# Car accident right in front of you- do you help (offduty)?



## 9D4 (Dec 12, 2012)

Alright, so I know there's threads like this, but this exact thing happened to me yesterday.
I'm not NR certified yet, so keep that in mind. 
Yesterday, I was actually on my way to go take my psychomotor portion of my exam and stopped at Circle K for a quick drink. Hop out my car, hear tires squealing and look over. A Blazer that had just come out of the car wash (wet tires) was going through the parking lot at 35+ and took a corner. Wet tires+ top heavy car+ high speed+ sideways into a curb= bad, haha. She went completely sideways and hit a curb, rolled like 3 times and literally stopped like 4 feet in front of me and was going straight towards me (I $%$^ myself, needless to say, I had glass all over me, that's how close she was).

 I see the driver on the road side, look inside real quick, another person strapped in and completely mangled. Driver's in way better condition, with obvious open fractures on both lower portions of the leg and an obviously broken arm. Passenger, like I said, mangled. From what I could see, she had her arm out the window and quite a large bit of it is amputated, proximal part of the humerus is all that's attached, they had to use the jaws of life to get her out, then air evac'd (my friend watched).
So, honestly, I didn't help at all. I had no gloves, no nothing. I stood there and called 9-1-1, police showed up in like 10 seconds, he was in Circle K, didn't see him though. Guy runs over asks the cop if he has a jump kit, cop does and asks what he does. Guy is a paramedic. So, he gloved up and got to work. I stood there and watched for a minute, then had to leave to go take the NR. 
So, what would you guys have done? I felt really bad leaving, but I didn't want to play around with the NR by being late, figured that would be a no-no. 
Also, another reason I didn't help was because I don't have my certs. I didn't want that to come back and bite me. Would I have been ok to help, as long as it was within my scope (basically, hold pressure on the driver's legs and bandage, since passenger had to be extricated still)?
To be honest, I was kind of pissed at the driver for nearly killing me :glare: (joking [sort of]). 
Just another thing, throwing it in because I'm excited, haha. Passed the psychomotor with nearly a perfect on everything  Super stoked, haha. Class final is tomorrow though


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## Medic Tim (Dec 12, 2012)

Calling 911 and giving accurate info is one of the best things you can do. It allows them to send the best/appropriate resources. You did more than a lot of ppl would have done.  I would have helped out...provided it was safe to do so...blah blah blah..... though where I am we have a duty to act on and off duty.

NR cert means you passed the test it does not give you a right to practice.... the state does. You do not have a scope of practice as you are not yet an emt. As long as you were/are acting in good faith and not doing something you know you shouldn't be doing you will be fine. AKA basic first aid......even if you were an EMT .. off duty you can only do first aid.

Congrats on passing the practical.


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## EMT B (Dec 12, 2012)

where i am there really is no such thing as "off duty." 70% of our department is made up of a call force..so I keep my gear bag and my jump kit in the back of the car. I dont do anything fancy--i have my radio, basic first aid supplies, and stuff to take basic vitals if we willl be waiting on a rescue. It really depends on where you live. 

If you live in a big area, have a phone and give a good report--you should know whata good radio report is if you have been around the block.


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## 9D4 (Dec 12, 2012)

Medic Tim said:


> Calling 911 and giving accurate info is one of the best things you can do. It allows them to send the best/appropriate resources. You did more than a lot of ppl would have done.  I would have helped out...provided it was safe to do so...blah blah blah..... though where I am we have a duty to act on and off duty.
> 
> NR cert means you passed the test it does not give you a right to practice.... the state does. You do not have a scope of practice as you are not yet an emt. As long as you were/are acting in good faith and not doing something you know you shouldn't be doing you will be fine. AKA basic first aid......even if you were an EMT .. off duty you can only do first aid.
> 
> Congrats on passing the practical.


