1. Cooperation and
Coordination of Emergency
Services for Traffic Accidents
Jim Holliman, M.D., F.A.C.E.P.
Professor of Military and Emergency Medicine
Uniformed Services University of the Health Sciences
Bethesda, Maryland, U.S.A.

2. Objectives of This Session
Explain the rationale for cooperation
among different types of personnel in
dealing with road traffic accidents
Point out specific methods by which
different personnel can help each
other
Stimulate interest in obtaining
emergency medical care training for
non-medical personnel

3. What Different Types of
Personnel May be Involved in
Caring for Road Traffic
Accidents ?
Police
Firefighters
Central Dispatchers
Rescue
Military
Medical
–Emergency Medical Technicians
–Paramedics
–Nurses
–Physicians

4. Who is in Charge of an
Accident Scene ?
Should be pre-determined by local or
regional agreements
Should be one easily identifiable
person
Sequence of transfer of command
responsibility to higher level person
also needs to be pre- agreed upon
Off - scene dispatchers also need to
know the command person designation

5. Who is in Charge of an
Accident Scene ? (cont.)
Specific command person should vary
according to type of accident :
–Gunfire or hostage situation :
ƒ Police
–Fire or hazardous materials spill :
ƒ Fire chief
–Non - entrapped medical or trauma patients
:
ƒ Medical personnel

6. Who is in Charge of an
Accident Scene ? (cont.)
Use of the "Incident Command
System" facilitates scene management
–Single pre-designated Incident Commander
–Establishes Incident Command Post
–All arriving personnel report to Incident
Command Post for duty assignments
–All communications routed thru Incident
Command Post

7. What is the Role of
Dispatchers for an Accident
Scene ?
May provide pre-arrival instructions to
bystanders at the scene
May provide navigation information to
responding units
Ensure the appropriate types of
personnel and vehicles are enroute
Maintain communication to the
Incident Commander in case secondary
responding units are needed

8. What Pre-Arrival Instructions
Should
be Considered by Dispatchers ?
Environmental safety
–turn engines off
–use fire extinguishers or hose water on
smoking engines
–avoid downed electrical lines
–get uninjured people off the roadway and
away from the scene
–breaking out windows if vehicle full of
smoke

9. What Pre-Arrival Instructions
Should be Considered by
Dispatchers ?
Emergency first aid
–Pressure bandages on active bleeding sites
–airway maneuvers (with cervical spine
precautions) if patient not breathing
–keeping victims warm with blankets if cold
environment and anticipated delayed
arrival of medical personnel

10. Other Pre-Arrival Instructions
for Dispatchers to Consider
Person to guide responding vehicles
to the scene (if difficult to locate)
Clearing access to scene by removing
other vehicles or obstructing objects
Maintain open phone line to scene
Calling electrical company to turn off
power if downed lines at the scene

11. Rationale for Medical
Training for Police and
Firefighters
May arrive on-scene long before
arrival of medical units
Early emergency medical care ("first
aid") may prevent the patient(s) from
dying before medical crew arrival
If multiple patients, limited number of
responding medical personnel may
need to assign medical tasks to police
& firefighters

12. The U.S. "First Responder"
Course
Designed for police, firefighters, and
vehicle drivers who may be first to arrive
on-scene
40 hours instruction
Covers basic anatomy & medical terms,
interpretation of vital signs, CPR, basic
trauma care, simple extrication & splinting
May also encompass use of Automatic
External Defibrillator (AED)

13. Advantages of the First
Responder Course
Stimulates interest in medical care by
first responders
Enables better communication
between first responders & medical
personnel ("common language")
Enables medical personnel to take
care of greater number of patients in
multi-casualty situations

14. Further Advantages of First
Responder Training
Enables first responders to better
understand the needs of the patient
and the priorities for medical care
Allows more accurate and faster triage
if first responders are bringing multiple
patients to a central triage area where
medical personnel are located
Represents cost effective use of
limited training funds

15. Police Duties to Consider
Coordinating at the Accident
Scene
Stopping or re-routing other vehicle
traffic
Crowd control
Scene security
Arresting & removing uncooperative
persons who interfere with the rescue
effort
Preserving scene evidence for
investigation
Ordering obstructing vehicles to be
moved

16. Firefighter Duties to Consider
Coordinating at the Accident
Scene
Extinguishing vehicle fires
Hosing down spilled fuels
Encasing spilled hazardous materials
Directly rescuing patients from smoke
areas
Stabilizing tilted vehicles
Protection of other personnel and
patients from downed electrical lines

