Over the last week I have attended three horrendous RTCs. The first two happened at the exact same spot but on different days. Both cars were a complete write off with the engines ripped from the cars landing about 50 yards away on each occasion. How on earth anyone got out of the alive is nothing short of a miracle. Neither patients were trapped and both were out of their respective cars on our arrival. The first guy had some chest pain but was said to be fine at hospital. He had been working 7 days a week for the last few weeks and was clearly worn out, he went on to tell us that he feared being fired if he didn't put in the hours! In the UK we have laws that prevent people having to work excessive hours, his boss obviously wasn't up to speed with them. We thought he might have fallen asleep at the wheel.
The next lad, who had only passed his test six weeks ago, was only a teenager and after being questioned by the police officer on scene it was discovered he had been drinking needless to say he failed his road side breath test. Why do they do it? This car was actually slightly worse than the first and it was only due to the car being modern and with lots of airbags etc that he survived. I don't think he'll be driving again for quite a while
The third accident was to a car that had gone side on into a wall, the patient was also a teenager. This was a lot more serious. Fire & Rescue were on scene along with police and another Paramedic crew. No time for the roof to come off, this was a rapid ex job. Rapid ex is a way of extricating someone from a vehicle who has life threatening injuries but using very basic c-spine care. He was on O2, had an oral airway in situ and a c-collar on. With the help of the firefighters we got him out onto a long board and then started assisting his breathing with a BVM while quickly wheeling him to the truck. On board he was hooked up to the monitors, while the other Paramedic was ventilating him, I got a 16g IV in his right arm and started fluids. We had a Basics Dr attending as well who is an anesthetist at the local hospital and as he arrived I put in a 14g IV into the patients chest to decompress it. After explaining what we had he said 'Right, let's RSI him and then I'll do bilateral thoracostomies.' 'OK Doc.' we said and that's what happened. We weren't on scene long and raced this young lad to hospital. Sadly he lost his battle to survive a few hours later in the operating theatre.
Some times people who are badly injured are so far down the dying line that no matter what you do it's just not enough.