14 year old EMR - beach cardiac arrest - feel bad/somebody's opinion?

[AmbalampsDriver1987]

I have technicallybeennincibtrol of a scene involving multiple simultaneous pediatric cardiac arrests, 1 adult cardiac arresest, three pediatric alpha traumas and two adult bls patients for 4 minutes as a bls provider with 2 months experience before ems arrived.

Dude was a jackass who lost his cool. You did the right thing.

 

[Accelerator]

Don't take it personally. Some people just loose their cool easily.

 

[joshrunkle35]

Don't take it personally. If a doctor stepped in and said, "I'm a doctor, how can I help?" I'd keep giving orders and ask for his/her assistance. If a doctor stepped in and starting telling me how to run the scene, then I would say, "Ok, this is my patient, but you are now implying that you wish for them to be your patient by giving me orders. So, if you want to assume responsibility for the patient, you can take them as your patient, escort them to the hospital and I will assist your patient however you wish." Frankly, I'd love to have an emergency room doctor step in and assist. On the other hand, a podiatrist may not be up to current emergency standards, and it would be hard for them to justify taking a patient from EMS. In that sense, I don't take issue with how a doctor assists on scene, it's jut that I want to know what type of medicine they actually practice and who they really are. When I lived in Guatemala, a "doctor" from the U.S. was assisting at clinics in the jungle...until we found out that his medical license had been revoked 10 years ago.

So...do you keep your EMR card on you? Even if you do, how does someone that doesn't know you know that you can perform the skills adequately?

The appropriate response in the future is to calmly walk up and say, "I'm a trained emergency medical responder, do you need assistance?" If they say yes, help. If they say no, then walk off and leave the situation to them.

 

[Accelerator]

Don't take it personally. If a doctor stepped in and said, "I'm a doctor, how can I help?" I'd keep giving orders and ask for his/her assistance. If a doctor stepped in and starting telling me how to run the scene, then I would say, "Ok, this is my patient, but you are now implying that you wish for them to be your patient by giving me orders. So, if you want to assume responsibility for the patient, you can take them as your patient, escort them to the hospital and I will assist your patient however you wish." Frankly, I'd love to have an emergency room doctor step in and assist. On the other hand, a podiatrist may not be up to current emergency standards, and it would be hard for them to justify taking a patient from EMS. In that sense, I don't take issue with how a doctor assists on scene, it's jut that I want to know what type of medicine they actually practice and who they really are. When I lived in Guatemala, a "doctor" from the U.S. was assisting at clinics in the jungle...until we found out that his medical license had been revoked 10 years ago.

So...do you keep your EMR card on you? Even if you do, how does someone that doesn't know you know that you can perform the skills adequately?

The appropriate response in the future is to calmly walk up and say, "I'm a trained emergency medical responder, do you need assistance?" If they say yes, help. If they say no, then walk off and leave the situation to them.

If they want to take charge of the scene I always ask docs and nurses who their malpractice insurance provider is and their name and address so we have it for our records. They usually take the hint. I never turn away helping hands at least until I get the patient to the truck but I have enough bosses already I don't need more.

 

[COmedic17]

If they want to take charge of the scene I always ask docs and nurses who their malpractice insurance provider is and their name and address so we have it for our records. They usually take the hint. I never turn away helping hands at least until I get the patient to the truck but I have enough bosses already I don't need more.

In reference to first bolded section- So if your running a cardiac arrest, you won't accept the help of a pshycian until you stop what your doing and obtain their info?
That seems unnecessary. When they start assisting you, it will take you about ten seconds to tell if they are completely incompetent. If so, then politely dismiss them. I don't think the middle of the scenario is time to obtain infurance info. That can happen after. No doctor is going to try to volunteer to help on their day off unless they feel they have something to offer the situation. They value their medical license the same as you value yours. Self preservation. A podiatrist isn't going to voluntarily attempt a intubation.


In reference to the second bolded section- It's a shame someone of your intellect has to answer to anyone. Especially a pshycian. Teach me your ways.

 

[Accelerator]

In reference to the second bolded section- It's a shame someone of your intellect has to answer to anyone. Especially a pshycian. Teach me your ways.