17. Rescue Duties to Consider
Coordinating at the Accident
Scene
Major vehicle disassembly to get access to
patient or to free patient from entrapment
Extracting patient and / or rescuers up or
down a steep slope
Turning, rolling, or moving a wrecked
vehicle
Removal of physical hazards from the scene
(sharp objects, etc.)
Providing lighting or electrical power to
scene for rescue

18. Secondary Police Duties at
the Accident Scene
(these should not interfere with
medical care)
Write damage & accident cause reports
Identify & protect dead bodies
Recover & safeguard property
Notify authorities & families about
deaths
Respond to missing person reports
Control entry to area (prevent looting)
Photograph & document scene
Decide on disposition of vehicles

19. Important Principles for Fire
& Rescue Personnel to
Remember
Extrication of patients from vehicles should
utilize the simplest & fastest method
–Power tools & vehicle disassembly often NOT
needed
–May just unlock door to get access to patient
–If long spine board can get into vehicle, then
usually patient can be removed via open door
or thru removed windshield
–Medical personnel should insist on use of
fastest method

20. Considerations for Use of
Helicopter Evacuation of
Patients from Vehicle
Accidents
Important to pre-decide which personnel have
authority to call for helicopter
–In U.S. some areas empower first responders
and most areas empower medics to call
–Should utilize pre-agreed criteria for dispatch
ƒ May vary somewhat according to traffic or
weather conditions
Helicopter should be able to directly
communicate with on-scene personnel

21. More Considerations for
Helicopter Evacuation of
Patients from Vehicle Accidents
Safe landing zone must be established
Responsibility for landing zone must be
pre-agreed (usually would be police)
If landing site somewhat distant from
scene, transport of helicopter crew to
scene & back to landing site must be
planned (may ned another vehicle)
Transfer of responsibility for patient
from ground to helicopter crew must be
clear

22. Considerations with Exposure
of Accident Victims to
Hazardous Materials (Toxins)
Requires close cooperation of medical
personnel with fire / hazmat personnel
Best if patient can be decontaminated
prior to entering ambulance
If decontamination incomplete in field,
must communicate this to receiving
hospital prior to arrival there
Police may need to evacuate others from
area

23. Other Considerations for
Accidents Involving Hazmat
Incidents
Usually fire / hazmat trained personnel
should be in charge of the scene, and
medical personnel should follow their
instructions
Initial patient access and care may need
to be done only by the hazmat personnel
who are wearing special protective
equipment
Rescuer safety should always take
precedence

24. Should a Physician Be in
Charge of the Accident Scene
?
NOT in all cases
If not an emergency physician, and if
unfamiliar with prehospital personnel,
should limit his participation to direct
patient care, and follow advice &
requests by other personnel
Fire, hazmat, and police
considerations may initially take
precedence over patient care

25. "Debriefing Conferences" : A
Useful Technique to Develop
Cooperation Among Different
Personnel
After a major vehicle accident, may be helpful
to schedule a conference of all the involved
personnel (fire, medical, & police)
–Should be moderated by an administrator or
local government leader
–Should review sequence of events
–Should elicit comments on suggestions for
improvements
–Should not be used to criticize or assign
blame

26. Practice Drills : Another
Useful Technique to Develop
Better Cooperation
Should involve all local services
(medical, fire, rescue, police)
Mid - and upper level administrators
from each service should be present
Should have followup critique session
Another technique is for different
personnel to do "ride-alongs" with the
other services to become familiar with
their daily work

27. Use of "Cross- Training" of
Personnel to do Different
Duties
This approach has been used in the U.S. in
North Carolina successfully
–Police also trained as firefighters
–Police and firefighters rotate as dispatchers
–All have at least first responder medical
training
–Helicopter medics in Maryland are also full
time police officers
Local governments like this approach since
they can hire fewer personnel

28. Facilitation of Interactions
with Hospital Personnel
Hospitals should provide feedback to
prehospital personnel on patient outcomes
Having fire and police spend observation time
in the emergency department may be useful
–Response vehicles could be based at the
E.D.
Hospital may coordinate medical training
sessions or short courses
Hospital personnel could do "ride-alongs"
with prehospital, fire, or police vehicles

29. Important Principles of
Interaction by Different
Prehospital Services
Main goal should always be trying for
the best outcome for the patient(s)
Unusual situations may require
flexibility in duties and responsibilities
by different personnel
–People should not be rigid but should
be cooperative
When disagreements arise, should
make efforts at quick resolution

30. Cooperation and
Coordination of Emergency
Services for Traffic
Accidents : Summary
Best patient care results when
different services cooperate
Requires pre-established protocols
Drills and review sessions help in
improving interactions
Some degree of "cross-training" may
be useful