# motor vehicle accident



## tgustaf2 (Oct 2, 2012)

"You have responded to a single car, motor vehicle accident involving two patients who appear to be in their mid 70's. You are attending to the driver, a male patient, whom you determine after your primary survey requires urgent medical care at a hospital for possible internal injuries. You are attempting a speedy and safe extrication from the vehicle while your patient repeatedly questions you on the condition of his wife, who was the passenger in the vehicle and was subsequently ejected. From your own suspicious and confirmation from your partner you determine that this patient is VSA, and has been declared obviously dead." 
How do you answer and manage the patients concerns?


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## 7887firemedic (Oct 2, 2012)

A.Continue to treat the pt, inform him that you are there for him and his possible injuries while other responders are caring for his spouse.
B. Truth, your wife suffered devastating injuries from the incident that she did not survive.

Tough call, i usually go with option a, no lies or false hope yet not dropping the death bomb.


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## Anjel (Oct 2, 2012)

Sir right now we are focusing on you. Once we get to the hospital and make sure you are ok, someone will talk to you about your wife's condition. Right now YOU are my priority.


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## Medic Tim (Oct 2, 2012)

tgustaf2 said:


> "You have responded to a single car, motor vehicle accident involving two patients who appear to be in their mid 70's. You are attending to the driver, a male patient, whom you determine after your primary survey requires urgent medical care at a hospital for possible internal injuries. You are attempting a speedy and safe extrication from the vehicle while your patient repeatedly questions you on the condition of his wife, who was the passenger in the vehicle and was subsequently ejected. From your own suspicious and confirmation from your partner you determine that this patient is VSA, and has been declared obviously dead."
> How do you answer and manage the patients concerns?



Is this from your textbook or homework from your instructor?

What would you do?



These are tough situations to be in, especially if you have never dealt with anything like it before. I would not lie to the pt or give false hope. What I say and how I say it will depend on the situation.


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## Achilles (Oct 3, 2012)

I'm pretty sure textbook says to inform him when he is at the hospital and in stable condition. That way he doesn't lose all hope. My book is in my truck and it's raining so i won't be getting it to look, i'll check tomorrow.


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## tgustaf2 (Oct 3, 2012)

Medic Tim said:


> Is this from your textbook or homework from your instructor?
> 
> What would you do?
> 
> ...



It was a scenario I was given to think about, and I really didn't know if the proper thing was to tell him or to somewhat keep it from him. In the end I responded with telling him my partner was checking his wife and that my most important duty was to extract him as safely and promptly as possible to get him to the hospital quickly to treat his internal injuries--didn't lie, but didn't tell him what I knew right at the time because he may go into shock or become hysterical which would make caring for him harder.


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## mycrofft (Oct 4, 2012)

Somewhere I posted on the same type of deal excepet the husband was trapped with his wife.

Said "She's stable" and went on getting him out.

Told him in ambulance on the short way in "She didn't make it".


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## NYMedic828 (Oct 4, 2012)

mycrofft said:


> Somewhere I posted on the same type of deal excepet the husband was trapped with his wife.
> 
> Said "She's stable" and went on getting him out.
> 
> Told him in ambulance on the short way in "She didn't make it".



Technically not a lie... she is pretty stable...


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## Melclin (Oct 4, 2012)

Hard decision. I think its a case by case type of deal. 

I've used the "Right now our priority is you" line before knowing full well the wife was dead having just finished working on her before moving to assist others on the husband. I think I prefaced it by saying she was very sick or something, but essentially omitting the obvious truth of the matter.

My judgement at the time was that he would flip out and become almost impossible to manage. He was already quite difficult. 

Perhaps if I thought the person would handle it in a way that didn't impede my ability to treat them or they weren't sick enough for me to be worried...maybe I'd tell them the truth.

Interested to hear other people's opinions.


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## Veneficus (Oct 4, 2012)

While I do not advocate misinformation or not accepting the responsibility of informing a family member of the death of a loved one...

I am not sure in the field during an acute event is the proper place to inform another victim of the incident in the death of a family member.

It presents an interesting conundrum. 

Since it is likely to be me that has to inform of the death anyway, I would probably say something along the lines of:

"You are both very seriously hurt right now and I have to concentrate on you. I will however find out as soon as reasonable and let you know."

This does not skirt the issue, acknowledges the gravity of the situation, establishes a positive rapport, and most importantly will not only avoid introducing depression early in acute treatment, but will allow me to actually find out some circumstances to the inevitable questions regarding the death. 

That way the later conversation is not "she died, I don't know anything more, have a good night and get well soon."

Since EMS is usually not in the position to have this conversation and will lack any details to answer questions which may create conflicting accounts later, I think a simple:

"I am focusing on you right now" would suffice.


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## Maine iac (Oct 4, 2012)

Similar sort of conundrum over at Life In The Fastlane-

http://lifeinthefastlane.com/2012/09/household-words-chapter-1/

There is a part two already published so make sure to check that out.


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## Blake (Oct 6, 2012)

If another crew was there I would say... Sir the other crew is attending to your wife. Right now we need to get you to the hospital due to your injuries. Your wife has sustained injuries and is in critical condition, but we are doing everything we can do for her. And just play it by ear from there. That way you didn't say she is dead or alive and the doctor can notify him after they are sure he is in a stable mind set before they break him the news.


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## Handsome Robb (Oct 6, 2012)

Veneficus said:


> "You are both very seriously hurt right now and I have to concentrate on you. I will however find out as soon as reasonable and let you know."
> 
> This does not skirt the issue, acknowledges the gravity of the situation, establishes a positive rapport, and most importantly will not only avoid introducing depression early in acute treatment, but will allow me to actually find out some circumstances to the inevitable questions regarding the death.



I like this. That would be a fantastic way to put it.

I also agree with not telling him directly that she is deceased during the extrication. Only fatal MVA I've had as an attending paramedic was a single vehicle rollover with partial ejection with the driver being the only occupant so I can't say that I have experience in this type of situation.


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## mycrofft (Oct 9, 2012)

House MD approached this conundrum once, but blew past it.

Would you lie to a pt ordinarily? No.

Would you lie to a pt if the truth at that time would be adverse to the pt's well-being? How would you determine the potential for harm? Good question.


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