# I'm new..and scenario I've been wondering about



## arez10 (Feb 24, 2008)

This is my first time posting here..so hi  I'm a fairly new EMT (got my EMT-B for NJ in August) and I have a random question. Let's say you're driving or walking and you witness a really bad car accident. You're obviously not with your rig and have no equipment. You check on the passengers and let's say one of them is in cardiac arrest. Do you move them into a supine position in order to do CPR? But then what about spine immobilization? Do ABCs just take priority over that? But then if you do revive them they can be living but paralyzed. It would probably never happen to me, but just one of those "what if's" that I would really like to handle properly if it ever did! Thanks for your feedback in advance.


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## JPINFV (Feb 24, 2008)

Well, tramatic arrests don't have a good resuscitation rate anyways [which should bring up the question of did the accident cause the arrest or did the arrest cause the accident].
 There is some debate on just how much good C-Spine precautions do. 
 No amount of spinal immobilization will help a dead patient.
 Patients who are not breathing and do not have a pulse are clinically dead
 While I'm not sure on NJ law, most states have "Good Samaritan" laws that cover providers when off duty provided they provide BLS care [generally geared towards physicians since their licenses do not limit when/when/what they can do, unlike EMS licenses/certifications. This distinction is why I mentioned BLS care. Without the physician oversight offered while on duty, advance medical care could be considered practicing without a license]


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## reaper (Feb 24, 2008)

Life Before Limb!!!


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## EMTryan (Feb 24, 2008)

I am a relatively new EMT as well but here is what I would recommend:

*Remember the ABCs*.:excl: Airway, Breathing and Circulation. Airway managment takes priority over spinal immobilization. This would be a situation were you would want to quickly assess the patient. If the pt is obviously not breathing you would need to rapidly extricate the pt trying to protect the head/neck/back as much as you can. Lay the pt supine and open the airway using the Jaw-thrust technique if possible (if you can't open the airway with the jaw-thrust then use the headtilt-chin lift). Preform your initial assessment and provide care based on the conditions that you find.  

You can spend a lot of time trying to immobilize the patient but it would be totally unnecesary. The ABCs take priority.

From what I have heard the pt in this scenario is almost certainly going to die. Very few people survive traumatic cardiac arrest in situations like this.


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## KEVD18 (Feb 24, 2008)

well if its truly a traumatic arrest you might as well bag em and tag em right there. IIRC, and im sure R/r will be along to correct me, traumatic arrests have <1% survival rate. its almost not even worth the effort.

however if your were of the motivation to work it, and your alone, theres nothing your going to be able to do to maintain c-spine. pull em out and flog away.


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## MSDeltaFlt (Feb 24, 2008)

Since this is a "What If":

You are the only one on scene with multiple passengers of a bad MVC, one is in arrest, and you're BLS.  Since you are only one caregiver with more than one victim, you are automatically in a MCI situation.

This is assuming that the scene is safe: the vehicle(s) aren't in danger of exploding or anything of the sort.

1. Contact 911 giving them a rapid triage assessment and get the ball rolling.
2. Black Tag the arrest.  He's dead.  Leave him be.
3. Start tending to the other(s).  

This is a diar situation where hard decisions need to be made.

My two cents


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## KEVD18 (Feb 25, 2008)

MSDeltaFlt said:


> Since this is a "What If":
> 
> You are the only one on scene with multiple passengers of a bad MVC, one is in arrest, and you're BLS.  Since you are only one caregiver with more than one victim, you are automatically in a MCI situation.
> 
> ...



while your quite corrects if those are the circumstances, the op didnt specify the status of the rest of the cars occupants. i took that to mean they were just dany and the arrest was the only pt. what say you then...

and aas soon as i hit post reply, it occured to me: a death in the vehicle is considered significant moi, meaning all occupants need to be throuroghly examined on scene. but lets assume, since its really the heart of the op post, that it was a car v. tree and the driver is the only occupant.


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## Ridryder911 (Feb 25, 2008)

I really don't care how many other occupants, or their extent of their injuries (hang nail, etc) they will get treated by me before the traumatic arrest prior to my arrival. Trauma dead = DOA. Off duty, even more so.. I will call 911 and probably cancel the EMS unit. 

