Situation tonight, was I wrong?

matty4522

Forum Ride Along
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0
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Hey Everyone,
I've been lurking for a while but registered tonight to tell this story. I'm an EMT-B out of MA. Still working on getting onto an EMS Service. I'm 19, been licensed for about 2 months. I was driving with friends (non EMS ones sadly) and came around a corner of a dark tricky road. I saw a State Trooper with his lights on, and a car smashed up against a tree. I stopped and yelled and asked if he needed help. Trooper screams "YES" I get out, said "Sir I'm an EMT whats up?" Choice of words could have been better but whatever. He says "He's got no pulse I can't find a pulse" One male driver in the seat, Head leaning on left shoulder, multiple face and scalp lacs, eyes and mouth open, blood and teeth in mouth. I tried for carotid pulse, tried for radial. Nothing. I yelled to the trooper who was at his car 10 feet away on the radio. I said "Sir do you have a breathing barrier we need to start CPR on him" He ignores me. I said "SIR I need your first aid kit" (Which he had out on his hood) He says "Ok ok" and walks to his trunk.

I have nothing against the State Police, this trooper was panicked. I was surprised at how calm I was. Trooper continued to ignore me. I walk to the road and look, no pocket mask in the bag. I yell "TROOPER I NEED A BREATHING BARRIER" to get his attention. He finally gets one out of his car for me. I walk back over and tried to get the pt out. His legs were slightly trapped, I am not a big guy at all, so I needed help. I opened the back door and got in. I tried to lift him and slide, nothing. I said to my friend "We need to get him out just help" He says "His neck is broken don't bother"

At this point, I'm second guessing myself. The guy wasn't too warm, had serious serious trauma, pupils fixed and dilated and from all I could sense, Dead. I felt as though I needed to try something. I needed to start CPR and try. I figured this is what I'd want someone to do with my relative, TRY. I said "Trooper we need to start CPR are you going to help?" He says "Just wait for fire" I replied and said "Well where are they?" As I said that they came around the corner. FF's get out, I said "No Pulse, no breathing" They walk over and two finally get him out of the car. The old FF starts chest compressions which I could see were not quality at all. Not even close. He tells the other FF to forget the OPA and o2 and just bag him. FF at head does not perform ANY maneuver to get the airway open, no lift, no jaw thrust, nothing. I could see there was no chest rise. As the FF was giving compressions he says to the trooper "Just call the medical examiner" Other Police show up, Troopers take my info and I leave. I see a BLS and and ALS Truck rush up the hill as I was going down. I waited and when they came back down, no lights or sirens. I assume the worst.

Was I wrong? This was my first "Code" but I felt like we should have tried. Provided, the 5 minutes wouldn't have brought him back but I feel we should have tried. I'm mad at myself for not trying harder to get him out and start CPR. I was alone in the situation and had a cop telling me "No don't do it" I wish the outcome was different. I wish the cops could tell his family that we tried. Instead of "He couldn't get him out of the car alone so I stood there and watched" Was I wrong? Should I just give up next time and say forget it?
I'm not so much freaked out, I'm just a little glum. I'd like to think that quality compressions and breaths could have given him more of a chance than I did.
 

MrBrown

Forum Deputy Chief
3,957
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Brown admires you for working this dude because I wouldn't have.

This qualifies as an "inappropriate to commence resuscitation" so no I don't think you did anything wrong, if anything, you did more than I would have!

Good work mate :)
 

CAOX3

Forum Deputy Chief
1,366
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No, in the sense you werent wrong you want to help thats what brings most of us into this field. You have to determine patient viability. If his injuries are not compatible with life its futile and best left alone.

It seems this guys fate may have been determined before you arrived. The survival rate for traumatic arrest is dismal. We do work them on occasion however when you find them dead they usually they stay dead despite our best efforts. The fact that the ambulance didnt transport is a sign this guys injuries were not compatible with life.
 

lightsandsirens5

Forum Deputy Chief
3,970
19
38
Hey Everyone,
I've been lurking for a while but registered tonight to tell this story. I'm an EMT-B out of MA. Still working on getting onto an EMS Service. I'm 19, been licensed for about 2 months. I was driving with friends (non EMS ones sadly) and came around a corner of a dark tricky road. I saw a State Trooper with his lights on, and a car smashed up against a tree. I stopped and yelled and asked if he needed help. Trooper screams "YES" I get out, said "Sir I'm an EMT whats up?" Choice of words could have been better but whatever. He says "He's got no pulse I can't find a pulse" One male driver in the seat, Head leaning on left shoulder, multiple face and scalp lacs, eyes and mouth open, blood and teeth in mouth. I tried for carotid pulse, tried for radial. Nothing. I yelled to the trooper who was at his car 10 feet away on the radio. I said "Sir do you have a breathing barrier we need to start CPR on him" He ignores me. I said "SIR I need your first aid kit" (Which he had out on his hood) He says "Ok ok" and walks to his trunk.

I have nothing against the State Police, this trooper was panicked. I was surprised at how calm I was. Trooper continued to ignore me. I walk to the road and look, no pocket mask in the bag. I yell "TROOPER I NEED A BREATHING BARRIER" to get his attention. He finally gets one out of his car for me. I walk back over and tried to get the pt out. His legs were slightly trapped, I am not a big guy at all, so I needed help. I opened the back door and got in. I tried to lift him and slide, nothing. I said to my friend "We need to get him out just help" He says "His neck is broken don't bother"

At this point, I'm second guessing myself. The guy wasn't too warm, had serious serious trauma, pupils fixed and dilated and from all I could sense, Dead. I felt as though I needed to try something. I needed to start CPR and try. I figured this is what I'd want someone to do with my relative, TRY. I said "Trooper we need to start CPR are you going to help?" He says "Just wait for fire" I replied and said "Well where are they?" As I said that they came around the corner. FF's get out, I said "No Pulse, no breathing" They walk over and two finally get him out of the car. The old FF starts chest compressions which I could see were not quality at all. Not even close. He tells the other FF to forget the OPA and o2 and just bag him. FF at head does not perform ANY maneuver to get the airway open, no lift, no jaw thrust, nothing. I could see there was no chest rise. As the FF was giving compressions he says to the trooper "Just call the medical examiner" Other Police show up, Troopers take my info and I leave. I see a BLS and and ALS Truck rush up the hill as I was going down. I waited and when they came back down, no lights or sirens. I assume the worst.

