# I hesitated. And this guy might've lost his life..



## ITBITB13 (Aug 13, 2011)

I was driving home from work. I was about two blocks away, when I see a crowd in the middle of the street. It was a car vs. bicycle. I was 1st on scene. The victim was laying there, in somewhat of a recovery position, in his own blood, and a bunch of other stuff. It was my first time coming across something like that, without the help of a partner, and a fully-stocked rig. I spent about 5 minutes there, by myself. All I did was get some vitals. Not even that, I just took a pulse, since I didn't have any equipment with me. He had agonal respirations, at a rate of about 4. I should have flipped him over, and started CPR right away. But no. I just stayed there by him, not really doing anything, but monitoring his condition. PD and FD showed up with Care, and took over, flipping him over, and starting CPR, which I could've started a good while back. I keep thinking to myself that if he ends up dying, that I will be somewhat responsible.:sad: I think I just failed as an emt.


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## Sasha (Aug 13, 2011)

You arent responsible for his death, whoever hit him is.

Likely he was going to die anyway, traumatic arrests dont have any kind of ok survival rate.

Sent from LuLu using Tapatalk


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## abckidsmom (Aug 13, 2011)

Now you know why there are long debates on here about stopping to help at a scene.  It can really suck.

I might not have done anything, either.  I am loathe to get in other people's blood when I am off the clock.  The most you could/should have done was chest compressions only, and who can say if that would have made a difference?

Blunt traumatic arrest outside of the hospital has such a low survival rate that it's just not worth kicking yourself over, but it's definitely worth remembering this feeling for next time and either having a ricky rescue bag in your car and being ready to use it, or not stopping.


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## daj72 (Aug 13, 2011)

In PHTLS it is said that blunt traumatic arrest in the prehospital environment can´t be resuscitated. And in the case you describe it sounds like the victim was all ready dead and therefore even with CPR you could not save him.

Sometimes we learn things the hard way, so in my eyes, you did not fail as an emt. You got wiser. You have learned more from this one out-duty case, than ten on-duty-cases. Mark my words


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## SanDiegoEmt7 (Aug 13, 2011)

Around these parts... blunt traumatic arrests only get worked if they are within 5 minutes of a trauma center.  There's just not much you can do in the field for these patients.  You weren't the responsible party or ems provider.


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## usalsfyre (Aug 13, 2011)

He died because of the accident. As noted by others blunt traumatic arrest is a DOS situation.


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## 8jimi8 (Aug 13, 2011)

Open thoracotomy and cardiac massage is the indicated treatment for 
A blunt trauma arrest.  

In Texas, off duty responders are limited to BLS.


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## usalsfyre (Aug 13, 2011)

8jimi8 said:


> Open thoracotomy and cardiac massage is the indicated treatment for
> A blunt trauma arrest.
> 
> In Texas, off duty responders are limited to BLS.


If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")


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## dixie_flatline (Aug 13, 2011)

usalsfyre said:


> If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")



:censored: that, I'd be calling for guys with guns if I saw someone wrist deep in anyone.


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## JPINFV (Aug 13, 2011)

usalsfyre said:


> If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")


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## lightsandsirens5 (Aug 13, 2011)

JPINFV said:


>



He can do cardiac massage without splitting a chest open. Lol!

Op. You did more than is expected of an off duty provider. The guy had a rendezvous with his own fate when he climbed out of bed this morning and nothing you could have done would have changed anything. His fate was sealed when that vehicle struck him, not when you didn't start CPR. I would have done nothing more than you did. If I even did stop. 

I know it has been said over and over and over, but my intervention is usually limited to calling 911 and asking if the incident has been reported. If not, I report it. If so, I say thank you and leave it. 


Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.


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## usalsfyre (Aug 13, 2011)

dixie_flatline said:


> :censored: that, I'd be calling for guys with guns if I saw someone wrist deep in anyone.



That's what sh....

Ahhh never mind.


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## firetender (Aug 13, 2011)

Ivan_13 said:


> * crowd in the middle of the street
> * car vs. bicycle
> * 1st on scene
> * victim was laying there, in recovery position


 
what does "somewhat" of a recovery position mean?



Ivan_13 said:


> * in his own blood, and a bunch of other stuff.


 
what is "and a bunch of other stuff"? Gray matter? Intestines?



Ivan_13 said:


> * without the help of a partner, and a fully-stocked rig
> * I spent about 5 minutes there, by myself
> * All I did was get some vitals. Not even that,


 
Here's where it's good to learn how things work on this site. At this point, what I'm hearing is that you really had no idea what was going on, nor did you take the time to do a head-to-toe evaluation. It sounds like you didn't know what you were working with. I suspect that might not be the case, but then again, it could.

The lesson from my point of view would be about the first thing you do once you commit to showing up on a scene to help. Figure out -- as best you can -- what is the immediate condition of the patient. At the very least, that is what you'd communicate to the responding unit.

Yes, the scene was understandably overwhelming at your level of experience, but still, whether the guy lived or not because you did or didn't start CPR is irrelevant (based on what you said) because you didn't appear to know what you were working with.

One point I'm making is we just got through a 90+ post thread where it wasn't until the end that we got the whole story. In the meantime, the poor OP got praised and condemned and though the thread was very interesting, a lot of it was based on faulty info, therefore, lots of false speculation by Monday Morning Quarterbackers.



Ivan_13 said:


> * I just took a pulse
> * He had agonal respirations...a rate of about 4.
> * I should have flipped him over, and started CPR right away. But no. I just stayed there by him, not really doing anything, but monitoring his condition.


 
There's a blank that needs to be filled in here. MY take is that you assessed that the guy was beyond repair; that there was really nothing to do and that was based on your best judgment. That means you would have had to observed and evaluated much more than you reported to us.

(Personally, sometimes the BEST you can do is be with your patient as a human being in his or her last moments.)



Ivan_13 said:


> * PD and FD ... took over, flipping him over, and starting CPR, which I could've started a good while back.


 
I didn't hear the part about them making a head-to-toe evaluation either, which this situation requires. 

No one should automatically begin CPR on a MV vs. bicycle with a patient in agonal respirations, so in that, you weren't amiss, but the piece of the puzzle I need is did you consciously choose to NOT begin resuscitation or, overwhelmed, did you just blank out?

I'm not here to put pressure on you, but I need to make a point or two in general.

1) EMS, whether it be here or in the field is about communication. Often, on this site, firestorms start popping up over Posters not communicating adequately to us and thereby making themselves sound unprofessional, neglectful or unworthy of the job.  

2) This site is good practice to make sure, when it comes to talking about calls, you take the time to get clear on what you're both presenting and asking.




