I hesitated. And this guy might've lost his life..

[Tigger]

First, as far as how I was taught, it is always your legal duty to act, both on and off duty. If you have any sources that say otherwise then I retract that statement.

Well, we have a 16 page sticky devoted to said topic. http://www.emtlife.com/showthread.php?t=5825

Such laws are regulated at the state level, so not everyone is obligated to act when off-duty. I know for a fact that there is no law in Mass that mandates I act when off-duty. I can't cite that since it's not written into the MA General Laws. Unless there is a law that specifically states off duty EMS providers are required to render aid, you are not legally obligated to assist.

Second, it took between 7-10 min before EMS arrived on scene on that call. If CPR hadn't been initiated immediately as it was, he would be dead. Given I actually witnessed the fall so in other cases where you have no idea how long its been, I could see your point and I should have clarified further.

You are likely right about this, though I am sure you are aware that people can survive cardiac arrest despite being down for 7-10 minutes. That time-frame lessens the chance of survival, it doesn't eliminate it. I only add this since you mentioned working to save the 1% earlier, if you knew someone was down for that long, would you work them then even though by your admission they will likely die?

 

[mrswicknick]

Well, we have a 16 page sticky devoted to said topic. http://www.emtlife.com/showthread.php?t=5825

Such laws are regulated at the state level, so not everyone is obligated to act when off-duty. I know for a fact that there is no law in Mass that mandates I act when off-duty. I can't cite that since it's not written into the MA General Laws. Unless there is a law that specifically states off duty EMS providers are required to render aid, you are not legally obligated to assist.



You are likely right about this, though I am sure you are aware that people can survive cardiac arrest despite being down for 7-10 minutes. That time-frame lessens the chance of survival, it doesn't eliminate it. I only add this since you mentioned working to save the 1% earlier, if you knew someone was down for that long, would you work them then even though by your admission they will likely die?

Thanks for the thread, I retract what I said.

As to your question, absolutely. Both due to my protocols and due to my personal feelings. They're not going to get any dead-er anyways.

 

[usalsfyre]

Second, it took between 7-10 min before EMS arrived on scene on that call. If CPR hadn't been initiated immediately as it was, he would be dead. Given I actually witnessed the fall so in other cases where you have no idea how long its been, I could see your point and I should have clarified further.

Your patient survived out of sheer luck. Rogue Medic had an excellent post on CPR and trauma. http://roguemedic.com/2011/11/why-doesnt-cpr-work-for-trauma/

Third, at least under my protocols, we will work anyone that isn't showing obvious signs of death. Again, what hurt is it to work someone at least until ALS tells you to stop? What if they are that 1%? If they aren't, its not like they're not going to get any dead-er. We as basics don't have the knowledge to rule out anything but obvious death, and even if you do, you cant unless you really want to get sued.

Blunt traumatic arrest pretty much an obvious sign of death. Treating the 1% (actually it's more like the 0.01%) just because "they might make it" is poor medicine, as is letting your emotions influence this decision making process (hard I know, but emotion can't override good judgement here).

 

[emtwacker710]

In my own opinion, I don't stop when I'm not working (Unless its in my vol. fire district in which case we do 1st response anyways) but depending on whta your state laws are, you may or may not have a duty to act when your off duty. Just to cover my own *** I will not stop on the scene of something out of my district off duty, and my vehicle is unmarked as well. Just something to think about, check with your states duty to act law...

 

[mrswicknick]

Damn, well I stand corrected. Thanks for the article usal.

 

[Roheline]

Even if you don't feel morally/emotionally obligated, here's another reason to stop and help:

http://www.huffingtonpost.com/2009/12/25/eutisha-rennix-death-jaso_n_403440.html
http://www.nypost.com/p/news/local/brooklyn/mike_rips_emts_in_preg_mom_death_5d0UDQYANcSrLDN4ZnqitI

Or if you don't plan on stopping, at least make sure that you're not wearing anything that could identify you as a first responder.

 

[Handsome Robb]

Even if you don't feel morally/emotionally obligated, here's another reason to stop and help:

http://www.huffingtonpost.com/2009/12/25/eutisha-rennix-death-jaso_n_403440.html
http://www.nypost.com/p/news/local/brooklyn/mike_rips_emts_in_preg_mom_death_5d0UDQYANcSrLDN4ZnqitI

Or if you don't plan on stopping, at least make sure that you're not wearing anything that could identify you as a first responder.

First link has nothing to do with this, they were on break, but still on duty therefore they have a duty to act. Second link yes, they probably should have acted but who are we to monday morning quarterback?

