# First Shooting



## DOS7272 (Nov 4, 2010)

My partner and I were driving back to the base after a fairly slow day. We were late for shift and stuck in traffic driving back to base. Probably about a mile or two away from the base, the fire radio starts blaring for the "unknown medical" about two blocks from our position, dispatching, in due course, a paramedic unit from the base. This didn't concern us, as it would take the medic maybe 1 minute to arrive.

About 5 seconds later, the call upgraded to a possible shooting. My partner called dispatch and told them we were right on top of the call and started responding. I mapped it quickly and we arrived about 15 seconds later, observing 2 police vehicles parked on either side of the street. I saw a body in the street immediately to the right of the ambulance surrounded by people. They yelled to pull up, and that there was a police officer shot. 

I jumped out with the bags and started helping apply pressure to stop the bleeding. Fire and the medic arrived shortly after, and the five of us dead lifted him onto the stretcher, got him on O2 and loaded him in about 30 seconds. My partner went to work on the cop with the medics,  when I heard a FF yell for an AED. He was doing compressions on someone in their early 20s with 3 entry wounds to the clavicle and the sternal area.

He had stopped breathing and another FF was ventilating. I applied the AED and got two "no-shocks". The FF had started him on backboard, so we strapped him in quickly. By then the second local medic had arrived, so we packaged him and put him in the truck and drove him about 3 blocks to the local hospital (the other ALS took the cop to another larger hospital that was somewhat further away because he was more stable). 

We got him in the trauma room, I was doing compressions while the team worked. They had to start IO drills IVs because of the poor quality of his veins, PTX, they had to needle decompress him. He was declared about 10 minutes later.

Been thinking about it, what I could of done better etc. or if I could have done anything at all that would have changed the outcome. It was my first actual trauma as an EMT, so I just thought I would sort of debrief it in my own head here.

Thanks for listening!


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## Aidey (Nov 4, 2010)

Scene safety?


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## SanDiegoEmt7 (Nov 4, 2010)

DOS7272 said:


> My partner went to work on the cop with the medics,  when I heard a FF yell for an AED. He was doing compressions on someone in their early 20s with 3 entry wounds to the clavicle and the sternal area.
> 
> He had stopped breathing and another FF was ventilating. I applied the AED and got two "no-shocks".



Sounds like an intense call.  Question though, why were you guys attempting to defibrillate a traumatic arrest?


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## DOS7272 (Nov 4, 2010)

I agree scene safety was neglected in this situation. There was, as usual, very little information on the incident at the time so I suppose another gunman could have been running around. There were multiple police units on scene at the time, however, so we weren't necessarily running into the dark.

I reacted, however, to the situation. That, I suppose, is what gets us killed.


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## DOS7272 (Nov 4, 2010)

SanDiegoEmt7 said:


> Sounds like an intense call.  Question though, why were you guys attempting to defibrillate a traumatic arrest?



This occurred before the second medic had arrived. Per our protocol, if time permits in a traumatic arrest situation, and if the action of defibrillating does not take the place of proper care or transport time, then one can attempt defibrillation. We attempted twice during the boarding process, but upon arrival of the stretcher and the medics promptly packaged and transported. 

I do understand the point of deciding not to defibrillate when multi-system trauma is possibly in the works however.


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## SanDiegoEmt7 (Nov 4, 2010)

DOS7272 said:


> This occurred before the second medic had arrived. Per our protocol, if time permits in a traumatic arrest situation, and if the action of defibrillating does not take the place of proper care or transport time, then one can attempt defibrillation. We attempted twice during the boarding process, but upon arrival of the stretcher and the medics promptly packaged and transported.
> 
> I do understand the point of deciding not to defibrillate when multi-system trauma is possibly in the works however.



Gotcha.  In our BLS protocols we do not bother with AED on traumatic arrest.  In our ALS protocols, we can defibrillate if the patient is in V-tach/V-fib. So it sounded odd to hear an AED being used. 

Also, in light of Scene safety issues, was the other medic staged or simply sent to the scene immediately.  I would have followed whatever instructions they received, or double checked with dispatch.  I don't mess around with shootings, stabbings, assaults, etc.


