crush syndrome is normally associated with a limb and the time frame is somewhat longer.

A very good explanation can be found here --> http://en.wikipedia.org/wiki/Crush_syndrome


To give my 2 penneth worth to the question...to which, I am sure, others will have differing views.

If the vehicle is bearing down upon the casualty causing respiratory distress, then the vehicle needs to be lifted.

Access to the casualty is required for primary survey to permit treatment to ensue to those injuries that may be life threatening (if presented) that can be treated.

As for internal injuries....never met anyone yet with x ray vision that can confirm beyond reasonable doubt that the weight of a car will keep someone alive. If there is a requirement to apply pressure to an area then I would suggest this should be a local pressure carried out by hand and not a vehicle. As always with a limb there is a set course of treatment protocols to prevent catastrophic bleed and again access to the casualty will be required.

You can only diagnose from what is presented to then treat accordingly, if the casualty has internal injuries that may cause the loss of life then I can assure you that the only saviour the casualty has, is the surgeon in theatre. This of course is measured against those fine paramedics who can give life saving relief to clearly identifiable internal S&S that present at the scene such as tension pneumothorax / haemothorax as examples.

In summary... the vehicle needs to be lifted from the casualty.
I agree with "Mountain_Boy",

You would need to immobilise the cyclist as best you could before lifting the car, C/collar-Ortho slid down either side of him if possible under the car/rescue board/trolley alongside car/if you can get to a limb cannulate and get the fluids going before lifting and then as soon as the car is clear of the body then use the ortho to drag the cyclist clear, get him onto the trolley and get the clothing off to see what your dealing with, and at least if there was no other medical backup on scene (HEMS ect) you would be in a position to get the blue call into the nearest trauma centre and be away.

Just my opinion..
Ambulance en route...

Get the car off the casualty, then the medics can go straight to the "saving his life" bit, instead of waiting for air bags to inflate.

Having also seen a "drag" style casualty, I doubt the car is doing ANYTHING to stem bleeding.
Had this scenario in the mid 80's on a refresher course at the then Southern Ambulance Training School. Two of the class were the responding Ambulance crew and the other eight were passers by. With no rescue equipment and Trumptons eta 10+ mins away, the passers by were asked to get round the car and lift it up a foot or so, and the crew did a snatch rescue..
With later experimentation in the car park we found that 8-10 adults could lift most small-medium size family cars with ease..
Snatch rescue gets my vote.
Get the vehicle off them, your patient will die quicker from no chest movement than anything else.
F*ck c-spine
Correct C>A&B problems then rapidly evacuate. don't stay and play.
as for fluids, if you've got a radial pulse don't bother.
it sounds like this scenario is acute so crush syndrome isn't your first concern.
also crush syndrome focuses more on the "meaty" parts of you getting crushed, not the "cavities"
I/V lines, prepare for lots of fluid replacement aiming for hypotensive resuscitation, intubate and ventilate making sure the chest is decompressed, collar, then scoop and run. Likely to bleed out if pelvis is smashed, so may need pelvic stabisation at scene.

There is no right or wrong answer to scoop and run or stay and play, have to just go on information you have but whatever you do some scum sucking lawyer will always try to make it your fault whatever happens


Well you're going to have to get the car off him at some point. Surely the question should be 'What do you have to do/consider before you lift the car?'

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