Dozens Ignored a Man Dying on a Sidewalk in Queens, NY

[firetender]

Let's do a poll! How do you do that?

Homeless people and the people who choose to suckle the teat of support programs are beneath you, me and most of the people on this forum by that measure.

I'm curious how many here agree and what criteria do you use to figure out where you sit in the food chain? Who is above, and who beneath you?

...and does "beneath" justify applying what amounts to differing standards of care for people ill or injured in your presence?

AND, since you've got to be beneath someone else who could be a medic, would that justify having a different standard of care applied to you? (Everybody is somebody's Scrote)

And this is NOT about On or Off-duty. Even though it appears to be a reverse example, if you recall, the SS of Nazi Germany were just doing their jobs, it all boils down to how do you make choices around intervening in a life and death situation.

Is "Social triage" a Euphemism for "cleansing"?

Just stuff to think about.

 

[usafmedic45]

With the training you have (which means many tools to pull from to figure a way to intercede in a life and death situation without burning your own balls) calling 9-1-1 is NOT enough in a life-and-death situation.

So precisely what do you expect me to do when I don't carry anything with me? There are very few things that one can truly kill someone in a matter of a few minutes and can be fixed without carrying equipment with you. An obstructed airway is the only one that really comes to mind as happening with any frequency. Without gloves and a lot of gauze, I can't safely do anything to control bleeding and short of a femoral, brachial or carotid artery injury are the only two peripheral vascular injuries that are rapidly lethal in and of themselves so the idea that one needs to intervene RIGHT NOW with other injuries or the person is going to die is a misnomer. Calling for help is the best thing to do because short of an obstructed airway or the aforementioned vascular injuries there are few things that we MIGHT be able to do something about in the austere setting of off duty first response that are going to kill a patient within the five to ten minutes it takes to get a duty crew on scene in most jurisdictions. One can argue that doing compressions is beneficial but it's not "fixing" the problem and if the patient isn't vomiting or bleeding, I generally have no problem doing CPR without gloves on. It is actually one of the few first aid things I will do nearly without question (assuming no obvious bleeding or vomiting or open sores on the chest) while off duty.

how would you handle a life-and-death call (while on duty) where it was your Brother involved and you were the only person on the scene capable of rendering care?

On duty? I would have to take care of him. My hands are tied in that situation and I am legally obligated to take care of him regardless of what I think of him, just like any other patient. That is not the situation we are discussing here though. I would appreciate you appreciating the difference between "on duty" and "off duty" and not trying to combine the two.

 

[firetender]

usaf You're in the neighborhood...

how about a chat on-line?

 

[usafmedic45]

And this is NOT about On or Off-duty.

Yes, it is. The debate has turned into whether we are obligated to work while not on duty. There is no other question possible here since we are legally bound to do something while on duty.

...and does "beneath" justify applying what amounts to differing standards of care for people ill or injured in your presence?

It's not a different standard of care. It's a different standard of whether I am willing to risk my life when I don't have to. Let's phrase it this way: you're at the beach on your day off and you see your neighborhood pedophile or crack dealer being attacked by a shark are you going to jump in and pry him out of the shark's mouth as readily as you would say a child or your wife? We all make judgment calls based on what we think of people. I am just really open and blunt about it.

I feel no moral or ethical obligation to endanger or inconvenience myself to do my job when I'm not, well, doing my job.

Even though it appears to be a reverse example, if you recall, the SS of Nazi Germany were just doing their jobs, it all boils down to how do you make choices around intervening in a life and death situation.

Yes, but we're not talking about doing our jobs (i.e., "Hey you're on duty, go kill those Jews" to run with your example). We are talking about getting involved when you have no duty to do so. It's a choice. You choose to stick your neck out and meddle in cases where you are not obligated to do so because you're not on duty. I choose to pick and choose where I get involved.