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## dmc2007 (Nov 4, 2010)

Was this in Middlesex County, MA?


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## CAOX3 (Nov 5, 2010)

SanDiegoEmt7 said:


> Sounds like an intense call.  Question though, why were you guys attempting to defibrillate a traumatic arrest?




Am I missing something, why wouldnt you?


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## EMSLaw (Nov 5, 2010)

CAOX3 said:


> Am I missing something, why wouldnt you?



Presumably because it probably won't work, since the problem is traumatic rather than... well, I want to say physiological, but let's go with non-traumatic, since I can't think of the right word at 3 am. 

However, that being said, the time it takes to slap on the AED pads is negligible, and you might catch lightning in a bottle.  Are we that concerned about saving the $70 for a set of AED pads?

Our protocols are the same for traumatic and non-traumatic arrests.


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## CAOX3 (Nov 5, 2010)

EMSLaw said:


> Presumably because it probably won't work, since the problem is traumatic rather than... well, I want to say physiological, but let's go with non-traumatic, since I can't think of the right word at 3 am..



Well if we are basing treatment decisions on things that probably wont work, we all would be out of a job. EMS is one field that likes to eliminate evidence based medicine from the equation.  Lets see PASG, long spine boards, ACLS just to name a few.



EMSLaw said:


> However, that being said, the time it takes to slap on the AED pads is negligible, and you might catch lightning in a bottle.  Are we that concerned about saving the $70 for a set of AED pads?
> 
> Our protocols are the same for traumatic and non-traumatic arrests.



Im with you here, I understand the survival rates are dismal in traumatic arrests but who am I not to give that 1% a chance.  

If the guys viable he gets the works including electricity if deemed appropriate, if we are still following ACLS protocols that have never once been proven effective, you can be dam sure Im not eliminating something that has.


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## Chimpie (Nov 5, 2010)

Interesting call.

How are *you* doing?  Have you and your partnered talked about the call?  Talked about what went right, what didn't?  Talked about any emotions either one of you are feeling?

I'm sure the adrenaline is still pretty high, but working through your first shooting, which involved a cop, losing him.... make sure everyone involved gets the opportunity to talk it out if they need to.


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## Aidey (Nov 5, 2010)

Chimpie said:


> Interesting call.
> 
> How are *you* doing?  Have you and your partnered talked about the call?  Talked about what went right, what didn't?  Talked about any emotions either one of you are feeling?
> 
> I'm sure the adrenaline is still pretty high, but working through your first shooting, which involved a cop, losing him.... make sure everyone involved gets the opportunity to talk it out if they need to.



The cop didn't die, the other guy did.


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## Chimpie (Nov 5, 2010)

Aidey said:


> The cop didn't die, the other guy did.



Eh, I had a hard time following the story this morning without any caffeine. lol


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## Veneficus (Nov 5, 2010)

*nonjudgemental considerations*



DOS7272 said:


> I jumped out with the bags and started helping apply pressure to stop the bleeding.



Sounds good, did the bleeding slow or stop?



DOS7272 said:


> Fire and the medic arrived shortly after, and the five of us dead lifted him onto the stretcher, got him on O2 and loaded him in about 30 seconds.



Sounds like time to "snatch and run ya'll!"



DOS7272 said:


> My partner went to work on the cop with the medics,  when I heard a FF yell for an AED.



A completely useless intervention in this case. More on that later.



DOS7272 said:


> He was doing compressions on someone in their early 20s with 3 entry wounds to the clavicle and the sternal area.



Did anyone make any effort to close his open pneumos?



DOS7272 said:


> He had stopped breathing and another FF was ventilating. I applied the AED and got two "no-shocks".



Undoubtably.



DOS7272 said:


> The FF had started him on backboard, so we strapped him in quickly.



Too much time onscene. 

This Pts injuries are severe, and beyond EMS. The backboard was a waste of time. We will all rest well knowing secondary spinal damage to the corpse has been mitigated.



DOS7272 said:


> By then the second local medic had arrived, so we packaged him and put him in the truck and drove him about 3 blocks to the local hospital



So you delayed getting to a surgeon or even a doctor to wait for a medic? Not a good decision.



