Running from police is a bad idea...

[jjesusfreak01]

So, ran up on an accident off duty for the first time since I started in EMS. Went like this...

Getting onto the highway after taking my mom to dinner for her birthday. Notice there's a black unmarked chasing a car in front of us. We keep up for a minute, but they're going quick and the speed limit is quite low on this highway. We see another PD unit pulling off an exit, so we look as we're going over the overpass. The car they were chasing had knocked over a metal pole and was stopped dead on the road. We decided to pull off on the B-exit, we pull over, and I offered help to the PD.

They called me over immediately and I took a look in the car. The pt was unconscious at best, and we didn't have access to the car yet. I asked why he was running, LEOs didn't know (this question was for my safety, not curiosity). They took out the passengers side window, I hopped in, started assessment. He had a good carotid, was visibly breathing, minor bleeding. He started to wake up, complained on neck pain. I headed to the back seat, held c-spine, and tried to verbally comfort the patient until fire and ems arrived. I had fun and got to show my family what I do at work. My little brother thought it was awesome.

 

[firetender]

That was YOU on COPS?

(Joke!)

But I have to ask.

From what you wrote...

it sounded like you began a head-to-toe exam but STOPPED at the point you suspected the man on the lam had an injured neck. You committed to holding traction and essentially took yourself out of the game of either further assessment or treatment.

That was my interpretation based on your choice of words, which, I'll bet, sacrificed crucial detail for the sake of brevity. Regardless, WHAT you said got me thinking:

In a circumstance like that where more advanced help is on the way, is a trained passer's-by role to do a thorough evaluation to give the arriving unit a complete report or is it enough to provide immediate stabalization without getting the complete picture?

If you come upon the scene of an emergency and CHOOSE to take action HOW do you want to hand off your patient?

Is it even appropriate to view the affected person as "your patient"?

I really like that SOMEBODY/ANYBODY who cares about you got to see you in (spontaneous!) action without being on the wrong end of the stretcher. Stuff like that is even MORE RARE than saving a life!

 

[DesertMedic66]

(Joke!)

But I have to ask.

From what you wrote...

it sounded like you began a head-to-toe exam but STOPPED at the point you suspected the man on the lam had an injured neck. You committed to holding traction and essentially took yourself out of the game of either further assessment or treatment.

That was my interpretation based on your choice of words, which, I'll bet, sacrificed crucial detail for the sake of brevity. Regardless, WHAT you said got me thinking:

In a circumstance like that where more advanced help is on the way, is a trained passer's-by role to do a thorough evaluation to give the arriving unit a complete report or is it enough to provide immediate stabalization without getting the complete picture?

If you come upon the scene of an emergency and CHOOSE to take action HOW do you want to hand off your patient?

Is it even appropriate to view the affected person as "your patient"?

I really like that SOMEBODY/ANYBODY who cares about you got to see you in (spontaneous!) action without being on the wrong end of the stretcher. Stuff like that is even MORE RARE than saving a life!

For me if I lay a hand to try to help someone then they become my patient until I hand them over. If I stop at an accident (which I have done before) I will have police make access into the vehicle for me. I will start my assessment. If I need to hold C-spine I will call for an officer to assist me (PD isn't going to be doing much after an accident). Then I will continue with my assessment. I do as much of an assessment as I can before fire and/or ambulance arrives on scene. Then I do a hand over of all the info that I obtained.

I only carry a super basic first aid kit (literally just gloves, paper, and some bandaids) in my POV so all I can do is a basic assessment. If needed be I am pretty good, so I've been told, at improvising. Mock MCI drill I have 3 patients backboarded. 1 on a LSB, 1 on a hardwood door, 1 on a sturdy ironing board.

 

[sirengirl]

I had something similar happen to me a few weeks ago (I said SIMILAR!). I was driving to work and noticed that the nearest unit happened to be on what seemed to be a smoke alarm call. About a mile down the road, what appeared to be a just-occured ped v. vehicle. Female, supine on median, 3 concerned citizens, one on with 911, no lights/sirens in the area at all. I didn't see any blood but female was holding face and seemed to be very upset- I'd be too if I just got hit by a car.

Here's the thing. I didn't stop. I don't even have gloves or band-aids in my car the way OP does. Best I would have been able to do is palpate a pulse, RR, HR, and get a history and hold c-spine. If there had been egregious bleeding, I have a beach towel in my car. By the time I saw the responding unit coming down the road, I estimated I would have had 3 minutes to get in vitals, a head-to-toe, history, c-spine, and starting any bandaging that needed to be done. To this day I still feel like crap for not stopping- but at that point I'd be a barely useful set of hands among others, crowding the scene and making the medic's job probably more difficult if anything.