The better example, instead of comparing me to an SS officer liquidating Lebens unwertes leben, would be to suppose for a second that I care about starving children in Africa. I could do something about it, and imagine that I work for the UN food program shipping food to those same starving kids. I spend my day loading bags of rice onto container ships bound for some cesspool on the Dark Continent. Once I'm off duty, I come across a starving kid on my way home. I have no moral or ethical obligation to go get the kid food. I do have an obligation to report his state to the local authorities and nothing more. The same applies to when I clock out at the end of my shift as a medical professional. Why is that so hard to grasp?

BTW, no one seriously believes the Nuremberg defense. Anti-Semitism was a long standing characteristic of European culture (especially in the predominately Catholic areas) and it was engrained in children long before the National Socialists came to power that Jews, Gypsies, etc deserved to be destroyed. It's a fascinating subset of history.

 

[Trayos]

Seems to me

as if we are arguing over two different points. USAF raises the point that nobody would want to put themselves in harms way when not required to do so. firetender makes the point that as health care professionals, you will have the capacity to do more in the pre-hospital setting then a civilian walking by.

Both of these are valid points.

Firetender, if you came upon a recent pt. with open wounds and unidentified fluid, without any PPE, would you feel secure to do any more then basic triage and calling for supplied medical help?

USAF, if you were the first to come upon a scene where a pt. was lying on the ground, again bleeding with unidentified fluid, and you did have advanced PPE (say you just came from teaching an EMS/military medical class regarding them) would you render care until the local professionals arrived?

Thank you both for taking the time to do this.

 

[usafmedic45]

you will have the capacity to do more in the pre-hospital setting then a civilian walking by.

The thing is, without the equipment we have access to at work, we really don't.

USAF, if you were the first to come upon a scene where a pt. was lying on the ground, again bleeding with unidentified fluid, and you did have advanced PPE (say you just came from teaching an EMS/military medical class regarding them) would you render care until the local professionals arrived?

Honestly it would really depend on the factors I mentioned before. If it was the scenario played out in the original article? No, I would not. I would call for an ambulance and then go on my way.

 

[Trayos]

The thing is, without the equipment we have access to at work, we really don't.

I would make the argument that knowledge is just as important as a rig full of equipment. Again, you cannot do as much as the responding EMT's, but you can provide them with accurate information, and help make their job easier.

Honestly it would really depend on the factors I mentioned before. If it was the scenario played out in the original article? No, I would not. I would call for an ambulance and then go on my way.

I would appreciate it if you could try and imagine your response to the (albeit extremely limited) situation I previously mention. This would be without deep knowledge of the pt. and their socioeconomic status, but with indicators pointing them to be nothing extraordinary, and with human faults.

 

[adamjh3]

I would make the argument that knowledge is just as important as a rig full of equipment. Again, you cannot do as much as the responding EMT's, but you can provide them with accurate information, and help make their job easier.


I would appreciate it if you could try and imagine your response to the (albeit extremely limited) situation I previously mention. This would be without deep knowledge of the pt. and their socioeconomic status, but with indicators pointing them to be nothing extraordinary, and with human faults.

Honestly even if I've worked with you before and you're off duty turning this patient over to me, I'm still going to do everything the same. You didn't see him get stabbed, you don't know what's going on with him, you walked up to the same thing I did.

 

[usafmedic45]

but you can provide them with accurate information, and help make their job easier.

No offense, but unless you stood and watched the person get hurt, you are not going to be able to provide any more useful information than any other person. If it was a violent assault and you stood around while it happened, that pretty much makes you a fool in my book.

I would make the argument that knowledge is just as important as a rig full of equipment

Yes, but refer to my earlier points about how little there is that kill a person in a matter of minutes that we can do anything about without proper equipment. Otherwise, you're just watching someone die up close and personal with a better understanding of what is happening and a distinct lack of an ability to do much about it.

This would be without deep knowledge of the pt. and their socioeconomic status, but with indicators pointing them to be nothing extraordinary, and with human faults.

Like I said, it depends on the situation. You gave such a vague scenario that I really can't make a judgment call about what I would do. Sorry but socioeconomic status and other things about the patient are going to affect my decision and you left those out so I picked the scenario that sparked this debate. I don't need a "deep knowledge" of the patient (in fact, I prefer not having one for most of my patients to be quite honest; it makes it easier to remain impartial that way) to decide whether I'm going to get involved.