DOS7272 said:


> (the other ALS took the cop to another larger hospital that was somewhat further away because he was more stable).



Not enough info on this to discuss it. But the initial medics both went to work on the cop who was more stable (enough to both delay transport and divert?) instead of the most critical pt. Not only that but it caused a delay in transporting the critical pt.

Those medics failed. In a big way. They would be removed from ALS duty until they learn how do things properly if I was in charge From your description.



DOS7272 said:


> We got him in the trauma room, I was doing compressions while the team worked. They had to start IO drills IVs because of the poor quality of his veins, PTX, they had to needle decompress him. He was declared about 10 minutes later


 
A little late on the decompression. Again an ALS issue.



DOS7272 said:


> Been thinking about it, what I could of done better etc. or if I could have done anything at all that would have changed the outcome.



Anything you cold have done? Aside from insisting on immediate transport for the most critical, nothing that I can see. But ALS looks like a disaster.

In a traumatic arrest, the heart stops from a progressive physiological decompensation. Electricity does nothing to reverse this sequele. About the best you can hope for is that it doesn't kill viable cells. Which need at the very least blood. However if the shock state is irreversible, even that won't help. Though the pt may survive a few days in SICU while all of his cells finally die.

Don't speculate on entrance and exists, just find the holes and stop them from bleeding. Bullets have completely unpredictable tracts indide the body, the can wind up in amazing places for various reasons. Entrance and exit is useful for forensics, not for trauma surgery.


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## Journey (Nov 5, 2010)

At least the OP has now removed some identifying information from his profile.

However, this was a situation that made the national newswires. Not all the info was made available to the press and an ongoing criminal investigation was initiating. 

In the future you might try to refrain from publishing high profile cases with crime scene and patient information on EMS forums and facebook or whatever other networking community you use. You were a witness to some details in the crime scene as well as being a health care professional.  So tightened it up kid or you'll soon become an attorney's dream if you haven't already after this.

Seek out real people in your life who can maintain confidentiality like a senior EMS officer, minister or professional counselor.


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## CAOX3 (Nov 5, 2010)

Veneficus said:


> Sounds good, did the bleeding slow or stop?
> 
> 
> 
> ...



Maybe I'm confused here but your not using electricity in vfib arrests due to penetrating trauma?

In my experiencet these are the only traumatic arrests that have any survival rate to discharge, of course other stars have to align also to achieve that.


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## Veneficus (Nov 5, 2010)

CAOX3 said:


> Maybe I'm confused here but your not using electricity in vfib arrests due to penetrating trauma?



I would bet a considerable amount, that shocking vfib in a penetrating arrest where actual blood is not replaced is going to be absolutely useless if not harmful. 

For more detailed information, I like Guyton's medical physiology, Robins and Coltran Pathological basis of disease, ATLS (latest edition I think 8) and the plethora of research that came out of Israel, Iraq and Afghanistan.



CAOX3 said:


> In my experiencet these are the only traumatic arrests that have any survival rate to discharge, of course other stars have to align also to achieve that.



The statistics show penetrating arrest has a much higher suvival rate as well, and I don't dispute this. But if you shock vfib without addressing what caused it, even if you get a rythm back it won't last. 

Once a patient reaches the state of progressive shock, stopping that progression isw what is needed. Until the bleeding is at least slowed, blood replaced (not just volume) external defibrilation is like pissing in the ocean hoping to change the salt content.


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## CAOX3 (Nov 5, 2010)

Veneficus said:


> I would bet a considerable amount, that shocking vfib in a penetrating arrest where actual blood is not replaced is going to be absolutely useless if not harmful.
> 
> For more detailed information, I like Guyton's medical physiology, Robins and Coltran Pathological basis of disease, ATLS (latest edition I think 8) and the plethora of research that came out of Israel, Iraq and Afghanistan.
> 
> ...



I understand now.

Thats what I meant by the stars aligning (cardiac activity on arrival, short transport time to a level one) I wasnt basing my comment on solely a BLS response, just EMS in general.


We have had much more sucess with penetrating vs blunt trauma arrests.  There all dismal but I at least feel we have a slight chance based on our experience in the past.


