Rubberneckers, Lookie Loos, and other Civilian Interference Stories

[Bloom-IUEMT]

Another question-- I was taught, and I'm sure this never happens, that if we happen upon a scene where someone is doing CPR and its pretty much you and them---you set up the AED and instruct them how to use the BVM. Is this not correct or practical?

 

[usafmedic45]

Is this not correct or practical?

Not under any training program I am familiar with and I've been an EMS clinical and adjunct classroom instructor (with a focus on airway management), CPR and first aid instructor, ACLS instructor, PALS instructor and NONE of those courses have ever suggested (so far as I am aware):

you set up the AED and instruct them how to use the BVM.

I was taught, and I'm sure this never happens,

Are you sure you're not confusing what you were taught in preparation for your practical skills exam (where you are pretty much assuming they are trained in the use of the equipment....the "ghost" helper scenario as we called it) and what is taught to actually be done in real life? I know in many of the cardiac stations I've precepted, the scenario involved responding to a situation where another EMS provider was doing CPR awaiting the arrival of the AED and additional equipment. Normally the "instruct them" clause was taken to mean "How many compressions to ventilations do you want? What's the proper rate of ventilation?", etc. It is more a way of measuring the ability of the person being tested to rapidly recall the basics of cardiac resuscitation rather than being an indication you should be "instructing" in the literal sense.

An emergency is not the situation to be teaching an unskilled bystander to bag someone with an unprotected airway. That is really about all I should have to say. It's not exactly a complicated concept.

Why is BVM difficult skill to master?? What about it makes it difficult, I'm curious because I've only done a couple of times. There is not many components to it. Do people find it difficult to obtain a tight seal on the face because Ive had difficulty with that.

It has to do mostly with several common errors and the limited amount of time people spend practicing BVM ventilation. The fact that they view it as a "simple" technique without a lot of "components" is the main reason for this and the attitude that causes such overzealous underestimations of the procedure and its permutations is something to definitely avoid.

The mistaken belief that you push the mask onto the face is a major reason why people- of all training levels and often experienced providers- fail to achieve good ventilation. The trick is to pull the face into the mask. This is where the C-E clamp technique (it's described in most EMS textbooks and the ACLS manual) comes in handy. Also keep your fingers on the edge of the mandible and not the soft part of the neck under the jaw to avoid shoving the tongue up and back thereby occluding the airway. Those are the two main problems (along with poor head positioning or inadequate jaw thrust) that I've seen causing issues with BVM ventilation both in-hospital and out of hospital.

But seriously, check the ego

No ego....just being blunt. I see no point in trying to make it "nicer" which would have just made the points less clear. This is a technical and professional discussion and it gets a little pointed at times. That doesn't mean "ego" is at play. It's just how things come across when explained bluntly without the body language to imply that the person posting is not being a jerk but rather just firm with the reader. I'm sorry if I offended you. That wasn't my intention...

many "old dogs" (and I am referring mostly to the service I work for) seem to forget they were new once and don't realize all the knowledge they have I won't obtain in a week of working EMS

Not many of us truly forget it, but we do become particularly aggressive in correcting the same mistakes we see time and again (often the same ones we ourselves made as rookies). How do you think most of us obtained that knowledge? We screwed up, made the same mistakes or were misguided in the same way you are and someone chewed on our a** for it. We're all adults, we should be able to handle a little criticism and even a little browbeating should it become absolutely necessary without pulling a Cartman ("Screw you guys, I'm taking my ball and going home!").

"OH my god!! you don't how to do that!! What the hell!! You are stupid/ignorant/incompetent and you will never be as brilliant as me!"

I've had all of those yelled at me at one point or another (actually I've had most of those said to me by rookies on this forum who think their excrement is not particularly odorous)....and so has just about every veteran member of this forum. What's your point?

It makes me wonder why anyone would want to continue being an EMT.

Because we realize the criticism is not usually directly personal (it could be just as easily aimed at anyone who makes the same mistake, and not just at you) and take it for what it is: An indication that we need to work on something, be it a skill, our attitude, our knowledge of the science underpinning our practice. Instead of being a sore-tailed cat in a room full of rocking chairs looking for the way out, how about taking the criticism as an impetus to become the best damn EMT in Monroe County? If you have any questions and don't feel like airing them publicly, PM me and I'll be happy to help or to direct you to someone on here who can.