Ivan_13 said:


> * I keep thinking to myself that if he ends up dying, that I will be somewhat responsible.:sad: I think I just failed as an emt.


 
Most respondents were quick to come to your support, given the circumstances. But I see the central question, or maybe lesson, as a little bit different, so...

3) Whether you are on or off-duty, when you commit to a patient the first thing you do is make an adequate evaluation. (According to your post NO ONE did that for the poor guy!) In trauma like that, that's a Head-to-Toe exam unless it's OBVIOUS death is inevitable.

The truth is, you may have botched the call, but only if you didn't have a clue as to why you CHOSE NOT to begin resuscitation. Now that you've had the time to find out the outcome, what REALLY happened?

So it's clear, *sometimes fate throws us situations where we make poor choices that can appear to contribute to our patient's death.* The truth is, death NEVER happens in a vacuum and there are ALWAYS many contributing factors to it, of which we, at the scene, only play a minor part.

We can run from that, or face it and learn from it. The only way you can fail as an EMT in this situation is to not come back to the work -- or HERE for that matter.


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## Sasha (Aug 13, 2011)

Just to get this straight you are suggesting a head to toe over CPR?

Sent from LuLu using Tapatalk


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## firetender (Aug 13, 2011)

Sasha said:


> Just to get this straight you are suggesting a head to toe over CPR?


 
In trauma cases I did not automatically begin CPR in massive head or chest injuries unless I felt there was a reasonable chance for a return of vital signs. Maybe the picture I painted was off. Functionally, I'd begin a head to toe UNTIL I found that there were massive and likely life-ending injuries. The OP didn't let us in to the steps he actually took to decide NOT to begin resuscitation.

The initiation of care is based on an evaluation of the situation is my point.


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## MrBrown (Aug 13, 2011)

Do not worry about it mate, as others have said traumatic cardiac arrests do not go well and they are usually something we decline or cease resuscitation on pretty quick


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## Sasha (Aug 13, 2011)

I think his steps not to begin was the fact that he kind of froze and had a big "durr" moment.

Why would you not start resuscitation? You delay circulation to your patient and allow brain cells to die while you're doing your head to toe. Address the life threats first. Blood not circulating is a huge life threat.

Although, back to the OP I'd like to know what kind of vitals you got if the patient was in arrest.


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## Hunter (Aug 14, 2011)

usalsfyre said:


> If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")


 
:rofl::rofl::rofl::rofl::rofl:


and about the head to Toe vs CPR, You should do a rapid head to toe, and a rapid head to toe should only take 90 seconds at MOST, go ahead start CPR, but don't cover up the massive bleed he has on his back.


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## clibb (Aug 14, 2011)

firetender said:


> In trauma cases I did not automatically begin CPR in massive head or chest injuries unless I felt there was a reasonable chance for a return of vital signs. Maybe the picture I painted was off. Functionally, I'd begin a head to toe UNTIL I found that there were massive and likely life-ending injuries. The OP didn't let us in to the steps he actually took to decide NOT to begin resuscitation.
> 
> The initiation of care is based on an evaluation of the situation is my point.



I check my ABCs before I do a rapid trauma.


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## Hunter (Aug 14, 2011)

clibb said:


> I check my ABCs before I do a rapid trauma.



While you check his respirations and lung sounds he has severe internal bleeding from one of his femoral arteries, The rapid head to toe in an unconscious patient is like getting a chief complaint from a concious patient, since you can't ask them, "where does it hurt?" You gotta check for stuff, your ABCs take you about 3 minutes, head to toe takes you 1 if you're good.


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## usalsfyre (Aug 14, 2011)

ABCs take 3 minute?!? About 5 seconds from across the room via an experienced provider...


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## JPINFV (Aug 14, 2011)

clibb said:


> I check my ABCs before I do a rapid trauma.




That's nice, but when are you going to check the patients?

[I'll be here all night. Try the veal, remember to tip your waitress...]


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## Hunter (Aug 14, 2011)

usalsfyre said:


> ABCs take 3 minute?!? About 5 seconds from across the room via an experienced provider...



Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...


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## Sasha (Aug 14, 2011)

Hunter said:


> Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...


You dont need to count resps, you can.tell if theyre within normal too slow/too fast without going "1...2....3"

If your patient isnt breathing/in resp distress what the heck are you doing listeningto lung sounds and checking a bgl before cpr?

Also you can get an idea of how well thryre perfusing by skin color.

Sent from LuLu using Tapatalk


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## Shishkabob (Aug 14, 2011)

Hunter said:


> Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...



No, but you should generally be able to do the ol' PEPP routine (Sick/Not Sick) and go "Oh sh**, something needs to be done and fast"


I can tell if a patient is having difficulty breathing from across a room, and I don't need to listen to their lungs/ check a pulse ox/ do anything else other than see them.


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## JPINFV (Aug 14, 2011)

Hunter said:


> Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...



Out of all of those, airway and respiration rate are the only ones that are actually a part of checking ABC. Respiration rate, in terms of ABCs really can be characterized on sight by "none, too slow, normal, too fast" with tidal volume being "none, too slow, normal, too fast." Similarly, you should be able to get a good idea of a patient's airway by looking at them (are they gagging, are they breathing, do they have trouble talking?). Circulation is similarly just as simple. How are they acting? What's their skin color like.


ABC = "Is there anything obviously life threatening?" not "Do a full respiratory exam?"


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## usalsfyre (Aug 14, 2011)

Hunter, experienced provider vs new provider. As noted above what you listed is patently unneeded for me to assess ABCs. My 5 second assessment goes something like...

A&B)Is he breathing? Are there any noises coming out? Are the upper airway or lower airway noises? How's his chest excursion. Is he sitting up in tripod position? Is he using accessory muscles? Is he breathing fast or slow?

C)Is he pink warm and dry or pale,cool and diaphoretic? (just as an aside, this tells me a hell of a lot more about perfusion status than an isolated BP, your instructors opinions not withstanding). Does he have a pulse? Is it too fast or too slow? Regular or irregular? Narrow or wide? Dies he have that peri/immediately post-arrest duskiness? Do I see mass amounts of blood pouring out, or that may have just finished pouring out?

We can even throw in D)Is he conscious? Did he turn and look at me when I walked in? Is he ambulatory, if so do I see ataxia? Sitting? Is he leaning to one side? If he speaks back to me is it clear? Are any limbs missing or bending the wrong way? Does he move both sides?

Except for taking a pulse, feeling skin temp I can do all this from the door. I assure you I am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.