I have an application in to become a freelance supreme court justice. Hopefully won't have to answer to anyone after that goes through.

 

[ERDoc]

If they want to take charge of the scene I always ask docs and nurses who their malpractice insurance provider is and their name and address so we have it for our records. They usually take the hint. I never turn away helping hands at least until I get the patient to the truck but I have enough bosses already I don't need more.

And how is their malpractice carrier relevant? If I offered to help and came across a "provider" who said something like that, I would just have to laugh like I do when the 3rd pt of the day tells me they are calling their lawyers. I can see getting name and license info, but after the call.

In reference to first bolded section- So if your running a cardiac arrest, you won't accept the help of a pshycian until you stop what your doing and obtain their info?
That seems unnecessary. When they start assisting you, it will take you about ten seconds to tell if they are completely incompetent. If so, then politely dismiss them. I don't think the middle of the scenario is time to obtain infurance info. That can happen after. No doctor is going to try to volunteer to help on their day off unless they feel they have something to offer the situation. They value their medical license the same as you value yours. Self preservation. A podiatrist isn't going to voluntarily attempt a intubation.

Never say never and don't underestimate the degree of stupidity that is obtainable by those type-A gunners that become physicians.

 

[Carlos Danger]

don't underestimate the degree of stupidity that is obtainable by those type-A gunners that become physicians.

Or by those paramedics who insist that no one else could possibly ever be helpful on a scene.

 

[SomeGuy9005]

No doctor is going to try to volunteer to help on their day off unless they feel they have something to offer the situation. They value their medical license the same as you value yours. Self preservation. A podiatrist isn't going to voluntarily attempt a intubation.

Never say never and don't underestimate the degree of stupidity that is obtainable by those type-A gunners that become physicians.

^This

Or by those paramedics who insist that no one else could possibly ever be helpful on a scene.

^ And this!

 

[itsgordon]

OP, You should never just stand by and not help. At the very least ask if they could use your assistance and then go from there. Worst case scenario they say that they have enough people.

 

[TimRaven]

Here in my county, EMS crews are required to give a card to bystanding physicians stating their options and liability.
They can choose to (1) act as an ALS provider but under the control of paramedic, (2) only provide advice, or (3)assume full responsibility of the patient after contacting medical control.

 

[LiveForTheTones]

Just because someone is trained in CPR does not mean they are able to do it well.

Ain't that the truth!
In my class, we were going over CPR even though we were all previously certified. One lady in particular just scared the living crap out of me.
You've got the infant mannequin and you're administering chest thrusts and back slaps to dislodge a foreign object obstructing the airway. This lady was giving 'back slaps' on the chest and compressing the back.
And when holding the baby on it's back for compressions, she was letting the head sag. When holding the baby on the stomach to back slap, she was covering the nose and mouth.
AND SHE'S CERTIFIED IN CPR!
I was just staring in abject horror thinking, "Holy sh--. You just killed that baby...and you're actually certified to do this on living people. How...?"
It's a terrifying thing. They literally don't let you fail that course...and people just forget everything. And when the need for it arises, they don't really know what they're doing.

 

[joshrunkle35]

Ain't that the truth!

This lady was giving 'back slaps' on the chest and compressing the back.

Sincerely: CPR used to be give on the back about 50-60 years ago. In 50-60 years, CPR will be given a different way. Perhaps drones will fly in, open doors, place and administer the equipment to provide compressions.

Point being...who cares how someone did it, as long as they are going to a class and trying to better themselves.

With CPR, we are essentially discussing people who are dead, who just haven't figure out yet that they are dead. Some weird back slap is better or equal to no help...which still results in death. If someone else knows CPR, they will immediately identify incorrect techniques. The "bad" provider will know things like "activate the emergency response system" and "get an AED". They can still be quite beneficial, even if they are terrifyingly horrible at CPR.

On the plus side, look how many people have been trained to provide CPR and use an AED today, compared to the 1960's.

 

[LiveForTheTones]

Sincerely: CPR used to be give on the back about 50-60 years ago. In 50-60 years, CPR will be given a different way. Perhaps drones will fly in, open doors, place and administer the equipment to provide compressions.