 

[Trayos]

Okay, so let me try and reiterate your perspective (there is a point to all this, believe it or not )

You feel that in a situation where you are given no more equipment/information then a civilian, you should behave as one when arriving on a situation that you wish to keep in your professional life. You also feel that your personal decision to do anything more then what is expected/hoped for of a civilian should be solely at your discretion, based on a multitude of factors (as outlined before)

Just trying to tie it up in a neat little package, so it can be compared to firetender's perspectives/rationale.

 

[usafmedic45]

Okay, so let me try and reiterate your perspective (there is a point to all this, believe it or not )

You feel that in a situation where you are given no more equipment/information then a civilian, you should behave as one when arriving on a situation that you wish to keep in your professional life. You also feel that your personal decision to do anything more then what is expected/hoped for of a civilian should be solely at your discretion, based on a multitude of factors (as outlined before)

Just trying to tie it up in a neat little package, so it can be compared to firetender's perspectives/rationale.

Pretty much. My belief is that it is our choice to use our skills while off duty. I do not feel any more compelled now to help than I did before I entered EMS. In some ways, I am less likely to help because I am more aware of a poor risk-to-benefit ratio now than I was as a civilian.

 

[firetender]

Firetender, if you came upon a recent pt. with open wounds and unidentified fluid, without any PPE, would you feel secure to do any more then basic triage and calling for supplied medical help?

It's very simple for me. YES, I would do everything I could without endangering myself. I'd duck the blood piss and vomit as best I could and find somewhere to intervene. I know quite well I could get caught (as easily as I could get hit by a truck while getting equipment or help or...) but I'd have to look at my personal 12 years EMS experience and say not once did I get harmed by intervening in a life and death situation either on or off duty (enough to knock me out of the game, anyway!).

I wouldn't even waste the time to thoroughly evaluate all dangerous aspects of the situation because to this day, I completely trust my (non-equipment related) preparedness to take care of me moment-to-moment as well. And emergency calls live in the moment.

I'm glad I got to that point because that may be key. I have no idea of what I could pick up out there these days because I've been out of the field for 25 years. But even then, 90% of what I dealt with was in the realm of the unexpected. Today I wouldn't hesitate to act because what I learned to do as a medic then was observe and respond, and do it while minimizing the danger to myself. I made sure I was prepared to act.

Maybe the key is I had/have complete confidence in my ability to do what I've been trained to do while minimizing my exposure. I don't worry about the unknown, I just act with what is, as carefully as I can.

If EMS teaches us nothing else (and not everybody learns it, unfortunately) every second of our lives we are subject to disaster. Everybody (most likely reading this post) will die. All we can do, as professionals, is prolong life, we can't stop death, not even our own. Something is gonna take me out, and pain and suffering are often involved! Period.

My only point is each of us must decide what we can live with. usaf has clearly stated what works for him, I have stated what works for me. Now, I encourage all of you who read this to take the time to know who you are in this.

...and many thanks to usaf (and respect!) for taking the time to really look at his position, sharing it with all of us without restraint, and not backing down from something he has obviously worked hard to come to terms with.

This is the open sea you all (now, and me, then) are being asked to navigate through. (Tough waters!) Key to it is coming to terms with the unavoidable fact that it doesn't matter what you do, you're a human being doing it; and each of us has to come to terms with that in his/her own way.

I'm satisfied, usaf, Thank You! and thanks to TRAYOS for seeking clarity.

 

[usafmedic45]

but I'd have to look at my personal 12 years EMS experience and say not once did I get harmed by intervening in a life and death situation either on or off duty

You've gotten lucky. Do you really want to bet your life on your luck holding out? Also, you know what they say about relying on experience alone. It simply means you keep making the same mistakes with an ever increasing level of confidence until something comes up to bite you on the butt.

I wouldn't even waste the time to thoroughly evaluate all dangerous aspects of the situation because to this day, I completely trust my (non-equipment related) preparedness to take care of me moment-to-moment as well. And emergency calls live in the moment.