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## MediMike (Jan 1, 2011)

I'm a fairly large fan of backboarding any arrest patient. A) The straps keep them on the stretcher B )Having a hard firm surface underneath the pt makes CPR just a tad bit more effective than pumping onto a soft mattress. I doubt spinal immobilization was the consideration here. Now if they'd thrown a KED on him...

I also agree with there being a serious pt. care issue with regards to the less critical pt. being taken care of first.  It sounds like a classic Medical Ethics scenario...now I can just imagine the can of worms that would be cracked open with the "Take care of the cop or the bad guy first" question haha


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## Veneficus (Jan 1, 2011)

MediMike said:


> I'm a fairly large fan of backboarding any arrest patient. A) The straps keep them on the stretcher B )Having a hard firm surface underneath the pt makes CPR just a tad bit more effective than pumping onto a soft mattress. I doubt spinal immobilization was the consideration here.



CPR on a patient with multiple open pneumos and massive blood loss?

Sounds like futility to me.


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## MediMike (Jan 1, 2011)

Regardless they need to operate off of their protocols, and from a BLS standpoint I'm guessing they did what was expected of them.


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## b2dragun (Jan 2, 2011)

Aidey said:


> Scene safety?



If the cops are waving them in I would take that as a code 4, I would then go in and treat the pt.


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## reaper (Jan 2, 2011)

b2dragun said:


> If the cops are waving them in I would take that as a code 4, I would then go in and treat the pt.



Always make sure the scene is safe! 

There was an officer shot. Those officers on scene are not thinking of your safety. They are thinking of getting help to their buddy.

I learned this the hard way, when a suspect walked up and shot the pt I was treating, with 10 cops standing around me!

This is your life. Make sure it is safe before entering!


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## b2dragun (Jan 2, 2011)

reaper said:


> Always make sure the scene is safe!
> 
> There was an officer shot. Those officers on scene are not thinking of your safety. They are thinking of getting help to their buddy.
> 
> ...



Valid point...to each his own.  It could also be that the second pt was the shooter and they took care of that.


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## Aidey (Jan 2, 2011)

If you are staging close enough to get "waved in", you are too close to the scene.


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## usafmedic45 (Jan 2, 2011)

Aidey said:


> The cop didn't die, the other guy did.


Excellent.  He got what he deserved. 



> If you are staging close enough to get "waved in", you are too close to the scene.



As one of my military instructor said, "If you're close enough to see them, you're well within range for them to shoot you."  



> It could also be that the second pt was the shooter and they took care of that.



Are you willing to bet your life on "could be"?


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## mycrofft (Jan 2, 2011)

*Working from the OP's account*

Sounds like the usual fluster cluck in a multiple shooting, unlike the sanity experienced in an exercise or sitting at a keyboard. Coulda been worse.
Re "lightning in a bottle", if you have taken care of the critical stuff first or taking steps q-r-s-t won't detract from time and resources from a-b-c, then fine. Tincture of Giddyup is the prime component as/after immediate measures and recording are being done.
Oh, improbable bullet tracks... look for holes or obvious subcutaneous bullets, including flanks, *backs*, scalps. Record, treat and pass it on.
Last guy I saw shot to death had three scalp wounds, one from "straight up" because he was diving for the dirt and got a .38 straight into the top of his cranium; could not find it due to blood everywhere, long scrungy black hair, gorilla mask, watch cap, and darkness. ABC and didimau.


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## usafmedic45 (Jan 2, 2011)

> flanks, backs, scalps



Armpits too....especially when it's a small caliber wound, they can be a real PITA to see even on the autopsy table.


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## Veneficus (Jan 3, 2011)

usafmedic45 said:


> Armpits too....especially when it's a small caliber wound, they can be a real PITA to see even on the autopsy table.



Gluteal folds are another occult space that needs to be inspected.


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## medichopeful (Jan 5, 2011)

dmc2007 said:


> Was this in Middlesex County, MA?



Couldn't have been, as the only shooting in this area recently involved the death of a police officer as well.


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## dmc2007 (Jan 5, 2011)

medichopeful said:


> Couldn't have been, as the only shooting in this area recently involved the death of a police officer as well.



This thread is months old, and was timely to an eerily similar incident in which the Officer involved did, in fact, survive.


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