Civillians compromise Patient

[Zredmond]

Just thought I'd share this story with you wonderful folks.

Last summer while coming back from a family vacation, my father (also an EMT) and I were driving home. About 20 miles outside of a small California town on a very empty two lane highway we came across a blockage in the road. After pulling off to the side of the road we both got out of our vehicle and approached a large group of people standing in the center of the road. At first I noticed a deer laying on the side of the road, with a complete evisceration of its insides. About 10 yards up we saw a motorcycle laying on its side, in the blood tracks of the deer. Suddenly I put two and two together and realized that the motorcycle had stricken the deer at a high rate of speed. This all made sense when I noticed a group of people standing around something another 10 yards up the way. As we approached we notice a man supine on the ground. We introduced ourselves as EMT's and asked if there were any other medical providers on scene. One man told us he knew CPR...

We quickly began a primary assessment of a 64 year old male, who was AAOx1 (Person) with very short term memory. Pupils were unequal. BP was 140/88, HR: 140, RR: 24. Every thirty seconds we had to explain again what happened. While my father assumed C-Spine I began a rapid trauma assessment. Which revealed trauma to the head, including avulsion of the chin, and orbital area. The patient was laying supine with a pillow placed under his head, the pillow was also covered in blood from a lac to the posterior region of his head. I began asking witnesses what had happened, one person told me he struck the deer at about 75 mph and was ejected off the front of his bike and landed on his face. Bystanders repeatedly asked how long this was going to take, and if we could move him out of the road way. I asked the civilian why he was not wearing a helmet, and she replied he was, but one of the "good Samaritans" had removed it when the rolled him to his back. The other thing I noted was that the pillow was elevating his neck. The patient had an obviously deformed Left humerus as well as an open tib/fib fracture to his left leg. The patient was airlifted to a nearby trauma center. While questioning the man who removed the helmet and rolled the patient as well as placed a pillow under his head, he was quick to become defensive to his actions, even though he had no medical experience.

Unfortunately we do not know the patient outcome, other than he was listed in critical condition in the trauma center. I believe the "Good Samaritans" that were on scene before my arrival very well could have compromised this patient, almost to a life threatening level. Any thoughts on this incident, or suggestions on what to do when civilians who are untrained begin compromising the patient.

 

[cprted]

Rolling the DLOC patient supine with no one to manage airway, yeah thats a problem. How do you figure putting a pillow under his head was, "could have compromised this patient, almost to a life threatening level?"

I'm not trying to pick on you, I'm just not clear from your post what your specific concerns are.

Remember, these are Joe Blow who have watched few episodes of MASH or Grey's Anatomy ... you can't expect them to know anything. Being mad at a untrained bystander who did something before any official help arrived is like being mad at a fish for not being able to climb a tree. Bystanders do unhelpful things all the time.

 

[Zredmond]

Rolling the DLOC patient supine with no one to manage airway, yeah thats a problem. How do you figure putting a pillow under his head was, "could have compromised this patient, almost to a life threatening level?"

I'm not trying to pick on you, I'm just not clear from your post what your specific concerns are.

Remember, these are Joe Blow who have watched few episodes of MASH or Grey's Anatomy ... you can't expect them to know anything. Being mad at a untrained bystander who did something before any official help arrived is like being mad at a fish for not being able to climb a tree. Bystanders do unhelpful things all the time.

The pillow was lifting the guys neck way above in-line. Which I was concerned about 1. His airway and 2. His C-spine being compromised

 

[luke_31]

Bystanders typically don't know any better. The way I always handle bystanders is thank them for the help before we arrived and send them on the way, or give them some minor task that keeps them out of the way if they don't want to leave

 

[planetmike]

Pardon my ignorance, what is DLOC? That’s a new one on me.

 

[NomadicMedic]

I believe that means "decreased level of consciousness"

I'm curious if this patient had any airway compromise or any neuro deficits? Could he feel his fingers and toes? Could he wiggle his fingers? Did you have any numbness? Did you have any crepitus or step offs when you palpated his neck and back?

How long did it take before an ambulance arrived?

Sounds like a typical motorcycle accident.

As an EMT that arrives on a scene, if you choose to get involved, your best bet is to keep the lookee loos and well-meaning bystanders away and try to keep the patient from hurting himself worse. Sounds like you did that. Good job

 

[PotatoMedic]

It is bystander not civilian. Unless you are active duty military. Don't ask me why it bugs me but it does.