1st link the crew blew it, second link impounds the point to not wear your uni or identify yourself as a trained individual while off duty. In their defense, have you ever tried to ventilate a patient who was seizing? Good luck. They told them to call 911 which was what the patient needed. I don't condone their actions but how many people would have called them incompetent and 'idiots' if they would have kicked into work mode and she still died? Lose-lose situation.

What's your point?

 

[usalsfyre]

Even if you don't feel morally/emotionally obligated, here's another reason to stop and help:

http://www.huffingtonpost.com/2009/12/25/eutisha-rennix-death-jaso_n_403440.html
http://www.nypost.com/p/news/local/brooklyn/mike_rips_emts_in_preg_mom_death_5d0UDQYANcSrLDN4ZnqitI

Or if you don't plan on stopping, at least make sure that you're not wearing anything that could identify you as a first responder.

Right, because being on a coffee break in uniform is TOTALLY the same as driving by an accident on your POV off duty .

 

[Roheline]

In their defense, have you ever tried to ventilate a patient who was seizing? Good luck. They told them to call 911 which was what the patient needed. I don't condone their actions but how many people would have called them incompetent and 'idiots' if they would have kicked into work mode and she still died? Lose-lose situation.

What's your point?

This is my point. I'm not trying to condone or condemn their actions with my post, just presenting the scenario. The reality is that the public usually doesn't care whether or not they (or any of us) actually could have made a difference in terms of the patient's survival. I don't know how things might have gone differently if these two had jumped into action (and perhaps there really was nothing they could have done that would have altered the outcome), but I would bet that the public outcry would be much less if they had at least tried to do something. It's much easier for grieving family members to accept "we did all we could with the tools we had on hand but she still died" than "it was hopeless so why bother."

 

[Roheline]

Right, because being on a coffee break in uniform is TOTALLY the same as driving by an accident on your POV off duty .

No, it's not the same. But it is relevant to the discussion that's been going on as to whether or not to start CPR. I'm not trying to attack anyone with my post, just presenting another scenario for discussion. Never mind.

 

[Handsome Robb]

No, it's not the same. But it is relevant to the discussion that's been going on as to whether or not to start CPR. I'm not trying to attack anyone with my post, just presenting another scenario for discussion. Never mind.

Don't take his post offensively. It's just the fact that this topic has been beaten to death fifteen times over.

I agree with you. In a perfect society them trying to help would be viewed as a good thing, however in reality if the patient died despite their actions those two dispatchers would have been burned at the stake. :censored::censored::censored::censored:ty society we live in when it comes to things like this. Hollywood has built expectations that are not achievable but the general public doesn't understand that.

 

[usalsfyre]

No, it's not the same. But it is relevant to the discussion that's been going on as to whether or not to start CPR. I'm not trying to attack anyone with my post, just presenting another scenario for discussion. Never mind.

I see your point, and apologize. I guess I'm just appalled at this point by the extremism on this topic. Use some common sense. If your in uniform after a shift and someone falls out in line, it's probably a good idea to check on them. The flip side is don't tell me I need to stop in the middle of IH635 on my day off at a minor fender bender due to some deranged idea about "moral duty".

Practice a little judgment.

 

[mrswicknick]

I see your point, and apologize. I guess I'm just appalled at this point by the extremism on this topic. Use some common sense. If your in uniform after a shift and someone falls out in line, it's probably a good idea to check on them. The flip side is don't tell me I need to stop in the middle of IH635 on my day off at a minor fender bender due to some deranged idea about "moral duty".

Practice a little judgment.

In his defense, I don't think anyone was suggesting this. I would hope we're all smart and mature enough to practice common sense and use good judgment.

 

[usalsfyre]

Actually earlier in the thread folks were talking about our "code of ethics" basicly requiring us to intervene in any situation where there might be an injury.

Pretty wackerish stuff...

 

[Handsome Robb]

In his defense, I don't think anyone was suggesting this. I would hope we're all smart and mature enough to practice common sense and use good judgment.

I think usals' post stemmed from previous posts in this thread. I see what your saying though.

Crap, after all these post siding with usals people are gonna call me a fanboy! h34r: haha

 

[usalsfyre]

My first groupie!

I do wish you weren't, well, male though .

 

[Handsome Robb]

My first groupie!

I do wish you weren't, well, male though .

You have plenty of groupies. They are just not out in the open!

Hey I'll take groupie status seeing as I learn a ton from you. I'll start looking for a girl to takeover the other side of groupie status

 

[icefog]

Hmmm, the first thread I click on after the registration turned out to be a tiny gold mine, it's definitely interesting to see all the different opinions... and that's why this isn't really an answer to the OP exclusively, but rather trying to give my response on several points of view surfacing here - what to do first, how long a rapid assessment actually takes, what it involves, specifically, whether to stop at all, etc.