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## usafmedic45 (Aug 14, 2011)

Ivan_13 said:


> I was driving home from work. I was about two blocks away, when I see a crowd in the middle of the street. It was a car vs. bicycle. I was 1st on scene. The victim was laying there, in somewhat of a recovery position, in his own blood, and a bunch of other stuff. It was my first time coming across something like that, without the help of a partner, and a fully-stocked rig. I spent about 5 minutes there, by myself. All I did was get some vitals. Not even that, I just took a pulse, since I didn't have any equipment with me. He had agonal respirations, at a rate of about 4. I should have flipped him over, and started CPR right away. But no. I just stayed there by him, not really doing anything, but monitoring his condition. PD and FD showed up with Care, and took over, flipping him over, and starting CPR, which I could've started a good while back. I keep thinking to myself that if he ends up dying, that I will be somewhat responsible.:sad: I think I just failed as an emt.



Nah.  He was on his way out regardless of whether you did anything or not.  If he needed CPR, then he was dead.  Blunt trauma arrest = death.


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## abckidsmom (Aug 14, 2011)

usalsfyre said:


> i assure you i am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.



+1000


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## usafmedic45 (Aug 14, 2011)

> I assure you I am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.



+1000 again.


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## clibb (Aug 15, 2011)

Hunter said:


> While you check his respirations and lung sounds he has severe internal bleeding from one of his femoral arteries, The rapid head to toe in an unconscious patient is like getting a chief complaint from a concious patient, since you can't ask them, "where does it hurt?" You gotta check for stuff, your ABCs take you about 3 minutes, head to toe takes you 1 if you're good.



Really? If he doesn't have a pulse and is not breathing, your rapid trauma doesn't really matter. It's CPR you'll be doing anyways depending on your protocols and extent of injuries. 
Here's a question for you Hunter, how long are you supposed to spend on scene of a trauma patient? At the most 3 minutes. Extrication and other delays are considered.
After that, go ahead and do a rapid trauma if patient's airway is patent and you got a pulse while you instruct someone else to hold c-spine.


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## Melclin (Aug 15, 2011)

8jimi8 said:


> Open thoracotomy and cardiac massage is the indicated treatment for
> A blunt trauma arrest.



And in all likelihood, won't help anyway. The body wants to perfuse. When an gross traumatic injury is such as to immediately and continually force it not too, in _most _ cases there is little we can do about it. I say decompress if you find a PEA of reasonable rate, with reasonable downtime, with no obvious injuries incompatible with life, otherwise, call it. 



usalsfyre said:


> If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")



I think I'd be calling for a copper. That'd scare the :censored::censored::censored::censored: out of me.



usalsfyre said:


> Hunter, experienced provider vs new provider. As noted above what you listed is patently unneeded for me to assess ABCs. My 5 second assessment goes something like...
> 
> A&B)Is he breathing? Are there any noises coming out? Are the upper airway or lower airway noises? How's his chest excursion. Is he sitting up in tripod position? Is he using accessory muscles? Is he breathing fast or slow?
> 
> ...



This. ^^^.


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## usafmedic45 (Aug 15, 2011)

> Open thoracotomy and cardiac massage is the indicated treatment for
> A blunt trauma arrest.



E-mail Ken Mattox and ask him what he thinks about that.


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## jjesusfreak01 (Aug 15, 2011)

usalsfyre said:


> If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")



Our medics have the MDs cell number.


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## Hunter (Aug 15, 2011)

usalsfyre said:


> Hunter, experienced provider vs new provider. As noted above what you listed is patently unneeded for me to assess ABCs. My 5 second assessment goes something like...
> 
> A&B)Is he breathing? Are there any noises coming out? Are the upper airway or lower airway noises? How's his chest excursion. Is he sitting up in tripod position? Is he using accessory muscles? Is he breathing fast or slow?
> 
> ...



When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.


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## Shishkabob (Aug 15, 2011)

Hunter said:


> When you say ABC's I think of assessing everything I listed in my earlier post.



What you listed earlier was an assessment.  ABC are simple "Can they breath, are they breathing, and is the heart pumping?"


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## Handsome Robb (Aug 15, 2011)

Hunter said:


> CPR on a hemorrhaging patient isn't gonna do a thing.



Stopping the bleeding on a pt who isn't circulating blood isn't going to do a thing either...


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## Hunter (Aug 15, 2011)

NVRob said:


> Stopping the bleeding on a pt who isn't circulating blood isn't going to do a thing either...



Agreed, so let me correct your quoting



Hunter said:


> *...I understand that beginning CPR is something that's important.* But taken from the scenario that the OP posted since the patient was laying in a *pool of his own blood *and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR.* Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing*. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.



*"Idealy in real life you would wanna do both at the same time if possible"

*Think this part that you left out is sort of saying what you said?


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## usalsfyre (Aug 15, 2011)

Hunter said:


> When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.



If they've exsanguinated to the point of cardiac arrest and you don't have blood handy, you might as well let them lay. They're not coming back.


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## Hunter (Aug 15, 2011)

usalsfyre said:


> If they've exsanguinated to the point of cardiac arrest and you don't have blood handy, you might as well let them lay. They're not coming back.



As low of a chance as they have of coming back from that cardiac arrest, we're supposed to try no?


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## usalsfyre (Aug 15, 2011)

Hunter said:


> As low of a chance as they have of coming back from that cardiac arrest, we're supposed to try no?



Nope. Futile, expensive and dangerous care is just that. Futile, expensive and dangerous. EMS has got to get away from the "try to save everyone" mentality.


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## MrBrown (Aug 15, 2011)

Hunter said:


> As low of a chance as they have of coming back from that cardiac arrest, we're supposed to try no?



No, you said it mate, it is clinically futile and inappropriate to commence resuscitation on these people

The same can be said for somebody who is an unwitnessed arrest with asystole as initial rhythm or housebound dying from end stage cancer etc


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## Lady_EMT (Aug 15, 2011)

</lurking>



usalsfyre said:


> Nope. Futile, expensive and dangerous care is just that. Futile, expensive and dangerous. EMS has got to get away from the "try to save everyone" mentality.




Unfortunately, due to many protocols around the country (my area included), CPR is to be started on EVERY patient, unless there are injuries incompatable with life, or lividity/rigor have set in. So if I have a pt such as the one in the OP, I am to start CPR, or else my toosh will be on a silver plater. Unless, of course, but "stuff," it meant brain matter (but that's covered under 'signs incompatible with life'). 

To the OP, I have a few kind words of advice.

1) On this forum, and in real life in general, remember to be very specific. People in real life and on this forum will chew you up and spit you out if you aren't to-the-dot specific. (Trust me, I know  ) That isn't necessarily a bad thing, but if you want true and honest advice and support for these calls, you need to list everything just the way it is, as long as it doesn't violate HIPPA.

