How to safely provide off-duty assistance at crash scenes
Know when to stop, how much assistance to provide and how to hand off patient care to responding authorities
My role as the coordinator of our regional trauma advisory council gives me the opportunity to regularly travel around the region and visit hospitals and EMS agencies for various meetings and classes. Since my region covers twelve counties and over 12,000 square miles, I get many hours of “windshield time” each year. I was not in the position long before I realized that I needed to prepare for the inevitable crash scene that I would come across.
Even if you don’t hit the road as much as I do, as EMS providers, you probably want to be ready to stop and provide care if you encounter a MVC scene or other emergency when you are out and about in your vehicle. The following are my recommendations about being prepared to do just that.
Should I stop?
The first question you should ask is whether you should stop when you come upon a scene, or maybe even if you must stop. Do you have a “duty to act?” Laws vary from state to state but the common answer is that unless you are on duty (working a shift or on-call) in your service’s response area, you do not have a legal duty to respond. However, once you do stop at the scene and identify yourself as an emergency responder, you likely have a responsibility to provide appropriate care and not abandon the patient. (Disclaimer: I am not a lawyer, so check laws and regulations in your own state to be sure.)
Before deciding to offer help at a scene, also be sure that you are “fit to respond.” Certainly, you won’t be driving if you have been drinking, but in a scenario where you’ve had a few alcoholic beverages and are riding as a passenger, don’t even think about stopping.
Automotive first-aid kit
Do you have a trauma bag, jump kit, first responder bag or whatever you want to call it, in your car? I have a small kit of basic supplies in each of my family’s cars including:
- Exam gloves
- A pocket mask
- A tourniquet
- An assortment of bleeding control and bandaging materials
- A chest seal
- A rescue blanket
- Triage tags
- A pen and paper
I do not carry any advanced life support supplies or equipment.
Personal safety when responding to a MVC
Just like when I am on-duty and responding with an ambulance, my road-side safety remains a priority. My automotive supplies include a reliable flashlight and a bright yellow reflective vest. I do not have any emergency lights on my personal vehicle, so safe parking on scene is a big consideration, and each scene will be different. When you are pulling over, consider your visibility to oncoming traffic, and provide ample space for emergency vehicles to get in and any additional protection the scene may require. Don’t park behind vehicles with emergency lights already on scene, as you may prevent their lights from being seen by traffic.
Once you stop, call 911 or make sure that someone else has called for help.
When approaching any vehicles involved in the crash, assess the scene for hazards as you have been taught. It is even more critical when you are the first on scene. Be alert for electric wires, fires, running engines, leaking fluids and unstable vehicles. Be alert for traffic still driving through the scene and be sure that other good Samaritans remain safe as well. They are not as tuned into roadside dangers as you are.
How many patients are involved? What resources are needed? What information can be relayed to help responding units?
One of the most helpful things you can do for all patients on the scene is to make sure that the right help is coming for them. Do a quick triage sweep – I recommend using SALT triage – then call 911. Let them know that you are an EMS responder and then give them the details about the number of patients, any extrication needs and brief patient condition information. If one of the patients has injuries that you think require helicopter transport, let the 911 telecommunicator know that. It may be helpful to use the major trauma criteria outlined in the Guidelines for Field Triage of Injured Patients.
BLS or ALS?
Once triage is done, it’s time to start providing care to the patients involved. My plan is to provide lots and lots of basic life support care. I am a paramedic, but there are several reasons that I do not carry advanced life support “stuff” in my kit and why I don't plan to do any ALS care while I wait on scene for an ambulance to arrive.
One reason I do not provide ALS care is that by the time I do triage, call an update to 911 and provide BLS assessments and care, the first ambulance is usually on scene (though this may not be the case where you live and travel).
I am also leery about performing advanced skills, as I am pretty sure it would not be legal where I live. My state EMS rules are clear that I need a medical director’s authorization to perform advanced skills and, unless I am in my agency's service area and responding on behalf of my service, I do not have that liberty. Not only am I not authorized to perform ALS procedures, but I would also not have any medical liability insurance covering me. A portion of my paramedic brain cringes at the thought of not being able to administer advanced care but another portion of it knows that good BLS care remains the cornerstone of trauma care.
My kit is also limited to BLS gear simply because of cost. ALS gear is expensive, the medications and supplies expire quickly, and most cannot be left out in the extreme temperatures a car experiences.
Hand-off to responding authorities
Before you know it, local first responders and ambulances will arrive to take over the patient care. Identify yourself and give a quick report on any assessments and care you have given. Ask if you can provide any further assistance. Don't take it personally if they do not want you to continue helping. Think about it from their side: they have to control the incident, manage scene safety, and coordinate resources and patient care. They may or may not want extra people they don't know on scene.
If law enforcement is on scene, check with them to see if they need your name or any other information you may have about the incident.
Get back in the car
The toughest part of stopping for a traffic crash while you are off-duty is that you have to remember that you are, indeed, off-duty, and basically a well-trained good Samaritan. Know that you won't be part of the continued care and transport of the patient and you probably won't be privy to any follow up information about the patient(s). But, that is OK. You did a good thing. You helped and maybe even saved a life. Get back in your car, buckle your seat belt and safely continue on your travels.