Safety Service Patrol Perspective: Post-Crash Care
Care following a serious crash injuries is critical to improving patient outcome, and safety service patrol (SSP) functions play a vital role in improving these outcomes. SSP personnel are likely to arrive early or even be the first on scene following a vehicle accident, and thus their ability to provide crucial post-crash care can make positive outcomes much more likely. SSP personnel who understand the components and importance of post-crash care can provide definitive medical and intervention in the “golden hour”—the first 60 minutes post-trauma. “Routine” patrol is an integral part of SSP duties and typically will be most of a work shift. But in traffic incident management, we say, “there are no routine roadway incidents.” Any SSP operator who has been first on-scene at a serious injury crash will confirm that saying.
According to The US Department of Transportation (USDOT), “The timely arrival of emergency responders and well-trained Emergency Medical Technicians (EMTs) and Paramedics is a major factor ensuring an injured person receives the medical care they need to survive a crash. This is especially critical in rural and Tribal communities, where response times are longer and Emergency Medical Services (EMS) resources more limited” (USDOT 2022). It should be noted that not all SSP providers, agencies, or personnel are trained and/or certified in emergency medical care beyond basic first aid nor is it required by all as part of their regular duties.
Those first initial and critical actions taken will determine the level of safety for the SSP Operator, other responders, injured persons, others involved or on scene, and the safety of the approaching motorists. Communication of the scene size-up is the initial action taken and the establishment of temporary traffic control is the second. These tasks are most often done concurrently and should be handled quickly and clearly. Whether an incident is detected by the SSP Operator or from another source like the TMC, the likelihood of arriving early or first on scene is high in many cases.
Happening upon a serious injury crash unexpectedly, one will immediately feel the stress of time compression for the decisions and actions that need to be performed. This is when clear, concise communication and situational awareness tend to be most difficult. Being dispatched to an incident versus happening upon it while on patrol is very different. When SSP Units are dispatched it obviously allows some time for planning and prioritizing actions to be taken on arrival. This may also allow for back-up units and other resources to respond at the same time. Best practice is to remain calm, maintain situational awareness, follow known protocols and procedures in the correct order to provide for the highest level of responder and scene safety.
On scene safety includes proper vehicle parking/positioning, use of proper PPE, communicating a clear and concise windshield assessment or scene size up, and establishing initial temporary traffic control. Initial temporary traffic controls might mean only guiding traffic with an initial angled vehicle block and/or traffic cones to protect the scene in order to gather information or provide emergency medical assessment or care. If other special circumstances or hazards are identified during initial size-up then the need for quick and decisive action is magnified and should be communicated as early as possible in order to ensure scene safety.
Temporary traffic control is a high priority and should be established as soon as possible to protect the responders and the scene. This action can benefit the other emergency responders in reaching the scene quicker and may allow for proper placement of next arriving apparatus. It will also set the tone for any secondary actions once other services arrive and can also assist with EMS arriving, loading, and transporting quickly from the scene if necessary. The need for traffic detours, advance warning, and queue protection should be communicated quickly.
There are free, online training modules that address the recommended actions above, Examples include ‘Blocking Procedures at Roadway Incidents’, ‘The First 15 Minutes at Roadway Incidents’, and ‘Advance Warning’ online learning modules. All of these and more are available to all responders for free and can be accessed 24/7/365 online at The Responder Safety Learning Network.
Once patient care and/or assessment/triage has been initiated by SSP personnel best practice states that there should be a patient ‘hand-off’ communicated to the next higher level of emergency medical provider upon their arrival and when they take over patient care. This is true even if SSP personnel are only trained to the level of basic first aid. The relay of relevant and important initial information gathered about the patient(s), especially in serious injury/trauma situations is vital.
Post Crash Care is one of the critical components in the U.S. Department of Transportation’s recently created National Roadway Safety Strategy. “The United States Department of Transportation National Roadway Safety Strategy (NRSS) outlines the Department’s comprehensive approach to significantly reducing serious injuries and deaths on our Nation’s highways, roads, and streets. This is the first step in working toward an ambitious long-term goal of reaching zero roadway fatalities” (USDOT 2022)
There are five objectives outlined in the NRSS: Safer People, Safer Roads, Safer Vehicles, Safer Speeds, and Post Crash Care. These objectives are covered in detail within the USDOT’s use of a ‘Safe System Approach’ to accomplish these goals. According to the NRSS: “U.S. DOT adopts a Safe System Approach as the guiding paradigm to address roadway safety”.(1) “The Safe System Approach has been embraced by the transportation community as an effective way to address and mitigate the risks inherent in our enormous and complex transportation system. It works by building and reinforcing multiple layers of protection to both prevent crashes from happening in the first place and minimize the harm caused to those involved when crashes do occur. It is a holistic and comprehensive approach that provides a guiding framework to make places safer for people. This is a shift from a conventional safety approach because it focuses on both human mistakes AND human vulnerability and designs a system with many redundancies in place to protect everyone. U.S. DOT's National Roadway Safety Strategy and the Department’s ongoing safety programs are working towards a future with zero roadway fatalities and serious injuries. In support of this approach, safety programs are focused on infrastructure, human behavior, responsible oversight of the vehicle and transportation industry, and emergency response”.
The overall goal of the Post Crash Care objective is stated as: “Enhance the survivability of crashes through expedient access to emergency medical care, while creating a safe working environment for vital first responders and preventing secondary crashes through robust traffic incident management practices”. (USDOT 2022).
Safety Service Patrols will undoubtedly continue to do all they can to help accomplish the above mentioned goal by being proactive in their responses. By being trained to provide emergency medical care very early to seriously injured patients SSP personnel can reduce fatalities and serious injuries especially when first on scene, or as part of a team of responders such as in a multiple casualty incident. It is also important to continue partnering with other response agencies as part of a traffic incident management team. Training, and pre-planning for these types of incidents will help to increase situational awareness, and responder safety while also preventing secondary crashes.
As always: ‘Stay Safe, and Keep Training’ for the incidents you will encounter on the roadways.
About the author John M. Sullivan: John M. Sullivan is a Highway Response Supervisor 1 with the Tennessee Department of Transportation 'HELP' Unit serving Nashville and Middle Tennessee since 1999. Mr. Sullivan is also a Captain FF with the Pegram FD, and a TIMS, EVOC, Vehicle Extrication Instructor, and is a Committee Member for NFPA 1091 Standard for Traffic Incident Management Personnel Professional Qualifications. John has been married 22 years and he and his wife Teresa have a teenaged daughter. Click here for John M. Sullivan's full bio.