I'm in AZ. They don't have a state test, only the NR. Once you pass that, you're golden. 
Thanks for the clarification on that, like I said though all I would've been able to do is hold pressure on the her legs, but they weren't hardly bleeding, which really surprised me. First time I've seen a "major" trauma, so I expected a lot more. All the ride a longs I went on were fairly calm, so I never got to see trauma. 
Actually, though there was quite a few people that helped out. Her daughter was in the car wash vacuuming her own car and saw it all happen and sat there on the curb crying. Like 5 or 6 elderly women were trying to tell her it's alright. Another was trying to calm down the driver, wasn't doing anything much though. 
What really frustrated me, however was the police. I ran in to get my drink after I gave my statement to the responding officer and come back out and there's like 25 cops blocking every entrance. Two engines are trying to pull in and can't, because cops are blocking every way in. Blaring their horns and no ones moving a single car. They finally got in and the engineer of one of them sat there yelling at them for a good while, ha.
Edit: Yeah, when I was on my ride a-longs they made do vitals and report to the arriving ambo's every time for practice. So, have a bit of practice with those.


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## NYMedic828 (Dec 12, 2012)

As stated above, calling 911 to request appropriate resources is vital to the incident.

When you don't have an ambulance or any kind of toolbox, you aren't very useful. The patients needed to be extricated mechanically from the vehicle, odds are there wasn't any way you were going to directly help them.

You did the right thing to the best of your ability.


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## Tigger (Dec 12, 2012)

blittle said:


> I'm in AZ. They don't have a state test, only the NR. Once you pass that, you're golden.
> Thanks for the clarification on that, like I said though all I would've been able to do is hold pressure on the her legs, but they weren't hardly bleeding, which really surprised me. First time I've seen a "major" trauma, so I expected a lot more. All the ride a longs I went on were fairly calm, so I never got to see trauma.
> Actually, though there was quite a few people that helped out. Her daughter was in the car wash vacuuming her own car and saw it all happen and sat there on the curb crying. Like 5 or 6 elderly women were trying to tell her it's alright. Another was trying to calm down the driver, wasn't doing anything much though.
> What really frustrated me, however was the police. I ran in to get my drink after I gave my statement to the responding officer and come back out and there's like 25 cops blocking every entrance. Two engines are trying to pull in and can't, because cops are blocking every way in. Blaring their horns and no ones moving a single car. They finally got in and the engineer of one of them sat there yelling at them for a good while, ha.
> Edit: Yeah, when I was on my ride a-longs they made do vitals and report to the arriving ambo's every time for practice. So, have a bit of practice with those.



Calling 911 is always the priority when off duty, no matter if you have a massive jump kit in your trunk or not. 

Also, taking and passing the NR does not give you a license to practice, you still need to get an Arizona license or certification card. As to how that process works, I have no idea but note that no state allows EMT to practice with and NREMT card.


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## 9D4 (Dec 12, 2012)

Tigger said:


> Calling 911 is always the priority when off duty, no matter if you have a massive jump kit in your trunk or not.
> 
> Also, taking and passing the NR does not give you a license to practice, you still need to get an Arizona license or certification card. As to how that process works, I have no idea but note that no state allows EMT to practice with and NREMT card.


I know, I was just saying we don't have a state test. We take the NR, submit it somewhere in Az (have to find out where, I think it was dept of transportation, not sure why though) and then they issue a state card. 
I can't get hired anywhere, anyways though -_- Have to be 21 to be on an ambo and I just turned 18 a month ago. Fire dept doesn't hire without fire 1 & 2. I get my phlebotomy cert when I graduate from high school in May (hopefully, as long as I pass the NR for that, too. I still need two more sticks to sit, but that's no biggie. I got 8 today alone in my 50 minute class draw time) so trying to line up a position for an ER tech. Also have to sit for a Certified Medical Lab Assistant test. Way too many national registry's this year  hahah.   
So, as of now, I'm just volunteering. Been going out with hospice, as of late. I enjoy it, although it has it's dark moments. I feel like we really don't help with patients, just make them comfortable, even though I know there's nothing even the hospitals can do, let alone an EMT.


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## Tigger (Dec 12, 2012)

blittle said:


> I know, I was just saying we don't have a state test. We take the NR, submit it somewhere in Az (have to find out where, I think it was dept of transportation, not sure why though) and then they issue a state card.
> I can't get hired anywhere, anyways though -_- Have to be 21 to be on an ambo and I just turned 18 a month ago. Fire dept doesn't hire without fire 1 & 2. I get my phlebotomy cert when I graduate from high school in May (hopefully, as long as I pass the NR for that, too. I still need two more sticks to sit, but that's no biggie. I got 8 today alone in my 50 minute class draw time) so trying to line up a position for an ER tech. Also have to sit for a Certified Medical Lab Assistant test. Way too many national registry's this year  hahah.
> So, as of now, I'm just volunteering. Been going out with hospice, as of late. I enjoy it, although it has it's dark moments. I feel like we really don't help with patients, just make them comfortable, even though I know there's nothing even the hospitals can do, let alone an EMT.