2) Unless you have a jump bag in your POV, don't stop. There's nothing you can do, except call 911. Especially since you didn't have anything, I would assume that would mean you didn't have gloves, and for a trauma, no gloves is a big No-No. 

3) You had a blank moment. I'm going to pass on some advice to you that was given to me. This moment doesn't define you as an EMT. Many people in EMS will have a moment that makes them stop in their tracks. I agree with other people in that you didn't seem to do a proper size-up, and seemed to disregard scene-safety. But you jumped into a situation where you didn't have a partner by your side to help shake you from your freeze. Don't let this call define your career. And if you continue to have moments like this when you freeze up and can't function on your own, perhaps then you should reconsider another field. 

If you ever want to talk one-on-one with anyone, there are plenty of open and welcome PM boxes, mine included. Don't lose sleep over this one. It happens.


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## Sasha (Aug 15, 2011)

Hunter said:


> When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.



Bleeding control on a brain dead patient is equally futile.

Sent from LuLu using Tapatalk


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## McGoo (Aug 15, 2011)

Lady_EMT said:


> Unfortunately, due to many protocols around the country (my area included), CPR is to be started on EVERY patient, unless there are injuries incompatable with life, or lividity/rigor have set in.



I would class major blunt trauma combined with either PEA or asystole as incompatible with life. I wouldnt be surprised to find crepitus in the neck when moving the head to gain an airway either, which would make me think they have even less chance of living.


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## usalsfyre (Aug 15, 2011)

Evidence of exsanguination would be another injury incompatible with life.


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## Hunter (Aug 16, 2011)

Sasha said:


> Bleeding control on a brain dead patient is equally futile.
> 
> Sent from LuLu using Tapatalk


 
*"Idealy in real life you would wanna do both at the same time if possible"*


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## Sasha (Aug 16, 2011)

Ideally in real life, CPR comes first.


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## jjesusfreak01 (Aug 16, 2011)

usalsfyre said:


> Evidence of exsanguination would be another injury incompatible with life.



Usually. I've heard stories of esophageal variceal ruptures that looked like a horror scene with what was obviously multiple liters of blood around the patient. The medics were ready to call a DOA only to find the patient still had a pulse.


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## usalsfyre (Aug 16, 2011)

jjesusfreak01 said:


> Usually. I've heard stories of esophageal variceal ruptures that looked like a horror scene with what was obviously multiple liters of blood around the patient. The medics were ready to call a DOA only to find the patient still had a pulse.



Yep, key being "had a pulse". In a CPR situation it's not worth working.

Agree though that a varaciel rupture will make you redefine "exsangunating hemorrhage".


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## JonTullos (Aug 17, 2011)

In the region where I did my clinical time, most traumatic cardiac arrest is not worked. Mainly that has to do with the fact that there's only about a 0.01% chance of a ROSC. Even if you get ROSC, it may not last, not to mention the quality of life concerns. Don't worry about it. Chances are the patient was dead and just didn't know it yet.


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## usafmedic45 (Aug 17, 2011)

> Mainly that has to do with the fact that there's only about a 0.01% chance of a ROSC. Even if you get ROSC, it may not last, not to mention the quality of life concerns.



The ROSC rate is often about 1-2% actually and as for quality of life, I have two words for you:  ORGAN DONOR.


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## nmasi (Aug 23, 2011)

I find it extremely disturbing that nobody has brought up the fact that the OP obviously ignored the fact that there was the distinct posibility that the patient was in the transition to zombification and was in direct threat to his safety.


That and if the police, fire and ems crews werent there to respond, then the scene was most definately not safe for a sole bls provider to be on scene immediately following an accident.  He/she did not know the circumstances surrounding the incident.  Was the patient deliberately hit in an attemted retaliation for drug violations, did they just finish robbing a bank and are attemtpting to escape?  

Probably not a good idea to jump out and play Bobby Hero.  Stay in your car and observe so as to give a good report if needed as a witness.  Like most have said, blunt trauma arrest is a no bueno situation.


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## jjesusfreak01 (Aug 23, 2011)

nmasi said:


> I find it extremely disturbing that nobody has brought up the fact that the OP obviously ignored the fact that there was the distinct posibility that the patient was in the transition to zombification and was in direct threat to his safety.



Man, I always forget about this because my textbook didn't cover it in the well-being chapter.


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## dewey (Aug 24, 2011)

nmasi said:


> I find it extremely disturbing that nobody has brought up the fact that the OP obviously ignored the fact that there was the distinct posibility that the patient was in the transition to zombification and was in direct threat to his safety.


___________________

Just started as a basic, and don't have a clue what this means.  Little help please?  Are you saying the scene itself was unsafe(in which case I understand), or are you saying that the PT him/herself could become dangerous due to a lack of BSI?


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## Shishkabob (Aug 24, 2011)

It was a joke.

Hence "zombie"


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## dewey (Aug 24, 2011)

Yeah I'm a moron.  Thanks tho


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## BlakeFabian (Oct 16, 2011)

You did nothing wrong. Yes, you could of done CPR but in all reality it probably wouldnt of helped. If the guy died; It was from the accident, not from you.

In our service, a traumatic arrest resuscitation like that wouldnt even be initated. Our protocols says to give them a body bag & wait for morque personell to show. The survival rate of traumatic arrest is ungodly low.


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## EMT424 (Oct 16, 2011)

Ivan, 
 At a scene where apparently no one was helping this guy, you stepped up That is commendable. He sounds as though the outcome was pretty certain. If this helps you to be more aggressive next time then it is for the good. You shouldn't use it as an excuse to beat up on yourself, the fact is that we cannot save everyone. We can do our best, but the Decider is elsewhere.

Went to a similar situation with an MVA. We got the kid restarted 3 times and he lasted long enough at the hospital for the family to say goodbye. It suck still. 

You stepped up and tried and maybe gave the kid some sense of care and comfort as he left this world. That is worth something.


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## mspazz (Oct 19, 2011)

Hunter said:


> When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.



I think you have "Focused Assessment" and "Rapid Assessment" confused here bud.  ABC=Airway Breathing Circulation.  In no way shape or form does "listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP" fall into that category.   Those are a Focused Assessment.  Rapid assessments are used for finding life threatening injuries and treating them ASAP.


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## Melclin (Oct 19, 2011)

nmasi said:


> I find it extremely disturbing that nobody has brought up the fact that the OP obviously ignored the fact that there was the distinct posibility that the patient was in the transition to zombification and was in direct threat to his safety.



We have had recent guidelines introduced due to the threat of zombie apocalypse. We now have pick axes in the drug bag in between the morphine and glucose paste. 