First of all, mrswicknick beat me to one of the points I wanted to make. Regardless of whether or not it's your legal duty to stop and assist a victim, I would always stop. I always treat patients as I want others to treat me or a loved one, and I can't imagine who, when given the option, would prefer to wait for an ambulance and be ignored by a passing EMT. Before someone hits the big red "unprofessional subjectivity" button: no, I'm not talking about involving yourself emotionally and doing CPR with tears in your eyes until you make a dent in the floor - I'm just talking about stopping or moving along. But anyway, everyone makes their own choice in this.

To the OP: I think it's great that you stopped, regardless of how you rate your subsequent actions. If you're in the same situation again, I hope you'll still stop. Medical assistance wasn't developed based on a prerequisite of equipment and pills - actually, it was the other way around. Even the smallest things like a (space) blanket could help sometimes. And even if you have nothing, there's still quite a lot you can do with your own hands and head. Improvise, communicate, control - you can do CPR, control the bleeding, monitor vitals and/or call dispatch and give them further info (I'm always happy to hear a colleague is already on scene and giving me a bit of a heads up on the way).

As far as the rapid assessment is concerned, you can get a general impression in a maximum of 10-15 seconds (this includes evaluating surroundings, other people present, number of victims, possible dangers, patient responsiveness, obvious injuries, etc). OP: It's important to be very aware of all details around you, but everyone's already said that, and maybe that's something specific to focus on. Significant visible bleedings are important here, as well as injuries that are incompatible with life. In your situation, from what I understand, survival would have been quite a miracle, and CPR would have probably brought nothing at all. But it always depends on the situation - assess and make your own call.

As far as the actual rapid/primary assessment goes, I know it can vary according to local protocols. I work in Germany, and what we do is this: check breathing capability and quality, estimate - not determine, just estimate - respiratory rate, as well as the pulse rate and quality in addition to the recapillarization time; briefly examine the thorax, abdominal, pelvic and femoral regions. That's it for starters. Even for one off-duty responder, with experience, it all takes 30 seconds or less and no equipment, unless you encounter special difficulties. So, within 60 seconds (tops) after actually starting the patient evaluation, even with throwing in some "D" stuff like checking the pupils and GCS, you get a good image of what's going on and can make the first choices and take the first actions.

In any case, OP, here's what you absolutely should do: never take my opinions, or any others for that matter, for absolutes. The best you can do is be prepared - train, be aware, get as much information as possible so you can make your own decision and act upon it. I'll say it again, control the situation and make it your call. Even if it turns out to be wrong later (happens to everyone at some point), you know that at that point you acted and did what you thought was best - if you think you could have done better, very good, you've learned from it and you're gonna do better next time.

 

[Rural EMT]

Interesting read from the start.
Not wanting to get invovled with the moral obligation/duty to act drama thanks, but i do want to talk about the assessments, here in South Africa alot of the medics practice a primary and secondary survey, which seems to fit in with your rapid and focused survey's respectivly.
That said when I walk into a room or arrive on a scene i do my primary survey as I approach the patient, looking at the responsiveness initially IE: is the individual talking,moaning,*****ing,screaming or just sitting there quietly, if the patient is moaning,talking ETC. I can basicall tick off my primary A and B, and as logic would tell you if the guy is breathing he should have a pulse thus my primary ABC is completed, then you move onto secondary survey where things are looked at more thoroughly like pulse rates and rhythms, resp rates and A/E BP and HGT etc. Now as we are 2 on any scene the vitals are split so its done faster. Basically trying to get an overall "picture" in less than 5 minutes so treatment can be initiated, we seldom arrive and load the pt nd rush to hospital as our patient time is longer as we have only 3 hospitals in a HUGE area.

If anything i have said contradicts your personal training or views please dont attack me personally the simple fact is thats the way things are done here in South Africa.

Thanks for the entertaining read this morning chaps!

 

[DV_EMT]

Ya know.... I have to say I overlooked this thread and I know i'm probably going to beat the horse dead one more time as it's probably been mentioned a few times already -- but as a BLS EMT w/o any gear you could have only done a few things.

1. General Impression/Rapid Trauma Assessment - FUBAR
2. Check Vitals/Assess patient - ABC's (if probable neck injury - jaw thrust)
3. If you we're feeling perky - assist with ventilations / resuce breathing.

When in Doubt, ABC's. I've learned that its the safest bet.

Sounds like just being there for the person in their last moments was the best option. If they're FUBAR, there's really not a lot you can do.