But as de said. When you show up thank them for their help then do your assessment and pt management. If you need help ask or wait till reinforcements show. And if any interventions, like the pillow, that the bystnadards did you can easily reverse. No need to get angry at them. They did what they could with what they knew and it does not sound like anything was grossly bad. Heck taking the helmet off was the right thing to do especially if it was one of the half shells that really just make picking up the brain easier. Honestly nothing they did, I think, was horrible.

 

[BOS 101]

It is bystander not civilian. Unless you are active duty military. Don't ask me why it bugs me but it does.

But as de said. When you show up thank them for their help then do your assessment and pt management. If you need help ask or wait till reinforcements show. And if any interventions, like the pillow, that the bystnadards did you can easily reverse. No need to get angry at them. They did what they could with what they knew and it does not sound like anything was grossly bad. Heck taking the helmet off was the right thing to do especially if it was one of the half shells that really just make picking up the brain easier. Honestly nothing they did, I think, was horrible.

Except for bothering about how quick they can get him out of the way, little ****ish there. But otherwise I agree

 

[Zredmond]

It is bystander not civilian. Unless you are active duty military. Don't ask me why it bugs me but it does.

But as de said. When you show up thank them for their help then do your assessment and pt management. If you need help ask or wait till reinforcements show. And if any interventions, like the pillow, that the bystnadards did you can easily reverse. No need to get angry at them. They did what they could with what they knew and it does not sound like anything was grossly bad. Heck taking the helmet off was the right thing to do especially if it was one of the half shells that really just make picking up the brain easier. Honestly nothing they did, I think, was horrible.

He had no idea that his arm and leg were broken. Some compromised cms distal to the injuries.

 

[ERDoc]

It is bystander not civilian. Unless you are active duty military. Don't ask me why it bugs me but it does.

I'm glad I am not the only one bothered by this (or rappers calling themselves souljas). As to the OP, you are not dealing with medically trained people. Most have not even taken a first aid course. The extent of their medical knowledge is the wive's tales that have been passed down through the family. Cut them some slack and put them to work doing simple tasks.

 

[Tigger]

Yes, bystanders often do silly things. Not sure what else there is to say about that, try and undo them if you can, but really what can you expect?

 

[cprted]

Realistically, if the guy's c-spine wasn't pooched when he was ejected off his bike at 75 mph, sticking a pillow under his head probably wasn't going to hurt his c-spine either.

He had no idea that his arm and leg were broken. Some compromised cms distal to the injuries.

Then as the trained responder you assess and treat those injuries appropriately. When have the bystanders ever been trained to do an RBS and assess the injuries that they might find?

Being annoyed at untrained bystanders for not accessing an injury is like being annoyed with a turtle because it doesn't know how to fly.

 

[RocketMedic]

It's all good.

 

[azbrewcrew]

pretty sure when you're off duty you are just "a civilian" too. Were you sworn in by your agency?

 

[DesertMedic66]

pretty sure when you're off duty you are just "a civilian" too. Were you sworn in by your agency?

A decent number of EMS employees are not sworn in because they work for private companies.

 

[azbrewcrew]

A decent number of EMS employees are not sworn in because they work for private companies.

exactly

 

[Carlos Danger]

I've seen bystanders do some pretty dumb and potentially harmful stuff, as well. Once I saw a guy forcibly holding someone down to give them mouth to mouth.

I don't necessarily take the stance that "aww well, they don't have any medical training - at least they were trying to help". Helping isn't always helpful. I think that if people don't know what they are doing, they should not pretend that they do.

 

[Tigger]

A decent number of EMS employees are not sworn in because they work for private companies.

Unrelated to thread, but once you pass your field training at my AMR operation you get "sworn in" by the city council and fire chief. There's an elaborate badging ceremony to go along with that.

But yes, civilian as a term for bystanders is a bit much.

 

[cprted]

I've seen bystanders do some pretty dumb and potentially harmful stuff, as well. Once I saw a guy forcibly holding someone down to give them mouth to mouth.

I don't necessarily take the stance that "aww well, they don't have any medical training - at least they were trying to help". Helping isn't always helpful. I think that if people don't know what they are doing, they should not pretend that they do.

This is true. But the point I was trying to make was, you have zero control over what happens at a scene before you get there. Once you're on scene, take control and correct what you need to correct. There isn't much point in getting bent out of shape over it.