Chapter 1. Approaching the scene
Heading to the scene
• The Road Traffic Act allows certain exemptions to drivers of emergency vehicles who may:
• Exceed the statutory speed limit by 20 mph
• Treat red traffic lights as give-way indicators
• Pass on the off-side of a keep left sign
• Turn right where this is not normally permitted
• Use a bus lane
• Stop and park on clear ways
• Stop and park on a pedestrian crossing and its controlled area
• Park on double yellow lines
• Drivers of emergency vehicles are specifically NOT ALLOWED to:
• Park dangerously
• Drive without reasonable care and attention for other road users
• Ignore one-way signs
• Ignore stop signs
• Go the wrong way round a roundabout
• Cross double white lines
• Fail to stop after an accident
• Fail to provide information after being involved in an accident
• Ignore directions from police officers
• The public road user may react in a variety of ways to an approaching ambulance:
• Sudden braking
• Sudden changing of lane
• Failure to give-way
• There should be a 2 second gap between your vehicle and the vehicle in front
• Lights and sirens provide no legal protection in the event of an accident.
Accidents while driving
• Ambulance personnel have the same duties as the general public under the Road Traffic Act if involved in an accident, regardless of whether they are responding to an emergency call or not
• This Act requires that the driver stops and provides to persons having reasonable grounds for requesting it, the following information:
1. Name and address
2. Name and address of the owner of the vehicle
3. Registration number of the vehicle
4. Insurance certificate
• If this information cannot be provided, then the accident must be reported to a police officer as soon as possible and within 24 hours
• An NHS Traffic Accident Report form should be completed
• DO NOT accept liability for an accident; the circumstances will be established by investigation.
Parking at the scene
• Double-parking may be unavoidable, which may obstruct the flow of traffic – hazard lights or beacons are then used at the driver’s discretion
• When an ambulance is the first or only emergency vehicle to arrive at the scene of a road traffic accident, the vehicle is parked in the fend-off or in-line position to protect the incident
• If the ambulance is left unattended it should be locked.
Immediate-care doctors
A green beacon identifies a registered medical practitioner – sirens can only be used by doctors with the approval of the county’s Chief Police Officer after the completion of appropriate training.
Priorities at the scene
The priorities at the scene can be remembered as CONTROL then ACT. Overall scene control and traffic management is the responsibility of the police. The police are also responsible for establishing and controlling the outer cordon.
Control
• Beacons should be left switched on
• Members of the public should be cleared from obstructing the road
• The engine of the vehicle involved in the accident should be turned off.
Protecting oneself
Individual emergency service personnel must be responsible for their own safety. Suitable protective clothing includes:
• A high-visibility jacket marked with the level of training: a class 3 jacket is required for any incident on a road with traffic speeds above 30 mph (the classification of a jacket is clearly marked inside and is based on the amount of fluorescent and reflective material)
• A helmet with integral visor fitted with a secure chin strap (ideally marked with skill level and rank)
• Debris gloves must be worn in the presence of glass and cut metal
• Goggles should always be worn when working near fire service hydraulic lines and if there is a risk of splashing from body fluids
• Ear protection must also be worn when working in noisy environments (e.g. Fire service cutting equipment)
• Latex free gloves to protect from body fluids – wearing two layers is wise where glass fragments or cut metal are present
• Long sleeves must always be worn in the presence of body fluids, cut metal and glass fragments.
Always think of your own safety first, then the safety of other rescuers and bystanders and finally, the safety of the casualties. This is the 1-2-3 of safety. All patients should be assumed to be infectious in terms of communicable diseases such as hepatitis B and C or human immunodeficiency virus (HIV).
Ambulance officer’s personal protective equipment
• Hard hat with chin strap
• Eye protection (goggles, glasses or visor)
• Ear protection
• High-visibility jacket, with identifying markings
• Heavy-duty gloves
• Patient treatment gloves
• Robust footwear.
Protecting casualties
• The safety of the casualties is ensured by protecting the scene with the emergency service vehicles and a cordon
• It is the responsibility of the fire service to rescue casualties from a hazardous environment
• A snatch rescue may be appropriate when the patient’s life is in immediate danger, e.g. from fire or toxic chemicals. Every reasonable attempt should be made to extricate the patient safely, but spinal immobilisation in particular may have to be compromised in order to save life.
ACT
A – Assess
C – Communicate
T – Triage, treat and transport.
Assess the scene
After taking control of an incident the next priority is to assess the scene. There are three important elements to the scene assessment:
1. Assessment of hazards, both present and potential
2. Reading the scene
3. Rapid assessment of the number and severity of casualties.
An assessment of hazards will include:
• Actual hazards (fire, chemical spillage)
• Potential hazards (fire due to ignition of petrol on the road)
• Specific hazards (e.g. the electricity supply through overhead or broken cables).
Reading the scene:
• Observe the nature of deformation of a vehicle and its position
• At a medical incident there may be vital clues to the nature of a medical illness (bottles of pills, Medic-Alert bracelets, etc.).
Number and severity of casualties:
• Do not miss casualties hidden under vehicles or in undergrowth.
Read the scene for clues to injuries following trauma or to the reason for medical illness.
Communicate
• There are several levels of communication to consider:
• with the patient
• between ambulance crew members
• with ambulance control
• with other emergency services at the scene
• with the hospital
• When assistance is required at an incident scene, it is useful to remember the mnemonic METHANE when communicating with ambulance control:
• M – My call sign (Major Incident standby or declared if appropriate)
• E – Exact location
• T – Type of incident
• H – Hazards, present and potential
• A – Access
• N – Number, severity and type of casualties
• E – Emergency services, present and required.
The essential information the hospital will require in order to be able to assemble the appropriate staff and prepare equipment is:
• Age of the patient (the age of a child allows the hospital to prepare equipment such as endotracheal tubes and to calculate drug doses)
• Sex
• History
• Injuries/illness
• Condition of patient (vital signs and level of consciousness; Glasgow coma scale, GCS)
• Expected time of arrival (ETA).
Good communication is central to effective emergency service teamwork.
Triage, treat and transport
• Triage requires a rapid assessment and prioritisation of each patient
• Transfer to hospital must not be delayed by unnecessary treatment
• The golden hour is the time from injury to the time that definitive treatment is given (such as surgery for a trauma patient).
The golden hour does not start when the ambulance arrives on the scene but when the incident occurs.
• In prehospital care, it is more appropriate to think in terms of the platinum 10 minutes to stabilise the patient before moving to hospital.
For further information, see Ch. 1 in Emergency Care: A Textbook for Paramedics.