We wanted shot guns but the peer reviewed evidence suggested that there was an unacceptable chance of under kill as well as a very real chance of not looking cool while you wasted the mother f**ker. So our medical committee didn't approve it.


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## dudemanguy (Oct 19, 2011)

I have what may be a stupid question here, but youll have to excuse me as I just volunteer as a first responder and have only worked one cardiac arrest. 

Is there any time when you see agonal respirations that you wouldnt automatically begin Compressions? What if the patient had a pulse(the OP didnt state what he got when he checked for a pulse), would you still automatically flip the patient over and begin compressions due to the respirations?

Is it the case that the totally inadequate respirations automatically mean the heart is not pumping good enough and compressions are therefore warranted regardless of whether a pulse is felt? I mean with no equipment its not like you could do anything to assist with respirations unless youre gonna do mouth to mouth, right?


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## Handsome Robb (Oct 19, 2011)

No. If they have a pulse they don't get CPR. Unless its a lil' guy and the pulse is less than 60. 

If they are hypoxic chest compressions aren't going to help fix it, assisted respirations and O2 are. The heart is a muscle, it needs oxygen and glucose to function just like every other part of your body.


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## dudemanguy (Oct 19, 2011)

Thanks NVrob, Whether or not I did compressions would have depended on whether or not I felt a pulse, agonal respirations or not. I was worried maybe CPR guidelines have changed or maybe people with more field experience knew something I didnt.


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## Handsome Robb (Oct 19, 2011)

Biggest change in CPR is CAB instead of ABC, also no look listen feel. 

Your welcome.


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## Underoath87 (Oct 19, 2011)

BlakeFabian said:


> You did nothing wrong. Yes, you could *of* done CPR but in all reality it probably wouldnt *of* helped. If the guy died; It was from the accident, not from you.
> 
> In our service, a traumatic arrest resuscitation like that wouldnt even be initated. Our protocols says to give them a body bag & wait for morque personell to show. The survival rate of traumatic arrest is ungodly low.



Quick grammar lesson if you don't mind:
the word you're looking for is "have", not "of".  It only sounds like "of" when spoken because we're using a contraction to form "could've" instead of "could have".


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## mycrofft (Oct 19, 2011)

*I had one like that once.*

Motor cycle rider versus guy wire holding up a utility pole.
The second they turned him over his airway shut and he clinically died. He was dead when he hit that cable, but his side-lying position let the blood CSF and oral secretions flow to the dirt. This is what crash investigators call a "non-recoverable situation".

Tore the cable off it's anchor, he did.


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## BrushBunny91 (Oct 22, 2011)

NVRob said:


> No. If they have a pulse they don't get CPR. Unless its a lil' guy and the pulse is less than 60.
> 
> If they are hypoxic chest compressions aren't going to help fix it, assisted respirations and O2 are. The heart is a muscle, it needs oxygen and glucose to function just like every other part of your body.



Can someone explain why a child or infant might receive CPR in a pulse less than 60? My understanding is assisted ventilations bvm with supplemental oxygen and rapid transport would be within my protocols. At least until they reach respiratory arrest and then we would start compressions.


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## JPINFV (Oct 22, 2011)

NVRob said:


> If they are hypoxic chest compressions aren't going to help fix it, assisted respirations and O2 are.


Not according to the good Dr. Conrad Murray. 




> The heart is a muscle, it needs oxygen and *glucose *to function just like every other part of your body.



Actually a healthy heart prefers fatty acids over carbohydrates. There's also the creatine kinase shuttle that helps supply energy substrates to cardiac tissue.


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## Handsome Robb (Oct 22, 2011)

JP you cheat, your in med school!

Brushbunny, why would respiratory arrest warrant chest compressions?


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## mycrofft (Oct 22, 2011)

*ARC says compress the chest in resp arrest*

In collapsed adults, most resp arrest, other than obvious airway embarrassment, is either caused by or rapidly leads to cardiac "arrest" (insensible and ineffective circulation).
Not to say that airway clearance should not be attempted if they are still conscious and indicate they are choking, or ventilations done for people promptly pulled from a pool.
Next iteration we will go back to the 1950's chest compression/arm lift for resuscitation.:glare:


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## BrushBunny91 (Oct 22, 2011)

Sorry guys I meant cardiac arrest


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## dudemanguy (Oct 22, 2011)

BrushBunny91


> Can someone explain why a child or infant might receive CPR in a pulse less than 60? My understanding is assisted ventilations bvm with supplemental oxygen and rapid transport would be within my protocols. At least until they reach respiratory arrest and then we would start compressions.



A normal Pulse rate for an infant would be around 120 or therebouts, depending on how old they are. The logic is that if its less than 60 AND there are obvious signs of inadequate perfusion despite adequate ventilations, then compressions would be warranted. This is per the AHA, If your protocols differ then follow your protocols.


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## Yarbo (Oct 22, 2011)

There was a situation similiar to that around here in Canada somewhere. Crew found an infant with a pulse although slow, didn't start CPR and the infant died. All the details I know..


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## CritiqueMyCalls (Nov 6, 2011)

Jumping in here from page six, I can easily see myself running this "call". I run up on scene, and stare at the patient numbly until EMS and PD arrive. As soon as they take control of the scene, I facepalm and wonder why I just stood there cluelessly.

There's a lot of up-in-the air things about the scene, but at least being able to describe what injuries the patient had would be good. At best, I would have considered starting CPR. I wouldn't have considered a trauma assessment, even if the PT was sitting up talking with me.

Take away? If you have no idea what to do, at least figure out what you can tell to the people that do. If that involves touching the patient, that's ok.


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## BrushBunny91 (Nov 6, 2011)

CritiqueMyCalls said:


> Jumping in here from page six, I can easily see myself running this "call". I run up on scene, and stare at the patient numbly until EMS and PD arrive. As soon as they take control of the scene, I facepalm and wonder why I just stood there cluelessly.
> 
> There's a lot of up-in-the air things about the scene, but at least being able to describe what injuries the patient had would be good. At best, I would have considered starting CPR. I wouldn't have considered a trauma assessment, even if the PT was sitting up talking with me.
> 
> Take away? If you have no idea what to do, at least figure out what you can tell to the people that do. If that involves touching the patient, that's ok.



Necromancer*!*


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## paradoqs (Nov 12, 2011)

Where I am from, cpr comes before head to toe, vitals after (aside from abc vitals). And emt's always work arrests unless there is a medic there to pronounce or there are injuries incompatible with life. And blood and "stuff" on the ground is not one, unless that stuff is brain matter.