If you end up working for a private company that does transfers you may do a few to hospice, so that's good experience. And with hospice, helping the patient *is* making them comfortable.


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## Sublime (Dec 12, 2012)

Besides calling 911 there is really nothing you could have done. Maybe try to reassure the patient, and at most bandage / bleeding control if possible and you have the equipment. I imagine thats all the paramedic on scene was able to do till EMS / FD arrived.


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## Clare (Dec 13, 2012)

For something like this, if its an urban area with no ambulance on scene and clearly a significant road crash like ejected people etc then yes stop otherwise no I wouldn't stop; in a rural area yes always stop.  

Simple first aid and calling an ambulance is your bet bet; keep it simple, the two most important things are your phone and a good high visibility jacket so you can be seen easily, a couple OPA and a pair of gloves maybe too if you are keen but no more is necessary.


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## EMT B (Dec 13, 2012)

you dont even really need opas. you can hold c-spine with a modified jaw thrust to keep the airway open. gloves, gauze, cell phone, cpr mask hi vis jacket for urban, rural- gloves gauze penlight cpr mask cell phone hi vis jacket pen and paper to take vitals...in a lot of rural areas it can be very helpful to take vitals..especially when ems could be as long as 20 mins away


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## Handsome Robb (Dec 13, 2012)

Clare said:


> Simple first aid and calling an ambulance is your bet bet; keep it simple, the two most important things are your phone and a good high visibility jacket so you can be seen easily, a couple OPA and a pair of gloves maybe too if you are keen but no more is necessary.



I would highly advise against carrying OPAs. That's beyond basic first aid and depending on your state's laws it could bite you in the ***. A jaw thrust in a pinch will do just fine like the guy above me said or if you have multiple patients the recovery position can work as a temporizing measure until more hands show up. Even having a state card doesn't give you the right to practice beyond basic first aid unless you are at work functioning under your Medical Director's medical license. 

For what it's worth I have a CPR mask and a pair of gloves in my glovebox and that's it. 

I wont parrot the good advice others have given already. 

One thing I will say is always ask if people want/need an ambulance before you call. In this instance it was pretty obvious but it's an easy question to ask and can save a lot of time, resources and also keep crews and the public safer in the long run. If I had a nickel for every car accident I went code to to either be cancelled or write a couple refusals, not even AMA, literally a "I don't have a problem leave me alone" signature.


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## DrParasite (Dec 13, 2012)

call 911, park your vehicle in a safe location, ensure 911 has the exact location, and stay safe.

btw, if you are not certified, don't stop.  if you aren't trained, don't stop.  if you aren't confident in your ability to deal with a potentially unstable scene for 10+ minutes with limited equipment, don't stop.  if you don't have proper ID on you, so when Law enforcement tells everyone to back away, don't stop.

most important thing to do is call 911, and get the AHJ responding.  Even if you don't stop, make sure you call 911 an dgie them the proper location of the incident.


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## leoemt (Dec 18, 2012)

Clare said:


> For something like this, if its an urban area with no ambulance on scene and clearly a significant road crash like ejected people etc then yes stop otherwise no I wouldn't stop; in a rural area yes always stop.
> 
> Simple first aid and calling an ambulance is your bet bet; keep it simple, the two most important things are your phone and a good high visibility jacket so you can be seen easily, a couple OPA and a pair of gloves maybe too if you are keen but no more is necessary.



What is an OPA going to do in this situation? OPA's are pretty useless. Hence why they don't come in standard First Aid kits and you need to be an EMT to use them.


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## Clare (Dec 18, 2012)

leoemt said:


> What is an OPA going to do in this situation? OPA's are pretty useless. Hence why they don't come in standard First Aid kits and you need to be an EMT to use them.



An OPA here is an "ordinary intervention" which any person may perform including a lay person.  There are no specific restrictions around using pieces of clinical equipment such as this.

In many articles and presentations regarding attending a road crash as a medical professional it has been advised here to carry nothing more than a high vis jacket, a couple OPAs, some gauze pads and gloves at the most; I agree with such advice so I am repeating it here.