 

[Melclin]

No ego....just being blunt. I see no point in trying to make it "nicer" which would have just made the points less clear. This is a technical and professional discussion and it gets a little pointed at times. That doesn't mean "ego" is at play. It's just how things come across when explained bluntly without the body language to imply that the person posting is not being a jerk but rather just firm with the reader. I'm sorry if I offended you. That wasn't my intention...

Not many of us truly forget it, but we do become particularly aggressive in correcting the same mistakes we see time and again (often the same ones we ourselves made as rookies).

PM me and I'll be happy to help or to direct you to someone on here who can

Honestly, this is how half the arguments on this forum start. I know from experience how people can seem when you're new to the forum. It would be nice if more of the forums veterans would explain that easy little mistake like this.

.

 

[WuLabsWuTecH]

Another question-- I was taught, and I'm sure this never happens, that if we happen upon a scene where someone is doing CPR and its pretty much you and them---you set up the AED and instruct them how to use the BVM. Is this not correct or practical?

Where's your partner?

Running Medic-Basic, Medic is on the ACLS and defib, Basic is on the airway, bystander is thumping, once LEO or engine gets there, change in LEO or FF for bystander.

Running basic-basic, one guy on AED, one guy on airway, bystander is thumping. You uh... just might wanna call for ALS though!

 

[Bloom-IUEMT]

At risk of getting the thread off topic I'll say thanks for the advice. JUst pushing the mask down and not getting a good seal was the problem I had with my first instance of CPR. You are correct in assuming that I am referring to the practical skills test when it says *instructs first person on proper rate and ventilation of BVM* or something to that affect.
But before I started in EMS I made a pact with myself not to take it personally if my partner scolds me for an improper technique. The problem though is I am not being scolded on patient care, I'm being scolded on some bs things I shouldn't be scolded on. Like: this is how *I* want you to do paperwork because my old partner did it this way and all other medics want it done this way (which is not true). Or: *YOU* forgot to hook up the R Arm 4-lead even though we were both hooking up 4-leads. My favorite is when a medic mumbles something and says "why don't you listen when I talk" But I suppose that is because I'm new.

And to keep this post on topic--- This didn't happen to me but to my instructor and its one of my favorite stories and I don't have one of my own yet.
He came upon a MVC that was pretty bad and he goes to a car that was damaged pretty bad that was leaking gasoline all over the road. So he's trying to get a patient out and he's standing in a puddle of gas holding c-spine and a person who sees the wreck goes up and stands in the puddle of gas puffing away on a cigarette saying "what can I do to help?" So my instructor tells to back away, back away until he's out of the puddle and says to him to put the cig out. Haha, my instructor says he was afraid to say put out the cigarette because the guy might've thrown it down in the puddle.

 

[rescuepoppy]

If someone gets that close to a wreck with a fuel leak with a cigarette while i am in the hot zone. he will get some less than friendly advice that he has somewhere else he needs to be.

 

[HokieEMT]

Well they really didnt interfere but it bothered the crap out of me. Cardiac arrest inside a resturant. I was on the first arrival piece(rescue-engine), and we walk in and start CPR and prep for the AED. These two guys are sitting at the table right next to us, watching and still enjoying thier meal like they were watching TBS "Dinner & a Movie".

Hal9000, we had the same kind of thing. PT in bad condition but refused care until we found her dog who ran away after the crash. Luckily for us it had just snowed so we just had to follow the paw prints.

My dad has too many of the same story. There is a reason he won't eat at Double T Diner(local place), Golden Corral, and many other buffet styles places. He has even had ones where the pts friends pick up what the pt was eating and eat it.

 

[HokieEMT]

I had one this summer not too long after i got home from college. IT was a difficulty breathing pt and we were dispatched with the next closest career medic so we were basically the 1st Responder. We walk in and we havent even talked to the Pt when her friend is already asking "Where are you guys gonna take her" (there are multiple hospitals that we can transport to in the Baltimore Metro Area). She gives us like two bits of info on the Pt and then goes and gets the kids and comes back out and is like "I have to know right now where you're taking her," at this point the medic is there and he kinda shoves her of on us lol. He makes his decision from his first impression and that was that.

Its kinda funny because I play this "lookie loo" role a lot due to my job in our Corps of Cadets. Im the Regimental Medcial Officer so im in charge of the medical care and the EMTs within the Corps. We are basically Pre-EMS so were always there with a set of vitals and write up waiting for VT Rescue lol. Unless the situation dictates we are hands off once Rescue shows up except for maybe helping with the stretcher or movement.