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## mrswicknick (Nov 21, 2011)

Some of the comments here bother me. First, it is your legal duty to act when you witness an emergency. Not only that, but if you're not going to try and help someone when you have the proper skills to do so, why are you in this field. Even if the chance is so low for survival on that pt, anything and everything should be done to help so long as the scene is safe and you're pt is decapitated. I am not talking specifically about this case, but in general. What if the pt has a life threat that you could change or at least help until better care arrives and you just sit in your car or worse drive away?

Also, just because a pt is a blunt trauma arrest you're not going to even attempt to work him? Medics may have their reasoning, so this isn't directed towards them, but rather basics. I was first on scene, off duty, from a 3 story fall. Agonal resps, no pulse, but I started working him anyways. Medics arrived, did their job and the pt lives to this day to tell his story. It may be that I am new and haven't been on the job enough to lose hope, but even if 99% don't survive, how do you know that your pt isn't the 1% that does? 

To the OP, the best thing I can say is my old instructors motto. "We didn't create the problem, we're just here to help."  Like many have said, its a learning experience so that next time you will know what to do. 180 hours is not enough to give us any sort of muscle memory, and nowhere near enough to teach you how to stay calm and focused in what seems to be one of your first true emergencies. As someone else stated earlier, 1 call in real life is equal to 10 in class. Don't beat yourself up, you at least tried and that is all that matters.

I know I am new to this forum, and with only a little under 200 calls under my belt new as a basic as well. This is strictly my opinion and not a personal attack on anyone. I wrote this strictly so others can see a different light on the situation, and maybe to inspire those who said they wouldn't respond to think for another second the next time they're caught in a similar situation. I would hope that if I was hit by a motorcycle and had even the slightest chance for survival that one of you would work me through the ground as I would do the same for any of you.


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## Tigger (Nov 21, 2011)

mrswicknick said:


> Some of the comments here bother me. First, it is your legal duty to act when you witness an emergency. Not only that, but if you're not going to try and help someone when you have the proper skills to do so, why are you in this field. Even if the chance is so low for survival on that pt, anything and everything should be done to help so long as the scene is safe and you're pt is decapitated. I am not talking specifically about this case, but in general. What if the pt has a life threat that you could change or at least help until better care arrives and you just sit in your car or worse drive away?



It is *not* my legal duty to act when I witness an emergency if I am off-duty. In fact, such laws are exceedingly rare in the United States, though I cannot find the specific statue for Washington state. Suffice to say it is certainly not the norm, and I am not legally required to render aid in either state that I live in. 

I am in this field because I am interested in medicine and do in fact enjoy helping others. That doesn't mean I have to help everyone that I come across though. Sure I have the skills and knowledge (maybe), but if I injure myself or get myself sued, I'm not going to be able to work and that's going to affect my own personal wellbeing. Gotta look out for numero uno. And before you ask, I have stopped to help when off-duty, and will continue to do so when I feel that I will be able to make a difference while not placing myself in undue danger.



> Also, just because a pt is a blunt trauma arrest you're not going to even attempt to work him? Medics may have their reasoning, so this isn't directed towards them, but rather basics. I was first on scene, off duty, from a 3 story fall. Agonal resps, no pulse, but I started working him anyways. Medics arrived, did their job and the pt lives to this day to tell his story. It may be that I am new and haven't been on the job enough to lose hope, but even if 99% don't survive, how do you know that your pt isn't the 1% that does?



Congrats, you got a save. Seriously, that's awesome that you helped save a life. But at the same time can you honestly tell me that guy is alive because you stopped to help? I don't think so...

Also, if a medic is not going to start resuscitation efforts, there is no reason to for a basic to start them either. Sorry but I don't understand that reasoning at all. I know what a traumatic arrest looks like too.


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## mrswicknick (Nov 21, 2011)

Tigger said:


> It is *not* my legal duty to act when I witness an emergency if I am off-duty. In fact, such laws are exceedingly rare in the United States, though I cannot find the specific statue for Washington state. Suffice to say it is certainly not the norm, and I am not legally required to render aid in either state that I live in.
> 
> Congrats, you got a save. Seriously, that's awesome that you helped save a life. But at the same time can you honestly tell me that guy is alive because you stopped to help? I don't think so...



First, as far as how I was taught, it is always your legal duty to act, both on and off duty. If you have any sources that say otherwise then I retract that statement. Also, read "as long as the scene is safe." I am not suggesting anyone should go into any scene where you could be injured. And as long as you stay within your protocols and act appropriately to the situation, you're not going to lose your job.

Second, it took between 7-10 min before EMS arrived on scene on that call. If CPR hadn't been initiated immediately as it was, he would be dead. Given I actually witnessed the fall so in other cases where you have no idea how long its been, I could see your point and I should have clarified further.

Third, at least under my protocols, we will work anyone that isn't showing obvious signs of death. Again, what hurt is it to work someone at least until ALS tells you to stop? What if they are that 1%? If they aren't, its not like they're not going to get any dead-er. We as basics don't have the knowledge to rule out anything but obvious death, and even if you do, you cant unless you really want to get sued.


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## Tigger (Nov 21, 2011)

mrswicknick said:


> First, as far as how I was taught, it is always your legal duty to act, both on and off duty. If you have any sources that say otherwise then I retract that statement.



Well, we have a 16 page sticky devoted to said topic. http://www.emtlife.com/showthread.php?t=5825

Such laws are regulated at the state level, so not everyone is obligated to act when off-duty. I know for a fact that there is no law in Mass  that mandates I act when off-duty. I can't cite that since it's not written into the MA General Laws. Unless there is a law that specifically states off duty EMS providers are required to render aid, you are not legally obligated to assist.



> Second, it took between 7-10 min before EMS arrived on scene on that call. If CPR hadn't been initiated immediately as it was, he would be dead. Given I actually witnessed the fall so in other cases where you have no idea how long its been, I could see your point and I should have clarified further.



You are likely right about this, though I am sure you are aware that people can survive cardiac arrest despite being down for 7-10 minutes. That time-frame lessens the chance of survival, it doesn't eliminate it. I only add this since you mentioned working to save the 1% earlier, if you knew someone was down for that long, would you work them then even though by your admission they will likely die?


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## mrswicknick (Nov 21, 2011)

Tigger said:


> Well, we have a 16 page sticky devoted to said topic. http://www.emtlife.com/showthread.php?t=5825
> 
> Such laws are regulated at the state level, so not everyone is obligated to act when off-duty. I know for a fact that there is no law in Mass  that mandates I act when off-duty. I can't cite that since it's not written into the MA General Laws. Unless there is a law that specifically states off duty EMS providers are required to render aid, you are not legally obligated to assist.
> 
> ...



Thanks for the thread, I retract what I said. 