An OPA will enable you to look after an airway; a patient with poor airway who is trapped will need active jaw thrust to maintain his airway, if there is more than one patient involved or whatever then having a couple OPA means you can look after an airway easily and not be tied up solely performing a jaw thrust in a situation where other persons who stop are unwilling to help or whatever.  

I do not carry them but I don't see the harm in doing so I think they are sensible and reasonable; in the car I have a high vis jacket and a pair of gloves.


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## Achilles (Dec 19, 2012)

Clare said:


> An OPA here is an "ordinary intervention" which any person may perform including a lay person.  There are no specific restrictions around using pieces of clinical equipment such as this.
> 
> In many articles and presentations regarding attending a road crash as a medical professional it has been advised here to carry nothing more than a high vis jacket, a couple OPAs, some gauze pads and gloves at the most; I agree with such advice so I am repeating it here.
> 
> ...


A gag reflex is a  contraindication for an OPA.


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## leoemt (Dec 19, 2012)

Clare said:


> An OPA here is an "ordinary intervention" which any person may perform including a lay person.  There are no specific restrictions around using pieces of clinical equipment such as this.
> 
> In many articles and presentations regarding attending a road crash as a medical professional it has been advised here to carry nothing more than a high vis jacket, a couple OPAs, some gauze pads and gloves at the most; I agree with such advice so I am repeating it here.
> 
> ...



As mentioned a gag reflex is a contraindication for an OPA. On the contrary a lot of harm can be caused by improper use of an OPA. Children and the elderly often have soft palette  which can be damaged by an OPA and cause significant bleeding. 

An OPA does not create a patent airway. It helps to control the tounge. The rescuer still has to maintain control over the patient including performing jaw thrust. A patient cannot be left with an OPA in. 

OPA's are not appropriate for lay persons nor are they sensible or reasonable. EMTB and higher skill level only. 

http://en.wikipedia.org/wiki/Oropharyngeal_airway


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## epipusher (Dec 20, 2012)

Call 911 only.


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## gw812 (Dec 26, 2012)

911 first, pull over only if safe, act within the responsibilities of a lay-rescuer only. C-spine, CPR, basic bleeding control - that's where you live in this situation. 

Anything more and you could be considered practicing medicine without a license.


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## CritterNurse (Dec 27, 2012)

I've pulled over to see if someone needed assistance before, but it was never something that happened in front of me. Usually its a car pulled over well before I arrived. Usually they've already called for help and is just waiting for a tow-truck, husband, police, etc. I've helped change a tire a couple times. 

And of course if it doesn't look safe, I won't approach. I've called 911 a few times from the car to report car crashes on dangerous areas of the road where I didn't feel safe stopping.

Once I drove by a van with its 4-ways on, and as I approached, it looked like the driver slumped over the wheel, and I saw 3 kids in the back. I was concerned, so I pull over in a safe spot and headed over, with my phone in hand. The driver didn't move until I tapped on the window. She was sobbing, but more from the stress of being broken down than any injury. She was touched that I stopped to offer to call for help, but said she had already called.

The only time I've offered medical assistance to something I saw on the road was the time I saw a dog get hit by a car, and a few bystanders rushed over, and were likely to get bit or cause more injury to the dog from what they were doing. In that case I did don gloves and grab a blanket and stethoscope. I got a couple bystanders to go see if the dog belonged to any of the nearby houses or to someone at the nearby business. No luck though, and no collar on the dog. The dog wasn't a stray though. Looked well fed and well cared for.

Someone had called 911 to report the hit-and-run and give a description of the truck that hit the dog. I did a quick head-to-toe to check for broken bones, and then gently got the dog onto the blanket to make it easier to move him, and then a trooper arrived. There was some obvious head trauma, but the spine and pelvis seemed fine. The trooper brought the dog to the nearest vet, which is a good thing because I certainly didn't have the money to pay for the dog's treatment, and the nearest vet was the sort to charge the one who brings the dog or tell you to get lost. I was more than happy to let the trooper deal with him. 