 

[Seaglass]

Apparently we have some old civilian in the area that will lecture crews on our gas-guzzling vehicles and money-wasting ways. I thought he was an urban legend, but he struck again at dinner at last night.

 

[Mountain Res-Q]

Last night there was a fire down the road from me about a mile. Fully involved structure fire and was dispatched out as "explosions in the house and one victim trapped inside". Deputies were requested to respond from the word GO or 2 reasons: 1. There were people that were trying to reenter the houes to look for the missing person, which would have been futile and even more deadly as the house was already starting to collapse when the first Fire units arrive on scene (3 minute response time)... and 2. The (and I quote the Battalion Chief over the Radio) "Lookie Loos that are cloggin' up the streets (gosh)". Roads in my area are barely 2 lane, with no shoulders or sidewalks, with driveways that can have quite an angle... Space is always at a premiumm but everyone wanted to come on down and watch, thereby making it hard for the 8 engines, 3 water tenders, 3 chiefs, 2 ambulances, and other support vehicles to get in. I tell my Father what is going on, because he has friends that live right in that stretch of road, and based on the address, it was possible it was their house (actually next door neighbor, but they witnessed the explosians and were holding back family fro reentering the house)... after calling them on the phone and getting no response, he turns to me and wants me to drive with him to the fire to "check it out" (he wanted me because of my badge and connection to the Deputies and FFs)... I had to convince him that "maybe" it is a bad idea to do exactely what the Chiefs are complaining about (hence the deputies that would have no issue forcably removing people) and thereby hindering the FFs ability to stay safe while trying their hardest to save lives...

After my fathers preasure washer incident yesterday, this story, and his insistance that I don't really need rescue rated 10,000 lbs static rappelling rope when doing technical training (utility line from Lowes or Home Depot will do)... I feel like banging my head against a wall for an hour...

 

[usafmedic45]

After my fathers preasure washer incident yesterday, this story, and his insistance that I don't really need rescue rated 10,000 lbs static rappelling rope when doing technical training (utility line from Lowes or Home Depot will do)... I feel like banging my head against a wall for an hour...

Reminds me of the argument I had with my grandmother after the Columbine shooting. She claimed the blood of the kids in the library was on the hands of the "cops who hid like cowards behind their cars for an hour before going in". Sometimes even the brightest people can hold some truly boneheaded notions....

 

[fiddlesticks]

when a bystander pisses me off i just say hold this iv bag or carry this back to the ambulance they feel like they helped and made medics look good in the public eye. as for students that are eager and want to help their first day of class were all there at one point and we need to show them how to treat the public and by being asses that dosnt make us look good. and it just makes them think thats its ok to treat bystanders like that. i admit there is a time and a place to be and *** but for the most part they just want to help.

 

[skivail]

Theme Park VSA

I had been working a VSA at a local theme park when I happened to look up and notice that a group from a religious school had circled around us and started to pray. One of the group leaders then decided she wanted to place a cross on the womans chest. Fortunately police had just arived on scene and were able to talk the woman out of that idea. Nice idea, just a little creapy in my mind.

 

[mycrofft]

Maw Barker and her boys

A middle aged woman and her two late-twenties boys took an EMT-Ambulance class, painted their station wagon utility yellow, joined a vollie outfit so they could mount a yellow light bar and siren, and installed a scanner. They eventually wound up with their own spineboard, stokes litter, oxygen, and trauma bag (probably all stolen) and would beat local FD's to accidents at night. I never saw them in action, but they would do this and that (no drugs or IV's), then take the mask, spine board etc off when actual crews showed up, and leave. Finally a state trooper arrested them; rumor had been she was sister of a state senator in the Unicameral.

 

[ceej]

But seriously, check the ego. I've never would have believed I would be scolded so much as I am by paramedics---many "old dogs" (and I am referring mostly to the service I work for) seem to forget they were new once and don't realize all the knowledge they have I won't obtain in a week of working EMS. "OH my god!! you don't how to do that!! What the hell!! You are stupid/ignorant/incompetent and you will never be as brilliant as me!" It makes me wonder why anyone would want to continue being an EMT. But I suppose that's another thread--

I wouldn't take it personally. BHAS medics aren't highly regarded amongst their peers, you know .

