Simulated Patient Scenario

Motor Vehicle Accident - Multiple Patients

Scenario Details

Scenario: Multi-Vehicle Accident (MVA)

Incident Type: Head-on collision involving two passenger vehicles

Estimated Patients: 4-5 initially reported

Simulated Patients: Requires multiple mannequins/actors

Actors/Actress: Roles for Patients (varying injuries), Bystanders

MDT Information

Urgent Response - MVA High Mechanism
Two vehicles involved, head-on, suburban road
Multiple persons reported injured, some possibly trapped
Police, Fire & Rescue responding
First ambulance crew approaching scene
Weather: Clear, daytime

On Arrival / Scene Description

You are the first ambulance crew arriving. The scene is on a two-lane suburban road. Two cars have significant front-end damage consistent with a head-on collision. Debris is scattered across both lanes. Traffic is building up behind the incident.

Vehicle 1 (Sedan): Driver (approx. 30s Male) slumped over steering wheel, unconscious, trapped by legs. Front passenger (approx. 30s Female) self-extricated, sitting by roadside, appears dazed with facial lacerations.
Vehicle 2 (SUV): Driver (approx. 50s Female) conscious, complaining of chest pain, difficulty breathing, appears pinned. Rear passenger (approx. 10yo Child) crying in back seat, complaining of abdominal pain.
Bystanders: Several bystanders present, some attempting to help, others observing.
Hazards: Significant debris, potential fluid leaks (fuel/oil), undeployed airbags, traffic hazard.

Scene Safety Note: Park safely, ensure scene secured by police/fire, wear appropriate PPE. Be aware of traffic and vehicle hazards.

Initial Actions / Scene Management

Scene Safety: Confirm scene safety with other emergency services. Identify and mitigate hazards (traffic, fuel, vehicle stability).
Incident Command System (ICS): Establish/confirm command structure (e.g., Ambulance Commander). Liaise with Police and Fire Commanders.
Communication: Provide initial METHANE report (or local equivalent) to communications centre:
- Major Incident Declared/Standby
- Exact Location
- Type of Incident (MVA, 2 cars, head-on)
- Hazards (Traffic, debris, fluids)
- Access/Egress routes
- Number of casualties (Estimate 4 initially, update after triage)
- Emergency Services present/required (Police, Fire on scene, request additional ambulances based on triage)
Scene Size-up: Quick visual assessment of vehicles, patient numbers, mechanisms, potential hazards.
Establish Casualty Collection Point (CCP): Designate a safe area away from hazards for patient assessment and treatment.

Triage (Using START or similar system)

Perform rapid primary triage to categorize patients based on urgency. Announce triage categories clearly.

Patient 1 (V1 Passenger): Approx 30s F. Walking wounded (directed away from scene initially). Alert, RR <30, Cap Refill <2s, Obeys commands. Minor facial lacs. TRIAGE GREEN (Minor)

Patient 2 (V1 Driver): Approx 30s M. Unconscious, trapped. Airway requires opening (positional obstruction). RR >30 after airway opened. Cap Refill >2s. TRIAGE RED (Immediate) - Needs immediate airway management/extrication.

Patient 3 (V2 Driver): Approx 50s F. Conscious, severe respiratory distress, RR >30, complaining chest pain. Pinned. Cap Refill <2s. Obeys commands. TRIAGE RED (Immediate) - Needs urgent assessment/extrication.

Patient 4 (V2 Passenger): Approx 10yo Child. Crying, alert. RR <30. Complains abdominal pain. Cap Refill <2s. Obeys commands. No obvious major external bleeding. TRIAGE YELLOW (Delayed) - Requires assessment but breathing/circulation currently stable.

Action: Request additional resources based on triage count (e.g., 2 Red, 1 Yellow, 1 Green requires at least 2-3 more ambulances, plus supervisor/specialist resources).

Patient Summaries (Brief Examples)

Patient 2 (V1 Driver - TRIAGE RED)

Location: Trapped in driver's seat Vehicle 1.
Presentation: Unconscious (GCS ~6-8), positional airway obstruction initially, RR>30, HR tachycardic, BP likely low.
Obvious Injuries: Head injury, probable lower limb fractures (trapped).
Management Priority: Immediate airway management (manual opening, adjuncts), await extrication by Fire & Rescue, C-spine precautions, rapid assessment for other life threats once extricated.

Patient 4 (V2 Passenger - TRIAGE YELLOW)

Location: Rear seat Vehicle 2.
Presentation: Alert, crying, RR 24, HR 110, BP normal for age. Complaining of abdominal pain.
Obvious Injuries: No obvious external injuries, possible seatbelt sign.
Management Priority: Reassurance, move to CCP when safe, secondary survey focusing on potential internal abdominal injury, pain management, monitoring.

Assessment and Treatment Priorities (MCI Focus)

Command & Control: Maintain clear command structure and communication with other agencies and incoming resources.
Resource Management: Allocate arriving crews effectively based on triage categories and patient needs (e.g., assign crews to RED patients first). Request specialist resources if needed (e.g., aeromedical, critical care paramedics).
Treatment Prioritization: Focus on immediate life-saving interventions (Airway management, catastrophic haemorrhage control, chest decompression if indicated) for RED patients first.
Secondary Triage/Assessment: Perform more detailed assessments at the CCP as resources allow, starting with highest priority patients.
Packaging & Transport: Coordinate patient transport with communications centre and receiving hospitals. Prioritize transport of RED patients. Provide clear pre-notification/handover.
Documentation: Utilize MCI documentation/triage tags effectively.
Ongoing Scene Assessment: Continuously reassess scene safety and resource needs.

Debrief Focus Points

Scene safety assessment and hazard identification in MVA.
Application of Incident Command System (ICS) principles.
Effective communication (METHANE report, interagency liaison, crew communication).
Accurate and rapid primary triage using a recognized system (e.g., START).
Resource management and requesting additional assets.
Prioritization of treatment and transport in an MCI.
Performing life-saving interventions under pressure.
Documentation in an MCI setting.
Crew welfare and managing stress in complex incidents.