R/r 911


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## reaper (Feb 25, 2008)

But, May not be a trauma code.


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## BossyCow (Feb 25, 2008)

reaper said:


> But, May not be a trauma code.




good point, did the code cause the trauma or did the trauma cause the code?


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## MSDeltaFlt (Feb 25, 2008)

Mute point.  Dead, when you're the only one with multiple pts, is dead.  It doesn't matter how or why.  Black Tag him and move on.


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## MikeRi24 (Feb 25, 2008)

generally speaking, whats gonna kill him NOW? neatly immobilized trauma injuries arent gonna do the guy a whole lot of good if he has issues with his ABCs.


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## KEVD18 (Feb 25, 2008)

we're still not answering the question at the heart of the matter. the op(if i understand correctly) is inquiring about c-spine precautions and tx of cardiac arrest. so, as i said before, pretend its a car vs. tree and the only pt is the driver.


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## MSDeltaFlt (Feb 25, 2008)

OK.  Single patient scenario, but still solo caregiver.  Pull him out and start doing CPR just like you would in any AHA class.  You're not going to be able to hold C-Spine while extricating solo, so just get him out.  It'll be a blunt trauma traumatic arrest.  You will not get this person back, but it'll look good for the local paper with a few "Atta Boys" thrown in for good measure.

With multiple pt's, I wouldn't even bother.  Cover him up as best you can, and tend to the others.


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## reaper (Feb 25, 2008)

Just had one the other day. Car ran red light and was hit in rear passenger side. Got on scene and found that the driver had arrested prior to accident. Pt had no injury from mvc.

It does happen quite a bit. Not always traumatic code! Always prepare for the unexpected.

As stated if your alone, pull out and start CPR. With a crew, you can imobilize, but it does no good. You are moving the pt around during compressions. If their dead, it doesn't matter how much c-spine precautions you take!


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## piranah (Feb 26, 2008)

if you use a jacket around their neck and under their armpits to extricate, it immobilizes their C-spine and it adds for good collar for compression movement...just a little emergency extrication trick...


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## Gbro (Mar 1, 2008)

Good question for a new EMT. 
Prior to extricating pt. i would open the airway. It is very hard to access circulation in a stressful situation. The adrenalin you are poring into your system because you are new at this, and even for some of us that are seasoned makes it hard to feel with the tips of your fingers. 
i remember a 14 yof that was unresponsive in a MVA and I opened the airway, I was just ready to extricate and she came to. It was a difficult extrication and I would have done a lot of damage if I had extricated to soon. 
There are obvious signs, eyes(lackluster) large laceration & no blood(these are with unconscious/unresponsive) obvious trauma etc.
I have found myself holding shirts before and vic on ground as they can flow like water(its shocking).


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## milhouse (Mar 1, 2008)

now heres one thing that i think is a good point and its something my instructor told me when he was teach us about phtls. He said that a PT can live with a spinal injuries, but if they are not breathing they wont live. 

now ofcourse he also said that when dealing with multiple PT's black tag him (like everyone else has said) and move to the next PT even if that PT only has a  i dont know some sort of minor injury.

now to tell you the truth i dont know what i would do on scence because im also new at this. but i would hope that my medic would be able to point me in the right direction. because as we all know most people go on instincts. and when they see the first person DOA they go eeeekk and start slam dunking the PT. (atleast at some point in there EMS career.)


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## Keith (Mar 2, 2008)

I just skimmed through the responces, but I just felt I would respond with my own personal answer (sorry if I'm repeating anyone). If I showed up at a scene such as this, with no equipment, I would say that a life takes presidence over spinal precautions. I'm personally not sure if it violates protocols (in MA), but I am going to extract the patient and begin to perform CPR, hopefully with a bystander that can assist, and if not, Im gonna try like hell to keep that person alive. Protocols are one thing, but your right as a moral human being, may object to that, you just need to do whats right.