 

[hjp31bravoMP]

They just don't know when to stand back

In the military almost everyone is CLS (Combat Life-Saver) certified. They can start a saline lock/IV do a need le chest decompression, secure nasal airways...etc. When the Medics and Military Police roll out to respond to a casualty, everybody and their brother wants to "help." The MPs are supposed to be pulling security, but are so occupied keeping looky-loos back that it actually endangers the Medics. The worst are the Army photographers. They'll walk right into the middle of the scene and actually block the Medics' path to get "their shot."

I wish they'd let us cuff 'um!

 

[wvditchdoc]

... If you don't have enough people to do what you need to do beyond the airway, nothing gets done beyond the airway. I mean what else are you doing as an EMT-B that is so important that you're going to hand the airway (the thing that if you screw it up will kill the patient faster than pretty much anything else) off to someone with zero training?

I do believe I will have this put on a T-Shirt, after 15 years as a Medic it absolutely floors me the amount of people that don't get this. As a sidenote, this would apply to all providers, not just EMT-B's. ABC's are done in order of importance, if A cannot be positively controlled...you stop at A. That would include the lack of manpower to progress any further. :glare:

I have had more "I am a nurse/Doctor/X Ray Tech, can I help?" stories than I could ever remember. I live and work in a rual area back home in WV.

The thing to remember is to treat them as a professional at all times, but get your point across to get the H:censored::censored:L outta the way and let you do your job!

 

[dragonjbynight]

One of my first calls was to a MVA with ejection, though I was on the fire side and not rescue, we responded for traffic and scene safety (very small department) On my way to scene running lights in my POV, A young kid decides to play reverse chicken, slows down to 20 miles an hour on a 55mph stretch and swerves in front of me every time i attempted a pass. Another car came up on my rear and Ill be Da*&ed, turns on his lights. A LEO in the right place at the right time. I pulled over and he in turn pulled the car in front of me over, I continued on to scene just wondering what he said (and swearing the other driver out for being a complete moron) . I was working traffic and warning as the scene was on a particularly steep curved hill when the LEO arrived, I told him what had happened with that particular vehicle and he mentioned had pretty much berated the young man to no end, not to mention a few large fines.

Not five minutes later the young mans vehicle pulls up to the stop, and he recognized one of the involved vehicles, It was his parents. I have never seen a face drain of all color as fast. I radioed for the LEO to come back up the hill and asked for some assistance in telling the kid what to do next ( I was still very new) The same LEO came back up the hill and told the kid where the parents were being taken to, luckily for him, they were not critical.

I can't imagine the guilt that the boy would have had to have felt, after doing what he did. I know that several weeks later, the dept got a written apology from the boy and the parents had taken his car. But it just goes to show some of the complete lack of respect people have for VF/R.

 

[nomofica]

I felt like such a lookie loo this weekend.

I was working the Children of Bodom in my city as event security, working the barricade (pulling the crowd surfers off the crowd, making sure nobody jumps on stage, etc, etc. Near the end of the show an individual who was crowd surfing was hurled pretty far over the barricade and hit his head on the corner of the stage (causing a minor 2" lac and the usual looks-bad-but-isn't bleed that happens with scalp). Because I was the only one who is medically trained (other than CPR/standard first aid) and I witnessed it, I had to treat until EMS arrived.

Anyways, I had to go into the ambulance with EMS (which was already crowded... two medics and an EMT-A who was most likely doing training/practicum) and watch until the patient was released (chose no txp; went to hospital for sutures w/ his friends as we were right a couple blocks away from a hospital). Just standing there in the crowded box made made me feel like an annoyance, but I had to stay because I would I have to report what condition the pt was in/what treatment was needed for insurance/liability reasons.

 

[WolfmanHarris]

Just standing there in the crowded box made made me feel like an annoyance, but I had to stay because I would I have to report what condition the pt was in/what treatment was needed for insurance/liability reasons.

Did you ID yourself to the crew as a moonlighting Medic (or EMT-A)?

If it were me and you had I would have let you stay out of professional courtesy, but otherwise I would have asked you to stay out and just been sure to give you a quick run down before we left. That's what I do with PD (unless they're coming along), as well as foremans, security, teachers, etc. I don't mean shut them out as a snub, but I wouldn't want to be in the patient's shoes in a box that full.