Three Callers, One Crash, Conflicting Determinants
At 17:42, three 911 calls arrive within 90 seconds for the same two-vehicle crash on Route 6 eastbound near Exit 3. Caller A, an off-duty nurse, reports a 70-year-old male driver slumped over the wheel, breathing about 6 times per minute, pulse present, not trapped. Caller B, a passenger in the second car, says “everyone is fine, just a fender bender,” but keeps asking where she is and cannot name the road. Caller C, a passerby, says the first car is smoking and one person is “not breathing.” You have one ALS unit 6 minutes away, one BLS unit 3 minutes away, and a fire engine 8 minutes away. A 45-year-old with abdominal pain has been holding for 20 minutes for the next BLS unit. The CAD suggests a lower determinant for the crash because Caller B answered most key questions as “no.”
1. How should you reconcile the three conflicting reports and select a determinant?
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Use the protocol’s key questions with each caller, but weight the reports by what can be verified, not by vote. Caller A is an off-duty nurse describing a patient with a pulse and 6 respirations per minute - that is a life-threatening airway/breathing problem. Caller C says “not breathing” and reports smoke, which is a potential cardiac arrest and hazard. Caller B’s “everyone is fine” is unreliable because she is confused and cannot state the road; her answers may be due to head injury or shock. Re-contact A or C, ask C to check for normal breathing and consciousness, and ask A to confirm breathing and whether the patient is trapped. Treat “not breathing” as the highest-acuity finding until disproven. Do not let CAD’s lower determinant from Caller B’s “no” answers override the nurse’s respiratory rate and the passerby’s report. Select the determinant that matches the worst credible, protocol-supported finding, and document why.
2. Who goes to the crash, and what do you do with the abdominal-pain hold?
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Send the BLS unit 3 minutes out and the ALS unit 6 minutes out to the crash; send the fire engine for the smoking vehicle and possible extrication. The BLS unit can arrive first, confirm breathing, start CPR/AED if the patient is in arrest, and begin care. ALS is still needed for the slumped patient with 6 respirations per minute and possible trauma. Fire addresses the smoke hazard and extrication.
Do not divert the only BLS unit to the 20-minute abdominal-pain hold before the crash is stabilized; abdominal pain without red flags is lower priority than a patient with 6 respirations per minute or possible arrest. Notify the hold of the delay, reassess for red flags such as severe pain, syncope, pregnancy, or altered mental status, and request a mutual-aid BLS unit or supervisor if available. If no unit can cover, follow local policy for holding and escalate. Once the crash is stabilized, release BLS to the hold if ALS and fire are on scene.
3. What updates and reassessment points should you build into the incident?
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Set a short reassessment interval: confirm BLS arrival and first patient contact; ask for breathing, pulse, consciousness, and whether the patient is trapped. Ask the first-arriving unit to verify the number of patients; multi-call crashes often have more victims than reported. Update the determinant if the patient is in arrest, if there are multiple critical patients, or if the smoking vehicle becomes a fire. If Caller C’s “not breathing” is disproven, do not automatically downgrade the whole incident - the nurse’s 6 breaths per minute still supports a high priority. Document source reliability: nurse versus confused passenger versus passerby. Relay key findings to EMS and keep the abdominal-pain caller informed and log the delay. Close the loop with the incident commander.