I'm new..and scenario I've been wondering about

[arez10]

This is my first time posting here..so hi I'm a fairly new EMT (got my EMT-B for NJ in August) and I have a random question. Let's say you're driving or walking and you witness a really bad car accident. You're obviously not with your rig and have no equipment. You check on the passengers and let's say one of them is in cardiac arrest. Do you move them into a supine position in order to do CPR? But then what about spine immobilization? Do ABCs just take priority over that? But then if you do revive them they can be living but paralyzed. It would probably never happen to me, but just one of those "what if's" that I would really like to handle properly if it ever did! Thanks for your feedback in advance.

 

[JPINFV]

• Well, tramatic arrests don't have a good resuscitation rate anyways [which should bring up the question of did the accident cause the arrest or did the arrest cause the accident].
• There is some debate on just how much good C-Spine precautions do.
• No amount of spinal immobilization will help a dead patient.
• Patients who are not breathing and do not have a pulse are clinically dead
• While I'm not sure on NJ law, most states have "Good Samaritan" laws that cover providers when off duty provided they provide BLS care [generally geared towards physicians since their licenses do not limit when/when/what they can do, unlike EMS licenses/certifications. This distinction is why I mentioned BLS care. Without the physician oversight offered while on duty, advance medical care could be considered practicing without a license]

 

[reaper]

Life Before Limb!!!

 

[EMTryan]

I am a relatively new EMT as well but here is what I would recommend:

Remember the ABCs.:excl: Airway, Breathing and Circulation. Airway managment takes priority over spinal immobilization. This would be a situation were you would want to quickly assess the patient. If the pt is obviously not breathing you would need to rapidly extricate the pt trying to protect the head/neck/back as much as you can. Lay the pt supine and open the airway using the Jaw-thrust technique if possible (if you can't open the airway with the jaw-thrust then use the headtilt-chin lift). Preform your initial assessment and provide care based on the conditions that you find.

You can spend a lot of time trying to immobilize the patient but it would be totally unnecesary. The ABCs take priority.

From what I have heard the pt in this scenario is almost certainly going to die. Very few people survive traumatic cardiac arrest in situations like this.

 

[KEVD18]

well if its truly a traumatic arrest you might as well bag em and tag em right there. IIRC, and im sure R/r will be along to correct me, traumatic arrests have <1% survival rate. its almost not even worth the effort.

however if your were of the motivation to work it, and your alone, theres nothing your going to be able to do to maintain c-spine. pull em out and flog away.

 

[MSDeltaFlt]

Since this is a "What If":

You are the only one on scene with multiple passengers of a bad MVC, one is in arrest, and you're BLS. Since you are only one caregiver with more than one victim, you are automatically in a MCI situation.

This is assuming that the scene is safe: the vehicle(s) aren't in danger of exploding or anything of the sort.

1. Contact 911 giving them a rapid triage assessment and get the ball rolling.
2. Black Tag the arrest. He's dead. Leave him be.
3. Start tending to the other(s).

This is a diar situation where hard decisions need to be made.

My two cents

 

[KEVD18]

Since this is a "What If":

You are the only one on scene with multiple passengers of a bad MVC, one is in arrest, and you're BLS. Since you are only one caregiver with more than one victim, you are automatically in a MCI situation.

This is assuming that the scene is safe: the vehicle(s) aren't in danger of exploding or anything of the sort.

1. Contact 911 giving them a rapid triage assessment and get the ball rolling.
2. Black Tag the arrest. He's dead. Leave him be.
3. Start tending to the other(s).

This is a diar situation where hard decisions need to be made.

My two cents

while your quite corrects if those are the circumstances, the op didnt specify the status of the rest of the cars occupants. i took that to mean they were just dany and the arrest was the only pt. what say you then...

and aas soon as i hit post reply, it occured to me: a death in the vehicle is considered significant moi, meaning all occupants need to be throuroghly examined on scene. but lets assume, since its really the heart of the op post, that it was a car v. tree and the driver is the only occupant.