No offense but your attitude scares me a little. May I suggest you read a book called "Darker Shades of Blue: The Rogue Pilot" by Tony Kern? It's aimed at the aviation community but it has a lot of good information that can be applied in EMS about exactly why the cowboy sort of attitude that is pervasive in both EMS and aviation is really detrimental not only to individuals but entire organizations. Fascinating read and I recommend it to everyone on the list.

Today I wouldn't hesitate to act because what I learned to do as a medic then was observe and respond, and do it while minimizing the danger to myself. I made sure I was prepared to act.

Pardon another aviation reference, but one of the first lessons in dealing with crisis that new pilots are taught is what is called "winding the clock". It stems back to the days when the instrument panel mounted clocks had to wound up and the action took a few seconds. Telling new pilots that if you encounter a problem, wind the clock, gave them a few seconds to think about what was happening and what to do about it. Rushing into a problem seldom fixes anything. In fact, more often than not, it makes things worse by compounding the problem. There are few situations in aviation (at least for non-test and non-fighter pilots) that truly require split second reaction to fix or you are screwed. This is even more the case in first aid.

Maybe the key is I had/have complete confidence in my ability to do what I've been trained to do while minimizing my exposure. I don't worry about the unknown, I just act with what is, as carefully as I can

So you're prepared to die rather than follow accepted practices (i.e., bloodborne pathogens, etc)? Once again, I worry for your safety my friend. It's one thing to want to help, it's another to throw caution to the wind out of hubris and concern for your fellow man.

 

[Trayos]

Firetender, Im going to be the human compactor again.

You feel that because of your experience, you should enter the situation as quickly as possible, in order to most effectively render care. You also feel that it is detrimental to consider all the various problems you could have, when your experience has kept you safe in reasonable situations. You are not stating that you disregard basic scene safety, or would engage in efforts that pose a clear and present danger to your health or those around you.
feel free to edit ^_^

 

[firetender]

I will admit since the incident with the old(er) lady in the parking lot I do carry little plastic bag with a single pair of gloves in it in my back pocket now.

...and because of this thread, more than just this poster are looking at themselves, their preparedness, and making moves to be more effective.

 

[firetender]

Firetender, Im going to be the human compactor again.

You feel that because of your experience, you should enter the situation as quickly as possible, in order to most effectively render care. You also feel that it is detrimental to consider all the various problems you could have, when your experience has kept you safe in reasonable situations. You are not stating that you disregard basic scene safety, or would engage in efforts that pose a clear and present danger to your health or those around you.
feel free to edit ^_^

Because of my training I have been prepared to intervene in a medical emergency. If I come across one, in the absence of professionals or those better trained than myself (which does not necessarily include other health care professionals!), I will take action. Before taking action I will assess the level of danger that the situation presents (that's "winding the clock") but with my experience that takes place very quickly, if not instantaneously. The degree to which I slow down in that evaluation is proportional to my lack of preparedness. I am not stating that I disregard basic scene safety, or would engage in efforts that pose a clear and present danger to my health or those around me.

Nor am I saying this is about a "Savior" complex. I would try; and YES, absolutely YES, I would try just so far and stop when I decided there was no use or danger to me was imminent.

 

[firetender]

firetender is a hypocrite!

Having gone through these threads, admittedly self-righteously, let me share with you all this firetender guy in action:

Post-medic, I was walking along a deserted beach one day with a buddy of mine, a Psychiatrist, a real skinny guy. There was a form sitting at the edge of the seashore. As we got closer we saw a woman, about three-hundred lbs. sitting in the sand. The water lapping up a bit beyond her feet, the tide was coming in.

When we got close, obviously upset, she looked up at us imploringly, fear clearly in her eyes. "I'm stuck!" She pleaded, can you help me get up?"

I didn't ask if she was injured. A quick visual scan showed nothing obvious. I got in position to help, only to look up and see my buddy continuing to walk down the beach. He called out, "Not ME! I'm not getting involved!"

So there I was, alone, with the woman and, as I presented myself here completely flabbergasted that someone would just walk by a woman who, if she didn't move or get moved would soon be up to her eyebrows in water. I looked at her, her weight, its distribution, how deep she was in the water and immediately decided I'd probably get hurt if I helped. It was sunset, there was NO ONE around.