That being said, I'm ordering a car kit... but that's besides the point. For days afterwards I wondered if I should have stopped, the way OP did, or if I made the right clinical decision since there was nothing I could do but pat her shoulder and say, "There, there, your heart rate is 98 from all the excitement, and you're breathing 20 times a minute. The real help should be here soon."

<_<

 

[MrBrown]

Hmm, Brown wonders if that warrant for Brown's arrest in Broward County, FL has expired

 

[jjesusfreak01]

(Joke!)

But I have to ask.

From what you wrote...

it sounded like you began a head-to-toe exam but STOPPED at the point you suspected the man on the lam had an injured neck. You committed to holding traction and essentially took yourself out of the game of either further assessment or treatment.

I won't cop to starting a head to toe exam. He was unconscious when I entered the car, so I got a carotid pulse, saw he was breathing. He didn't look too visibly banged up besides some cuts on his face. He woke up and I asked him if his neck was hurting, he said yes.

My thinking was this. I work in this system, but a number of the medics don't know me because I haven't been there long. I'm probably going to get the, "who is this bum holding c-spine" look from the medic when they do get there. Based on our location, I knew it would only be a few minutes before we had medics onscene. The patient was under the influence (charged with DWI per local news) of EtOH and possibly some prescription drugs, and was little help upon questioning as to whether anything else was hurting him. I could have tried to do a further evaluation, but I wasn't going to get very far and the medics were going to do a rapid trauma as soon as they had him out of the car.

There's also a safety aspect here. I'm already putting my butt on the line stepping into a car with a guy who was running from the police. I don't know why he was running. Holding c-spine in the back seat seems like a safer activity than rummaging through his clothes and palpating everything while he has his hands free.

That was my interpretation based on your choice of words, which, I'll bet, sacrificed crucial detail for the sake of brevity. Regardless, WHAT you said got me thinking:

In a circumstance like that where more advanced help is on the way, is a trained passer's-by role to do a thorough evaluation to give the arriving unit a complete report or is it enough to provide immediate stabalization without getting the complete picture?

Here's another way to think about it. For all intents and purposes, this is similar to an MCI scenario. I only have one patient, but i'm the only medical provider onscene and the patient is in a location that precludes thorough evaluation. I started off as triage, prevented the cops from pulling the guy out of the car which they wanted to do, made sure he didn't actually need to be pulled out of the car quickly, and then did basic support until further resources arrived.

If you come upon the scene of an emergency and CHOOSE to take action HOW do you want to hand off your patient?

Is it even appropriate to view the affected person as "your patient"?

I tell them he's got a good pulse, he's breathing, he's talking, list meds, and then I handed c-spine off to a FF. This is a really common simple call except the whole running from the police bit. And I did consider him my patient. You can bet if I wasn't able to get a pulse I would have made the cops pull him out, grab a defib, and we would have worked the code until the medics got there and took over. He's my patient until on duty medical personnel arrive.

 

[mycrofft]

Seems to have gone well enough.

The first rule is "take five to stay alive" (scene safety)= done, with a caveat (below).
The first duty is to refrain from harm, and subclause "a" is to prevent further harm=done.
Clinically approriate? I guess. For a relatively new, unequipped and off-duty (no duty to respond) EMT, not bad, not bad.

Safety caveat: without at least FD there for extrication or for washdown or extinguishment, one needs to really consider an escape route if the pt gets unruly, or a fire begins, or (perish the thought) another car strikes the scene, or a family member or friend of the victim summoned by cell phone arrives. Hope you had a back door open.

 

[jjesusfreak01]

The first rule is "take five to stay alive" (scene safety)= done, with a caveat (below).
The first duty is to refrain from harm, and subclause "a" is to prevent further harm=done.
Clinically approriate? I guess. For a relatively new, unequipped and off-duty (no duty to respond) EMT, not bad, not bad.

Safety caveat: without at least FD there for extrication or for washdown or extinguishment, one needs to really consider an escape route if the pt gets unruly, or a fire begins, or (perish the thought) another car strikes the scene, or a family member or friend of the victim summoned by cell phone arrives. Hope you had a back door open.

Agreed, I had no issues for the escape route. Every LEO within 5 miles responded to the scene, and the traffic was well controlled. I never closed the door to the car, so I could have bolted any second, and the police were ready to extricate the guy if things went south with him or the scene.

I think my primary role here was preventing further harm, and I was ready to give further care if necessary. If he was in arrest or had been bleeding profusely I would have done a lot more. As it was, I made sure EMS had been dispatched, made sure the patient didn't need immediate life-saving intervention, and then attempted to prevent him from further injuring himself. I can't think of anything else I could have done here. I would have loved to have more of the patients medical history for the medics, but he was a bad historian (as the docs like to say) at the time.

Thanks for the support. I'm one of those crazy people who thinks EMS is ridiculously fun, so getting to stop and give care to a guy in a police chase made my day.