The reputable vets in the area have a 'stray fund' and will take in a hit-by-car dog, stabilize them, and then either turn them over to a shelter, or try to find the owner, but I didn't have the time to go out of my way to bring the dog to one of them and still make it to the appointment I had to get to. I did get the word out via facebook with a description of the dog, the address where the dog got hit, and included info on where the dog was brought just in case someone knew the owner. I never did hear what happened with the dog, or get my blanket back, but at least I did what I could.


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## Handsome Robb (Dec 27, 2012)

Please don't call 911 unless it's obvious emergency services are going to be needed or you've stopped and asked if they wanted you to call.


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## DrParasite (Dec 27, 2012)

NVRob said:


> Please don't call 911 unless it's obvious emergency services are going to be needed or you've stopped and asked if they wanted you to call.


respectfully disagree.  if the vehicle isn't drivable, if it's in the middle of the road, if it's in a bad spot, if it's on it's roof than CALL 911.  

i'd rather receive 5 calls about an MVA, vs 0 calls.  worst case, a cop is sent and writes a report.  best case, a cop, ambulance, paramedic, heavy rescue, engine, ladder, battalion chief, fire rescue, and PD emergency Services unit are all dispatched, cut the person out of the car, and transport them to the trauma center.

even if it's just an MVA in the roadway where PD is needed for traffic control, call 911.


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## Handsome Robb (Dec 27, 2012)

DrParasite said:


> respectfully disagree.  if the vehicle isn't drivable, if it's in the middle of the road, if it's in a bad spot, if it's on it's roof than CALL 911.
> 
> i'd rather receive 5 calls about an MVA, vs 0 calls.  worst case, a cop is sent and writes a report.  best case, a cop, ambulance, paramedic, heavy rescue, engine, ladder, battalion chief, fire rescue, and PD emergency Services unit are all dispatched, cut the person out of the car, and transport them to the trauma center.
> 
> even if it's just an MVA in the roadway where PD is needed for traffic control, call 911.



It's still worth it to stop and ask if they are hurt. There's no reason to have all of the above rolling to an accident and putting the crews and public at risk for something that can be handled by a squad car and a tow truck. 

I agree that it needs to be reported if the roadway is being blocked though. 

Sorry, I'm kinda jaded because I spent half of last night chasing fantom car accidents. We'd show up to find the skid marks where they spun out, backed up then drove off.


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## Veneficus (Dec 27, 2012)

Car accident in front of me?

Didn't see it...

Must have been paying attention to something else.


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## Achilles (Dec 27, 2012)

Veneficus said:


> Car accident in front of me?
> 
> Didn't see it...
> 
> Must have been paying attention to something else.



The hot girl in the car next to you? 

I always check to see if the girl driving next to my car is hot


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## Veneficus (Dec 27, 2012)

Achilles said:


> The hot girl in the car next to you?
> 
> I always check to see if the girl driving next to my car is hot



Whatever it takes to not see the car accident. 

Not listening either. La la la la la la la.


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## Trashtruck (Dec 27, 2012)

Ignorance is bliss.

I don't hear or see anything off-duty.


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## 9D4 (Dec 28, 2012)

NVRob said:


> It's still worth it to stop and ask if they are hurt. There's no reason to have all of the above rolling to an accident and putting the crews and public at risk for something that can be handled by a squad car and a tow truck.
> 
> I agree that it needs to be reported if the roadway is being blocked though.
> 
> Sorry, I'm kinda jaded because I spent half of last night chasing fantom car accidents. We'd show up to find the skid marks where they spun out, backed up then drove off.



I said in the beginning. Car rolled a few times, driver ejected/ responsive to tactile stimuli/ open lower leg fractures, car is on roof with driver partially under it. One passenger visible, arm amputated proximal humerus (I think she had it out the window when they rolled), scalp laceration.
Later found out there was a third passenger, not visible from where I looked in. They were in the back of the hatch mixed in with a bunch of random stuff.
Passenger was air evac'd, driver taken by ambo, third patient refused treatment. I had to leave, but my buddy works at the car wash that it happened at and he told me everything that happened after I left. 
Scene was in a private parking lot (car wash).
So, basically at the beginning all I was asking is; should I have done more than call 911? But the general consensus has been to just call 911 and wait for responders.
Edit: I could hardly pretend not to see it, the car rolled right towards me and stopped like 10 feet before it hit me and was going straight towards where I was standing, haha. Would've been hard to ignore that, lol.
Achilles; I also do that. Every stop light, haha.


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