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## ccems644 (Mar 2, 2008)

C-spine precautions take a back seat to CPR. You should always move a pt as carefully as possible to prevent further injuries but if your not breathing your not living. There are a lot of determining factors that play into any scenario that have to be taken into account that's one of the thing that make us professional while adding to the difficulty of our job.


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## LazarusHeart (Mar 4, 2008)

I have an additional question to add to this thread...Many of you caveated the scenario with "If I didn't have equipment with me I would...".  How many of you out there carry personal 'jump bags' in your POV, and what do you have in 'em?


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## Ops Paramedic (Mar 5, 2008)

Sooner or later all patients eventually die...


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## EMTIA2-7747 (Mar 5, 2008)

*Dear AREZ10*

That question always comes up during the EMT-B classes I teach. Without adding or taking from the scenarion you are concerned about, just think ABCs. A pulseless and apneic patient is a dead patient, regardless of the condition of his spine. Assuming that the scene is safe, and that there are no obvious reasons not to perform CPR (such as decapitation), you should attempt to get your patient in a supine position while still trying to maintain C-spine protection, and you should initiate CPR. Should your patient survive but become paralized, you will at least have saved the life of someones relative. Will your efforts pay off? probably not, but it is our moral responsibility to try.


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## emtwacker710 (Mar 5, 2008)

Yes, ABC's first, if you remember from class, you manage life threats 1st then go for secondary injuries. So in that case you would go for CPR until the rig arrives and tells you to stop.
Not trying to steal the tread but does anyone here happen to know the laws for NYS regarding stopping off-duty, I know some states require it does anyone know about NY?


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## emtwacker710 (Mar 5, 2008)

LazarusHeart said:


> I have an additional question to add to this thread...Many of you caveated the scenario with "If I didn't have equipment with me I would...".  How many of you out there carry personal 'jump bags' in your POV, and what do you have in 'em?



I believe we have threads on this already, but I do carry a BLS jumpbag, I have everything a basic EMT 1st responder would need on scene except O2 and c-collars, I'm working on getting a bigger bag to put c-collars and O2 in.


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## BossyCow (Mar 5, 2008)

Less stuff the better. The longer you are in EMS the less stuff in your jump kit. C-collars? Why? Can't you hold c-spine manually? I'm in a rural district and can often be alone on a scene until other volunteers or a rig shows up. Still, I only carry a small fanny pack with a pen light, BP cuff, pen, notebook, some basic dressings and tape, Pocket mask and lots of extra gloves. The only thing you really can't do without is your brain. Too many of us forget to pack that!


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## LucidResq (Mar 5, 2008)

LazarusHeart said:


> I have an additional question to add to this thread...Many of you caveated the scenario with "If I didn't have equipment with me I would...".  How many of you out there carry personal 'jump bags' in your POV, and what do you have in 'em?



My friend is not even an EMT (although he does have the equivalent training and by protocol can do everything an EMT can except airways) yet he keeps a trauma jump kit with stuff like c-collars, dressings, and even an oxygen tank in his trunk. 

I give him sooo much hell for it. He always defends himself by saying "but I want to be a paramedic"... 

Yeah but you haven't even graduated high school yet... yeesh. I don't get it. He's spent hundreds of dollars on it and he'll probably never use it... except maybe for a bandaid or something.

As for myself, I keep a sandwich sized ziploc with me in my backpack, purse, whatever. A lot of the stuff is for personal use.

It has gloves, a mask, a CPR face shield, hand sanitizer, orajel, pepto bismol chewables, bandaids, neosporin, antiseptic wipes, benzocaine wipes, 4x4s, roller gauze, tampons, cough drops, cold medicine, aspirin, acetaminophen, eye wash and sunscreen. I think that's about it. 

A lot of the stuff comes in handy on a regular basis.


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## JPINFV (Mar 5, 2008)

I wouldn't go out and buy stuff for a 'personal jump kit.'

I, technically, have one, but it was due to my water park job. It's got band aids, kling, 4x4s, pocket mast, trauma bandage, full iso gear (gown/mask/gloves/goggles), a quick cold, and sting-eze. It is, with a little bit of planning, amazing what you can fit into a fanny pack. As with the rest of my EMS stuff when I was working (steth, BP cuff, DVD player), it was stored in my trunk. 

