Ambulance Incident

A Category 2 incident is one clearly recognizable from the outset as beyond the capability of the forces to hand. The emergency services should be informed immediately of the magnitude of the incident and the specific location. The resources sent in response, e.g. the number of fire appliances, ambulances, police, need to be predetermined by good pre-planning. 

Chief Phillip A. Napier of the GVW Fire and Rescue Department, who also runs Napier s Hardware Store in downtown Graniteville, South Carolina remembers, We received a call that the train had possibly hit a building in Graniteville. Upon our response, I told the men to report to the station, and I would try to locate the incident site and find out what was involved. And evidently, by listening to the tapes at a later date, it is evident I was already beginning to be disoriented. I couldn t see. I called for an ambulance, and I couldn t say what I wanted it for. When I pulled up to the man on the railroad track, and rolled the window down, he told me they had had a head on collision with the train, they had a chemical leak, and he couldn t breathe. Then he fell to the ground, and later died. 

The opioid analgesics can activate the brainstem chemoreceptor trigger zone to produce nausea and vomiting. There may also be a vestibular component in this effect because ambulation seems to increase the incidence of nausea and vomiting. 

Brain injury from stroke is a major public health problem in most industrialized countries in the world. For example, in the United States over 0.5 million cases of stroke occur annually, the incidence of stroke doubles approximately each decade over the age of 45 and occurs in up to 2% in those over 75. Frequently, stroke causes major disability with the patient having difficulty in communication, ambulation and movement, or in reasoning. Fortunately, the incidence and severity of stroke has been reduced in many countries by the introduction of preventative measures aimed at controlling hypertension, hypercholesterolaemia, smoking and by the use of anticoagulants in high risk groups. 

The availability of capital resources is equally important. As mentioned, the current health care system— including the emergency, acute, and chronic care components—are all operating at maximal capacity. However, EMS vehicles, ED and hospital beds, and operating rooms will be needed in differing levels based on the incident (Auf der Heide, 2006 Pesik et al., 2001). For the EMS system, planners must know and address mutual aid issues. In upstate New York, Rural Metro Medical Services provides EMS in many cities and has a plan to shift resources between cities in event of crisis. Thus, additional ambulances, communications equipment, and maintenance facilities can be deployed throughout the region. In other areas, mutual aid compacts must be in place to allow for the immediate recruitment of as many additional EMS units as are needed (Auf der Heide, 2006). 

As the following account by a mountain rescue guide illustrates The incident involved a 15-year-old boy who sustained head injuries and a very badly broken leg. Helicopter assistance was unavailable and therefore we had to carry him by stretcher to the nearest landrover (several miles away) and then on to a waiting ambulance. 

Early ambulation has previously been implicated in transient radicular irritation. However, in a randomized trial there was no difference between early and late mobilization in patients who received intrathecal lidocaine 2% for inguinal hernia repair the incidence was 23% in both groups (256). 

Victims of chemical contamination need prompt and effective treatment, both at the scene of the incident and in hospital. Ambulance or emergency medical services and hospital emergency rooms provide the front line health response and most will already have tried and tested contingency arrangements for accidental chemical releases - often referred to as HAZMAT or HAZCHEM (hazardous materials and hazardous chemicals) protocols. Whether for an accidental or deliberate chemical release contingency arrangements need to address the following key objectives ... 

Major incidents cause fear and disorientation. The natural response to a sudden emergency is to move away and past experience indicates many people will leave the scene by any means available, especially in an urban environment. That was clearly demonstrated following the 1995 sarin attack in Tokyo where over 4000 people made their own way by taxi or car to hospitals or doctors offices throughout the city while under 10% were transported by ambulance (Kulling et al., 2000). 

All hospital plans should include provisions for a proportionate response to the arrival of contaminated casualties, with procedures for rapid lock-down and establishing entry and exit restrictions. Most ambulance service plans already provide for sending an immediate alert to all hospitals designated to receive casualties whenever a major incident is declared. Although patients may have already self-evacuated before the emergency services arrive, ambulance plans should also provide for warning all... 

MOAs are required with local MTFs, local emergency medical services, ambulance services, and regional or state emergency medical services officials. The MOAs and frequent coordination with these agencies are necessary to ensure that appropriate off-post resources will be available for support during a chemical accident or incident. 

Alexander, D. A. and Klein, S. (2001). Ambulance personnel and critical incidents. British Journal of Psychiatry 178 76-81. 

The Support Zone (also known as the cold or green zone) is where the Incident Commander, support teams, press, medical treatment areas, and ambulances are located. It is usually upwind, uphill, and a safe distance from the incident. 

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