As to your question, absolutely. Both due to my protocols and due to my personal feelings. They're not going to get any dead-er anyways.


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## usalsfyre (Nov 21, 2011)

mrswicknick said:


> Second, it took between 7-10 min before EMS arrived on scene on that call. If CPR hadn't been initiated immediately as it was, he would be dead. Given I actually witnessed the fall so in other cases where you have no idea how long its been, I could see your point and I should have clarified further.


Your patient survived out of sheer luck. Rogue Medic had an excellent post on CPR and trauma. http://roguemedic.com/2011/11/why-doesnt-cpr-work-for-trauma/



mrswicknick said:


> Third, at least under my protocols, we will work anyone that isn't showing obvious signs of death. Again, what hurt is it to work someone at least until ALS tells you to stop? What if they are that 1%? If they aren't, its not like they're not going to get any dead-er. We as basics don't have the knowledge to rule out anything but obvious death, and even if you do, you cant unless you really want to get sued.


Blunt traumatic arrest pretty much an obvious sign of death. Treating the 1% (actually it's more like the 0.01%) just because "they might make it" is poor medicine, as is letting your emotions influence this decision making process (hard I know, but emotion can't override good judgement here).


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## emtwacker710 (Nov 21, 2011)

In my own opinion, I don't stop when I'm not working (Unless its in my vol. fire district in which case we do 1st response anyways) but depending on whta your state laws are, you may or may not have a duty to act when your off duty. Just to cover my own *** I will not stop on the scene of something out of my district off duty, and my vehicle is unmarked as well. Just something to think about, check with your states duty to act law...


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## mrswicknick (Nov 21, 2011)

Damn, well I stand corrected. Thanks for the article usal.


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## Roheline (Nov 21, 2011)

Even if you don't feel morally/emotionally obligated, here's another reason to stop and help:

http://www.huffingtonpost.com/2009/12/25/eutisha-rennix-death-jaso_n_403440.html
http://www.nypost.com/p/news/local/brooklyn/mike_rips_emts_in_preg_mom_death_5d0UDQYANcSrLDN4ZnqitI

Or if you don't plan on stopping, at least make sure that you're not wearing anything that could identify you as a first responder.


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## Handsome Robb (Nov 21, 2011)

Roheline said:


> Even if you don't feel morally/emotionally obligated, here's another reason to stop and help:
> 
> http://www.huffingtonpost.com/2009/12/25/eutisha-rennix-death-jaso_n_403440.html
> http://www.nypost.com/p/news/local/brooklyn/mike_rips_emts_in_preg_mom_death_5d0UDQYANcSrLDN4ZnqitI
> ...



First link has nothing to do with this, they were on break, but still on duty therefore they have a duty to act. Second link yes, they probably should have acted but who are we to monday morning quarterback? 

1st link the crew blew it, second link impounds the point to not wear your uni or identify yourself as a trained individual while off duty. In their defense, have you ever tried to ventilate a patient who was seizing? Good luck. They told them to call 911 which was what the patient needed. I don't condone their actions but how many people would have called them incompetent and 'idiots' if they would have kicked into work mode and she still died? Lose-lose situation.

What's your point?


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## usalsfyre (Nov 22, 2011)

Roheline said:


> Even if you don't feel morally/emotionally obligated, here's another reason to stop and help:
> 
> http://www.huffingtonpost.com/2009/12/25/eutisha-rennix-death-jaso_n_403440.html
> http://www.nypost.com/p/news/local/brooklyn/mike_rips_emts_in_preg_mom_death_5d0UDQYANcSrLDN4ZnqitI
> ...



Right, because being on a coffee break in uniform is TOTALLY the same as driving by an accident on your POV off duty .


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## Roheline (Nov 22, 2011)

NVRob said:


> In their defense, have you ever tried to ventilate a patient who was seizing? Good luck. They told them to call 911 which was what the patient needed. I don't condone their actions but how many people would have called them incompetent and 'idiots' if they would have kicked into work mode and she still died? Lose-lose situation.
> 
> What's your point?



This is my point. I'm not trying to condone or condemn their actions with my post, just presenting the scenario. The reality is that the public usually doesn't care whether or not they (or any of us) _actually_ could have made a difference in terms of the patient's survival. I don't know how things might have gone differently if these two had jumped into action (and perhaps there really was nothing they could have done that would have altered the outcome), but I would bet that the public outcry would be much less if they had at least _tried_ to do something. It's much easier for grieving family members to accept "we did all we could with the tools we had on hand but she still died" than "it was hopeless so why bother."


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## Roheline (Nov 22, 2011)

usalsfyre said:


> Right, because being on a coffee break in uniform is TOTALLY the same as driving by an accident on your POV off duty .




No, it's not the same. But it _is_ relevant to the discussion that's been going on as to whether or not to start CPR. I'm not trying to attack anyone with my post, just presenting another scenario for discussion. Never mind.


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## Handsome Robb (Nov 22, 2011)

Roheline said:


> No, it's not the same. But it _is_ relevant to the discussion that's been going on as to whether or not to start CPR. I'm not trying to attack anyone with my post, just presenting another scenario for discussion. Never mind.



Don't take his post offensively. It's just the fact that this topic has been beaten to death fifteen times over. 

I agree with you. In a perfect society them trying to help would be viewed as a good thing, however in reality if the patient died despite their actions those two dispatchers would have been burned at the stake. :censored::censored::censored::censored:ty society we live in when it comes to things like this. Hollywood has built expectations that are not achievable but the general public doesn't understand that.


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## usalsfyre (Nov 22, 2011)

Roheline said:


> No, it's not the same. But it _is_ relevant to the discussion that's been going on as to whether or not to start CPR. I'm not trying to attack anyone with my post, just presenting another scenario for discussion. Never mind.



I see your point, and apologize. I guess I'm just appalled at this point by the extremism on this topic. Use some common sense. If your in uniform after a shift and someone falls out in line, it's probably a good idea to check on them. The flip side is don't tell me I need to stop in the middle of IH635 on my day off at a minor fender bender due to some deranged idea about "moral duty". 

Practice a little judgment.


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## mrswicknick (Nov 22, 2011)

usalsfyre said:


> I see your point, and apologize. I guess I'm just appalled at this point by the extremism on this topic. Use some common sense. If your in uniform after a shift and someone falls out in line, it's probably a good idea to check on them. The flip side is don't tell me I need to stop in the middle of IH635 on my day off at a minor fender bender due to some deranged idea about "moral duty".
> 
> Practice a little judgment.



In his defense, I don't think anyone was suggesting this. I would hope we're all smart and mature enough to practice common sense and use good judgment.