(the water park hired EMT-Bs for first aid. All first aid/CPR certified employees carried around a fanny pack with 4x4s, pair of gloves, and a pocket mask. The basics could use the supply room to 'stock' their's. There was also a tackle box style trauma box, AED, and medical backpack [Iron-Duck. it carred an O2 tank in addition to other supplies] in first aid for when we needed to go out into the park. The fanny pack was more for if something happened when we weren't in first aid [food, restroom, not guest needs needed everything]


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## el Murpharino (Mar 6, 2008)

I don't know if this point has been made or not, but if it's a bad car accident, remember to keep yourself safe first.  There could be unforseen hazards that may pose a threat to YOUR life after you develop the hero complex.  It's easy to forget scene safety; look at the people that will jump into a freezing pond to rescue citizens (for example).  Secondly, you'll need to triage all the patients there (since you mentioned there's more than one). If the other patients are green, then you wouldn't be wrong to attempt CPR on the patient, but remember that in MCI's living patients take precedence over the dead ones.  

One quick thing on these wacker bags...I've seen people mention they're going to get O2 in their personal bag.  Remember O2 is a drug, and there are state laws regarding carrying O2 without a prescription or license.  My department got all the EMT's a bag to carry in their personal vehicles, and to be honest I think it's too much.  I liked the idea of having a ziploc bag with some bandages, dressings, CPR mask (or simple face shield), bandaids, etc.).  I doubt most people in any situation are going to need an OPA, suction, c-collars, backboards, etc. for roadside incidents they happen to stumble upon.


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## Ridryder911 (Mar 6, 2008)

I personally would dial 911 and keep driving. There is little I can do as a first responder, and I do NOT carry any medical equipment in my personal car. 

I learned for my healthy outlook, when I am off duty, I am off duty. EMS is just a job, that I attempt to be very good in. 

R/r 911


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## el Murpharino (Mar 6, 2008)

Ridryder911 said:


> I personally would dial 911 and keep driving.



Do you at least stop to see if there is anyone injured?  I have gone on tons of calls put in by "drive-by hero's" when in fact noone was injured.  There is no need to put a rescue unit and EMS en route needlessly.


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## scottmcleod (Mar 6, 2008)

el Murpharino said:


> Do you at least stop to see if there is anyone injured?  I have gone on tons of calls put in by "drive-by hero's" when in fact noone was injured.  There is no need to put a rescue unit and EMS en route needlessly.



+1, I agree completely.

In my opinion (maybe it's because I'm canadian), that's a really reckless and selfish opinion to take.

My roommate who's an EMT-B (equivalent) up here in Canada came across an MVC involving multiple cars and unrestrained passengers. He ended up being first on scene, activating EMS, triaging, to the point that when the paramedics rolled up, they knew exactly what to expect, and how their game plan was to go.

(We're talking blood everywhere, bystanders being directed to help, everything. It was a pretty accurate example of the kind of good that an off duty EMT / FR can do to help save critical time.

Good notes above though on not forgetting our SETUP, DR 911 and ABC's when we find a situation off duty.

Just my $0.02


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## emtwacker710 (Mar 7, 2008)

does anyone happen to know what the laws are in NYS regarding stopping off duty? I know some states require it..anyone know what those are? because i do travel outside NYS quite often


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## Ridryder911 (Mar 7, 2008)

el Murpharino said:


> Do you at least stop to see if there is anyone injured?  I have gone on tons of calls put in by "drive-by hero's" when in fact noone was injured.  There is no need to put a rescue unit and EMS en route needlessly.


 
No, I don't. If I stop, then I have agreed I had a duty to act and if I leave, I have performed abandonment. In my metro areas, EMS is usually within 10 minutes away or sooner (not much a MFR can do). In the rural I might consider it. I  agree, hate those type of callers. After 30 yrs of EMS experience, I usually can gather if someone is hurt or not. Even though, one can misjudge sometimes, its not real rocket science. One usually can detect easily by MOI, etc. If it appears to be a minor MVA, I might report it as such and I am sure they will get plenty of responses. 

R/r 911


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