Motor Vehicle Crash Involving a School Bus -=- Please read and respond

[224FFEMT]

Scenario:
Your ambulance is dispatched for a commercial motorvehicle crash involving a passenger car and a school bus that is full of high school aged children. You arrive to find two injuries in the car and no obvious injuries on the bus. You have an un-dispatched engine coming from your station just because extra people showed up. No other resources en-route.

Questions:
1. Do all the children on the bus need to go to the hospital when they are obviously uninjured and have no complaints?
2. If yes how do you handle their transport?
3. If no from whom can you obtain refusals?
4. What additional resources to you request off the bat?

I know some of these answers might sound obvious but I am just trying to clear up some things with my company. Thanks in advance for your replies.

[Ativan]

Yes I think they should all go to the ED because the are all minors and notify parents from there. Handling transport, I would see if the bus is able to move and transport non criticals in that and red tags in the amboulance.
__________________________

[ADSNWFLD]

I think this was talked about before but,

In Illinois Region 8 (DuPage Co) Good Samaritan EMSS we can sign off the lot of them. We have a form and the system has set up policy. A representitive from the school Dean, Principal, Teacher in charge of the group can take responsibility for the group. The bus can only have one or two very minor or no injuries and no mechanism of injury.

Talk to your EMS system and they may be able to get their lawyers to agree on something that will work for you.

[firemedic74]

I agree Ativan, send them all to the hospital. Teen-agers obviously cannot tell if they are in any pain in response to an injury, at least not until they are 18. I'm sure the MI's and cardiac arrests at the overwhelmed ED won't mind waiting for treatment either. Enough sarcasm, you have heart but use some common sense too. Your idea will take a very minor field MCI into an ED. There's no need to transport, let alone rush an uninjured person(s) to an ED. I agree with ADSNWFLD, there is probably a school administrator that is allowed to make acute medical decisions on behalf of the parent. If there is any question, contact the parents or guardian. A lot of states allow 14 and 16 year olds to sign refusals. You could move the uninjured high-schoolers in a bus, like Ativan said, to either the school or hospital auditorium, to wait for parents if needed.

224FFEMT - #4: Go from dispatch reports, initial scene size-up, and your triage. How many people in your area are utilized for BLS and ALS care? Multiply that times your patients, that should give you an idea of how many people could be needed on scene for EMS care. Don't forget about the additional amount that could be needed for extrication, LZ's, fire control, command ops, etc.

[mfharris]

My service has the unique perspective of being posted at a school district transportation department (free garage space for our flycar) and we have actually had this discussion before, to preplan what we would do. Legally, at least in NYS, a representative of the school district, including the bus drivers, are the ones in charge of the students well being. If there are no injuries, the school representative is allowed to sign the release form for the minor students. Parents are normally notified of the incident by the district. The procedure here is that if no one complains of any injury, they are transported by the district back to school and the school nurse checks them out and makes notifications.

[tom2003]

This one is tricky. Its very easy for all of us to monday morning quarterback. The way I see it is, if they are not injured they are not patients, as long as you have not started an assessment then no AMA needs to be signed.

[mstclair190]

I've delt with a couple of school bus MVA's. For the very minor ones in which nobody was complaining of any injuries we allowed the school district representative (bus driver or administrator) to sign off for the children since they are in their charge at that time. We also got names and other demographic info from all of the kids and recorded such in the tripsheet along with the fact that everybody denied injury and didn't have any apparent injury. The kids were also instructed to inform their parents of the incident when they got home and to tell them if they started to have any pains later.

Sending an entire bus load of kids denying injury to the hospital from a very minor MVA, just because they are minors makes as much sense as sending nursing home patients to the ER to get a bandaid put on.

[JHall26]

First, are you THE Mark St.Clair?

Second, why does involvement in a motor vehicle accident necessarily make one a patient? I have been in an accident or 2 and never considered myself a patient. I would suspect that the majority of MVA's are without personal injury. Does the arrival of an ambulance make all involved patients? Legally, it probably varies from state to state, but rationally the answer is no. One could even scale down the situation to say a 2 car accident with 3 people in each. If we arrive on scene and nobody's hurt and they do not desire medical attention, then are we obligated to filling out refusal paperwork for each and every one? My current EMS affiliation would say, "yes"...prior one's would say, "no." I say no, because they are NOT patients until explicitly or implicity requesting to be categorized as such. And, we do not have a right to their information until such a request is made.
Now, one might argue that minors ALWAYS implicitly request our attention. But, does their mere presence on a bus that backs into a telephone pole make them patients? I would argue that only those who are sick or injured can be considered patients. It only gets dicey when things are not "clear cut." Relying on paramedic judgement would probably also be a mistake, as we all know that there exists a great variability amongst prehospital professionals in exercising good judgement. So what now? I would be tempted to argue mass casualty guidelines as, in such events, we cannot be expected to dot i's and cross t's when there exists immense strain on the system (perhaps, one PCR with lots of names). In any event, NYS allows the bus driver to take "custody" over the minors in the event of a school bus accident and multiple PCR's are not required (I can only speak for my region on the last one).

Aloha.

[mstclair190]

Why yes I am, atleast the last time I checked.

Would you be THE John Hall? Or is that Dr. Hall now?

[JHall26]

Yup, it's me. I'm on the way to Dr., but not of the sort you might think. As I have decided that people are generally not worth helping at pay associated with helping them, I am going for my PhD.
2-3 years to go.

[mstclair190]

Riiiiight.

[JHall26]

I am a mercenary when it comes to EMS nowadays. No pay, no play.

[Eng34FF]

We had this happen recently. The bus got off the shoulder and side-swiped a tree. Minor enough that the driver continued for about a mile before stopping.

We sent boarded and collared the ones complaining of neck pain, the rest were not complaining of injuries. Thanks to the miracle of cell phones, a lot of parents showed up on scene and we were able to get them to sign refusals. The person from the school district would not take the responsibility to sign, so we got another bus and driver and sent them up to the hospital. The hardest part was finding somebody licensed to drive the bus, luckily our rescue chief owns a bus company and is licensed.

Its unfortunate that we have to do that for liability reasons, but most of the parents were supportive of the decision: better safe than sorry.