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## usalsfyre (Nov 22, 2011)

Actually earlier in the thread folks were talking about our "code of ethics" basicly requiring us to intervene in any situation where there might be an injury. 

Pretty wackerish stuff...


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## Handsome Robb (Nov 22, 2011)

mrswicknick said:


> In his defense, I don't think anyone was suggesting this. I would hope we're all smart and mature enough to practice common sense and use good judgment.



I think usals' post stemmed from previous posts in this thread. I see what your saying though. 

Crap, after all these post siding with usals people are gonna call me a fanboy! h34r: haha


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## usalsfyre (Nov 22, 2011)

My first groupie!

I do wish you weren't, well, male though .


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## Handsome Robb (Nov 22, 2011)

usalsfyre said:


> My first groupie!
> 
> I do wish you weren't, well, male though .



You have plenty of groupies. They are just not out in the open!

Hey I'll take groupie status seeing as I learn a ton from you. I'll start looking for a girl to takeover the other side of groupie status


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## icefog (Nov 25, 2011)

Hmmm, the first thread I click on after the registration turned out to be a tiny gold mine, it's definitely interesting to see all the different opinions... and that's why this isn't really an answer to the OP exclusively, but rather trying to give my response on several points of view surfacing here - what to do first, how long a rapid assessment actually takes, what it involves, specifically, whether to stop at all, etc.

First of all, mrswicknick beat me to one of the points I wanted to make. Regardless of whether or not it's your legal duty to stop and assist a victim, I would always stop. I always treat patients as I want others to treat me or a loved one, and I can't imagine who, when given the option, would prefer to wait for an ambulance and be ignored by a passing EMT. Before someone hits the big red "unprofessional subjectivity" button: no, I'm not talking about involving yourself emotionally and doing CPR with tears in your eyes until you make a dent in the floor - I'm just talking about stopping or moving along. But anyway, everyone makes their own choice in this. 

To the OP: I think it's great that you stopped, regardless of how you rate your subsequent actions. If you're in the same situation again, I hope you'll still stop. Medical assistance wasn't developed based on a prerequisite of equipment and pills - actually, it was the other way around. Even the smallest things like a (space) blanket could help sometimes. And even if you have nothing, there's still quite a lot you can do with your own hands and head. Improvise, communicate, control - you can do CPR, control the bleeding, monitor vitals and/or call dispatch and give them further info (I'm always happy to hear a colleague is already on scene and giving me a bit of a heads up on the way).

As far as the rapid assessment is concerned, you can get a general impression in a maximum of 10-15 seconds (this includes evaluating surroundings, other people present, number of victims, possible dangers, patient responsiveness, obvious injuries, etc). OP: It's important to be very aware of all details around you, but everyone's already said that, and maybe that's something specific to focus on. Significant visible bleedings are important here, as well as injuries that are incompatible with life. In your situation, from what I understand, survival would have been quite a miracle, and CPR would have probably brought nothing at all. But it always depends on the situation - assess and make your own call.

As far as the actual rapid/primary assessment goes, I know it can vary according to local protocols. I work in Germany, and what we do is this:  check breathing capability and quality, estimate - not determine, just estimate - respiratory rate, as well as the pulse rate and quality in addition to the recapillarization time; briefly examine the thorax, abdominal, pelvic and femoral regions. That's it for starters. Even for one off-duty responder, with experience, it all takes 30 seconds or less and no equipment, unless you encounter special difficulties. So, within 60 seconds (tops) after actually starting the patient evaluation, even with throwing in some "D" stuff like checking the pupils and GCS, you get a good image of what's going on and can make the first choices and take the first actions.

In any case, OP, here's what you *absolutely *should do: never take my opinions, or any others for that matter, for absolutes. The best you can do is be prepared - train, be aware, get as much information as possible so you can make your own decision and act upon it. I'll say it again, control the situation and make it your call. Even if it turns out to be wrong later (happens to everyone at some point), you know that at that point you acted and did what you thought was best - if you think you could have done better, very good, you've learned from it and you're gonna do better next time.


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## Rural EMT (Dec 2, 2011)

Interesting read from the start.
Not wanting to get invovled with the moral obligation/duty to act drama thanks, but i do want to talk about the assessments, here in South Africa alot of the medics practice a primary and secondary survey, which seems to fit in with your rapid and focused survey's respectivly. 
That said when I walk into a room or arrive on a scene i do my primary survey as I approach the patient, looking at the responsiveness initially IE: is the individual talking,moaning,*****ing,screaming or just sitting there quietly, if the patient is moaning,talking ETC. I can basicall tick off my primary A and B, and as logic would tell you if the guy is breathing he should have a pulse thus my primary ABC is completed, then you move onto secondary survey where things are looked at more thoroughly like pulse rates and rhythms, resp rates and A/E BP and HGT etc. Now as we are 2 on any scene the vitals are split so its done faster. Basically trying to get an overall "picture" in less than 5 minutes so treatment can be initiated, we seldom arrive and load the pt nd rush to hospital as our patient time is longer as we have only 3 hospitals in a HUGE area. 

If anything i have said contradicts your personal training or views please dont attack me personally the simple fact is thats the way things are done here in South Africa. 

Thanks for the entertaining read this morning chaps!


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## DV_EMT (Dec 2, 2011)

Ya know.... I have to say I overlooked this thread and I know i'm probably going to beat the horse dead one more time as it's probably been mentioned a few times already -- but as a BLS EMT w/o any gear you could have only done a few things.

1. General Impression/Rapid Trauma Assessment - FUBAR
2. Check Vitals/Assess patient - ABC's (if probable neck injury - jaw thrust)
3. If you we're feeling perky - assist with ventilations / resuce breathing.

When in Doubt, ABC's. I've learned that its the safest bet.

Sounds like just being there for the person in their last moments was the best option. If they're FUBAR, there's really not a lot you can do.


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## MediFaithLoveCoffee (Dec 7, 2011)

Don't beat yourself up. You did the best you could in that moment. Keep on keepin on.


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## ksmith3604 (Dec 13, 2011)

I will just second everyone who has said dont beat yourself up.  In my EMS system we never work a traumatic arrest.  We are too far from the hospital.  Additionally, medics in the city hesitate to work an arrest.  I heard a great stat (I hate stats) the other day...."ONLY 1% of all trauma arrests would survive if they fell immediately onto the operating table with a full surgical team 100% ready to go." Traumatic arrests just dont survive.  That person on the scene didn't need you (no offense please dont take that the wrong way)....they needed a trauma surgeon.  Let it go...move forward...get help if you need it (no shame in that!)....try to save the next one.  We all know that you cant save em all!! Be safe out there!


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## Handsome Robb (Dec 13, 2011)

This thread just wont die!


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