 

[Ridryder911]

I really don't care how many other occupants, or their extent of their injuries (hang nail, etc) they will get treated by me before the traumatic arrest prior to my arrival. Trauma dead = DOA. Off duty, even more so.. I will call 911 and probably cancel the EMS unit.

R/r 911

 

[reaper]

But, May not be a trauma code.

 

[BossyCow]

But, May not be a trauma code.

good point, did the code cause the trauma or did the trauma cause the code?

 

[MSDeltaFlt]

Mute point. Dead, when you're the only one with multiple pts, is dead. It doesn't matter how or why. Black Tag him and move on.

 

[MikeRi24]

generally speaking, whats gonna kill him NOW? neatly immobilized trauma injuries arent gonna do the guy a whole lot of good if he has issues with his ABCs.

 

[KEVD18]

we're still not answering the question at the heart of the matter. the op(if i understand correctly) is inquiring about c-spine precautions and tx of cardiac arrest. so, as i said before, pretend its a car vs. tree and the only pt is the driver.

 

[MSDeltaFlt]

OK. Single patient scenario, but still solo caregiver. Pull him out and start doing CPR just like you would in any AHA class. You're not going to be able to hold C-Spine while extricating solo, so just get him out. It'll be a blunt trauma traumatic arrest. You will not get this person back, but it'll look good for the local paper with a few "Atta Boys" thrown in for good measure.

With multiple pt's, I wouldn't even bother. Cover him up as best you can, and tend to the others.

 

[reaper]

Just had one the other day. Car ran red light and was hit in rear passenger side. Got on scene and found that the driver had arrested prior to accident. Pt had no injury from mvc.

It does happen quite a bit. Not always traumatic code! Always prepare for the unexpected.

As stated if your alone, pull out and start CPR. With a crew, you can imobilize, but it does no good. You are moving the pt around during compressions. If their dead, it doesn't matter how much c-spine precautions you take!

 

[piranah]

if you use a jacket around their neck and under their armpits to extricate, it immobilizes their C-spine and it adds for good collar for compression movement...just a little emergency extrication trick...

 

[Gbro]

Good question for a new EMT.
Prior to extricating pt. i would open the airway. It is very hard to access circulation in a stressful situation. The adrenalin you are poring into your system because you are new at this, and even for some of us that are seasoned makes it hard to feel with the tips of your fingers.
i remember a 14 yof that was unresponsive in a MVA and I opened the airway, I was just ready to extricate and she came to. It was a difficult extrication and I would have done a lot of damage if I had extricated to soon.
There are obvious signs, eyes(lackluster) large laceration & no blood(these are with unconscious/unresponsive) obvious trauma etc.
I have found myself holding shirts before and vic on ground as they can flow like water(its shocking).

 

[milhouse]

now heres one thing that i think is a good point and its something my instructor told me when he was teach us about phtls. He said that a PT can live with a spinal injuries, but if they are not breathing they wont live.

now ofcourse he also said that when dealing with multiple PT's black tag him (like everyone else has said) and move to the next PT even if that PT only has a i dont know some sort of minor injury.

now to tell you the truth i dont know what i would do on scence because im also new at this. but i would hope that my medic would be able to point me in the right direction. because as we all know most people go on instincts. and when they see the first person DOA they go eeeekk and start slam dunking the PT. (atleast at some point in there EMS career.)

 

[Keith]

I just skimmed through the responces, but I just felt I would respond with my own personal answer (sorry if I'm repeating anyone). If I showed up at a scene such as this, with no equipment, I would say that a life takes presidence over spinal precautions. I'm personally not sure if it violates protocols (in MA), but I am going to extract the patient and begin to perform CPR, hopefully with a bystander that can assist, and if not, Im gonna try like hell to keep that person alive. Protocols are one thing, but your right as a moral human being, may object to that, you just need to do whats right.

 

[ccems644]

C-spine precautions take a back seat to CPR. You should always move a pt as carefully as possible to prevent further injuries but if your not breathing your not living. There are a lot of determining factors that play into any scenario that have to be taken into account that's one of the thing that make us professional while adding to the difficulty of our job.