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.
I hesitated. And this guy might've lost his life..
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Sasha
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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.
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Likely he was going to die anyway, traumatic arrests dont have any kind of ok survival rate.
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abckidsmom
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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.
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.
daj72
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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
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
SanDiegoEmt7
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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.
8jimi8
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Open thoracotomy and cardiac massage is the indicated treatment for
A blunt trauma arrest.
In Texas, off duty responders are limited to BLS.
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...")
dixie_flatline
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:censored: that, I'd be calling for guys with guns if I saw someone wrist deep in anyone.
JPINFV
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lightsandsirens5
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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.
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firetender
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what does "somewhat" of a recovery position mean?
what is "and a bunch of other stuff"? Gray matter? Intestines?
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.
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.)
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.
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
.
Sasha
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Just to get this straight you are suggesting a head to toe over CPR?
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firetender
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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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Sasha
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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.
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.
Hunter
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: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.
I check my ABCs before I do a rapid trauma.
Hunter
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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.