Before I even knew it, I said, "Sorry," sheepishly, and walked to catch up to my buddy. I didn't look back nor did I challenge his choice. I could have rolled her on her side and probably rolled her up further into the dunes, I could have gone for help, I could have done any number of things with maybe wrenching my back a little but I walked away.

To this day I have no idea what happened to her. Sure, if she got TO the beach she probably was mobile. I was off-duty, and there were no claims of injury, but do you think I would have brought this up if I felt "clean" about it?

That woman may very well have lost her life because I did not have the proper tools to work with, in this case, my friend, or EASY access to help or communication. I did my bit of social triage. Trust me, my thoughts ran along the line of, "Well, if you're stupid enough to put yourself in this situation then it's God's will now!" and to this day I feel like :censored::censored::censored::censored: about making a judgment call that her life was less valuable than my back and not trying.

 

[usafmedic45]

That woman may very well have lost her life because I did not have the proper tools to work with, in this case, my friend, or EASY access to help or communication.

That's a bit extreme I think. I mean the incoming tide would have made her efforts to stand up easier (fat is buoyant after all!) and she could have stood up. To say she could have died is a bit of hyperbole. It's like saying I could die falling out of the chair I am sitting on now. It could happen. Is it likely to happen? Not really.

Well, if you're stupid enough to put yourself in this situation then it's God's will now!" and to this day I feel like ____________ about making a judgment call that her life was less valuable than my back and not trying

That's the problem with taking the "never off duty, always in service of my fellow man" approach: it always leaves you gnawing at yourself for those times where you have to simply walk away or stand idly by. I used to take that approach. It ate me alive. Once I realized "off duty is off duty", life became much sweeter and there were far fewer nights spent sleeplessly wondering "What if I had...".

 

[firetender]

Can't resist, even tho I thought I was through!

It's like saying I could die falling out of the chair I am sitting on now. It could happen. Is it likely to happen? Not really.

I pretty much feel that way, today, about taking action around a bleeding person. If I do what I need to do to protect myself, with what is available right there, then I'm not likely to get killed, either.

Here's a good recent one I just thought of:

I'm a tour guide. While up on the top of Mt. Haleakala, a guy in his 80's, not on my tour, unsteady in gait (and also dealing with about 10% LESS O2 in the air because of the 10,000 foot elevation) stepped behind me, tripped and fell. He hit the ground and just above his ankle was a gash from a lava rock outcropping. He nicked an artery because blood came spurting out in one-foot streams. No one else was around who knew what to do.

I know what you'd do; call 9-1-1 with a one 1/2 hour response time? Or maybe walk to the Ranger Station, only 20 yards away, and find someone who may or may not be qualified to help? How long does it take an old guy struggling with lack of O2 to bleed out enough to throw his life force out of whack?

What I did was stick my hand in my pocket, pulled out a handkerchief (clean? no idea.) folded it over until it was thick, plop it on the wound and pressed hard. I caught it before the fourth spurt. I washed my hands well afterward (of course blood got on one!) and didn't even inquire if there were any other problems I should worry about. I recognized a potentially life or death situation, certainly considered the risks of blood borne pathogens and, figuring it had the same odds as for me to "die (while) falling out of the chair I am sitting on now." Acted.

Maybe we just have different cost/benefit ratios.

 

[usafmedic45]

How long does it take an old guy struggling with lack of O2 to bleed out enough to throw his life force out of whack?

I see your point. An extreme circumstance like that and a relatively low risk patient would spur me to take action. Now if it had been a homeless guy or a twentysomething, they would be on their own. In the setting of a younger hiker far from the trailhead and no gloves, he's getting a tourniquet well above the wound site. The risk is just too great in those populations to resort to unprotected direct pressure. In the case of the homeless guy, I probably would take my chances notifying someone at the ranger station. I simply don't value the life of a homeless person anywhere near enough to put myself at ANY risk beyond what I'm mandated to do as a requirement of my employment.