If this woman were elderly, I would have chalked it up to that. But if she's a day over 35, I'd be shocked.
You make valid points though, sir. And I am now considering myself humbled by the knowledge.
And actually pretty intrigued...probably going to look more into the evolution of CPR when I get off of here.

 

[Ewok Jerky]

OP- you did a good job. Just stepping up is a huge step. When the "on scene authority" dismisses you there isn't much else to do so dont feel bad or guilty.

As to the argument of bystander help (especially physicians)- CPR is not rocket science, if someone offers to help and I could use another set of upper extremities to pound on a dead person's chest for 2 minutes, I don't really care who they are.

 

[Noncreative]

Just from my days lifeguarding, they really don't want you to let anyone help unless they can prove their credentials on the spot for liability reasons.

 

[benasack2000]

Can't believe this just actually happened. I was just at the same beach when a child was found floating face down. Some other guy runs in and grabs the kid and I go in a few seconds later. We carry out the kid and lay him down. I check for responsiveness to find him unconscious. I check for breathing and a pulse. Nada on both. The other guy starts compressions while I turn the kids head to the side and start scooping out vomit and froth. I do rescue breaths. Looking back I hope I wasn't hyper-extending his neck. Animal control cop arrives with an AED but we don't attach it as the kid's in a huge puddle of water. Another cop gets there with a jump bag with a child BVM and I start ventilating. Fire-Rescue ambulance got there a minute later and the medic is doing CPR with one hand and dealing with the monitor in the other. A fire engine gets there next and the medic tells me to scream to the Engine guys to grab the IO drill. It's really amazing how in real life the entire code turns into a complete cluster-F. A respiratory therapist stepped up and took over the BVM. The kid vomited and I reached for the suction and started suctioning (and didn't realize there was a cap on it). I swore and took it off and suctioned him. I sized an OPA and the RT inserted it. We threw the kid on a scoop stretcher and ran to the truck and loaded him in. Closed the doors and they are off. Why does everyone have to OD or near-drown whenever I go to the beach

 

[Tigger]

Can't believe this just actually happened. I was just at the same beach when a child was found floating face down. Some other guy runs in and grabs the kid and I go in a few seconds later. We carry out the kid and lay him down. I check for responsiveness to find him unconscious. I check for breathing and a pulse. Nada on both. The other guy starts compressions while I turn the kids head to the side and start scooping out vomit and froth. I do rescue breaths. Looking back I hope I wasn't hyper-extending his neck. Animal control cop arrives with an AED but we don't attach it as the kid's in a huge puddle of water. Another cop gets there with a jump bag with a child BVM and I start ventilating. Fire-Rescue ambulance got there a minute later and the medic is doing CPR with one hand and dealing with the monitor in the other. A fire engine gets there next and the medic tells me to scream to the Engine guys to grab the IO drill. It's really amazing how in real life the entire code turns into a complete cluster-F. A respiratory therapist stepped up and took over the BVM. The kid vomited and I reached for the suction and started suctioning (and didn't realize there was a cap on it). I swore and took it off and suctioned him. I sized an OPA and the RT inserted it. We threw the kid on a scoop stretcher and ran to the truck and loaded him in. Closed the doors and they are off. Why does everyone have to OD or near-drown whenever I go to the beach

For the record, that is not how things are supposed to go down.

I hope I don't know where this is in MA. But good for you for stepping up and taking initiative. Seriously.

 

[SomeGuy9005]

Arrests turn into complete cluster Fs through poor scene management and lack of leadership. I'm sorry, one handed chest compressions and trying to use the monitor? WTF? Yelling for an IO drill? A) Why wasn't there one on your kit? B) There is no need to yell about anything, especially drugs that have little proven benefit.

Good work getting things started while the circus was on its way. As you progress in your training, know that these sorts of things shouldn't be emulated. That call was going to be busy and high stress, but it didn't have to be a cluster.

 

[benasack2000]

The kid was four and got pronounced at the hospital. They think he was floating too long and the mother wasn't watching him.