Was I wrong? This was my first "Code" but I felt like we should have tried. Provided, the 5 minutes wouldn't have brought him back but I feel we should have tried. I'm mad at myself for not trying harder to get him out and start CPR. I was alone in the situation and had a cop telling me "No don't do it" I wish the outcome was different. I wish the cops could tell his family that we tried. Instead of "He couldn't get him out of the car alone so I stood there and watched" Was I wrong? Should I just give up next time and say forget it?
I'm not so much freaked out, I'm just a little glum. I'd like to think that quality compressions and breaths could have given him more of a chance than I did.

How serious? From your initial discription it sounds like some facial lacs and blunt trauma to the mouth. Were there other obvious injuries? Chances are there were and you jsut didn't mention them?

And you probably couldn't help any. Don't feel bad. If he did have injuries inconsistant (that is how I am taking your serious, serious trauma line) then fire probably should not have even started CPR. Five more minutes of compressions if you have bled out are not going to help you any more than all the drugs, electricity and oxygen in the world would.

I struggled a little with the same sort of issues about a month or so ago. Was I really making a differance? Why didn't a CPR run or a traumatic pediatric death "get to me."

Because I can only do what is already fated to happen. If it is your time to die, I can't do a darn thing about it. That does not mean that I won't fight with all the tools I have been provided with, but if I cannot stop the inevitable and I have done everything I am allowed to do, that is not me being a bad caregiver, it is fate. What I can do though is hold someones hand, talk to them, calm them down. I have listened to peoples last words, but you just can't let it make you feel bad when you can't save one.

I agree with Kiwi Brown, good on ya for assisting the LEO. Good call on sot starting CPR.

Take care.
 

usafmedic45

Forum Deputy Chief
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The survival rate for traumatic arrest is dismal.

Specifically, less then 1% in most studies of blunt traumatic arrest.

Your only mistake was working the guy. I don't mean this as an insult, but it's a rookie mistake most of us- including myself- have made. The detachment and the judgment that will allow you to not intervene when the patient is beyond help will come with time. If you need someone to discuss this with further, you're always welcome to PM me.
 

Seaglass

Lesser Ambulance Ape
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Agreeing with the above. And it's better to work a code and be wrong than not work it and be wrong.
 

Mountain Res-Q

Forum Deputy Chief
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Were you wrong to stop and offer assistance? No. I would have done the same in a situation where their is an obvious serious MVA with only one LEO on scene. Kudos on stoping... Kudos on wanting to help; to do something; Kudos have some composure...

However, as stated before, this guy was never gonna make it. Traumatic arrest patients barely have a chance if the arrest happens in a Trauma Center. Consider the reason why he arrested... is there anything you (or anyone) can do to reverse that damage in the pre-hospital setting. Major trauma, arrest, getting cold, pupils fixed and dialated, etc... I would not have even worked the code. Being a newbie with no field experience, I do not fault you or trying or for being collect and in control (qualities that the trooper may have been lacking). Good for you... but I would not have even considered (for more than 0.38 seconds) working it based on your medical assessment. Yes, some traumatic arrests are worked, but survival rates are piss poor and there has to be significat reason medically why you think that your efforts might have a chance. On the other hand, flogging a patient who has no chance (and is already basically DEAD) does no one any good.

As for the Fire Guys... Granted you are a newbie, but if their treatment was substandard, then what was the point? Obviously this guy was DOA, so maybe they half-azzed it, which is a $hitty thing to do. Run the code or DON'T. Maybe they were just following protocol in starting working it but didn't really think they should (hence the crappy treatment), which is a mark against the system as well as them. Maybe they are crappy when it comes to EMS; in which case you did right to observe and note what you found substandard... you were learning. Should you get with an EMS Service never find yourself adopting the bad habits of others.
 
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firetender

Community Leader Emeritus
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Appropriate...

...pure and simple. Under the circumstances you did what you were trained to do. The man was not neglected. And yes, it's true, the circumstances of his death did not raise a whole lot of enthusiasm amongst the responders. That happens as well. You'll get to make all sorts of choices in this biz. As you go along, you'll get better at recognizing the choices that are easiest for you to live with.
 

usafmedic45

Forum Deputy Chief
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Appropriate

How do you figure?

Under the circumstances you did what you were trained to do

No offense, but I was taught not to work on people who are non-viable. I know you have that penchant for helping whenever you can, but let's not give the new guy the impression that flogging a corpse constitutes "helping". He made a poor choice with the best of intentions, but still needs to learn that no pulse in the field in a blunt trauma patient equals death.
 
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usafmedic45

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We do work them on occasion however when you find them dead they usually they stay dead despite our best efforts.

FDASTW= found dead and stayed that way
or it's in-hospital equivalent: ADASTW= arrived dead and stayed that way.

The only reason to work someone with an arrest from multisystem blunt trauma is if they code in front of you...or, if you know, you (or your student) need the practice.
 

firetender

Community Leader Emeritus
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appropriate at his level of experience

still needs to learn that no pulse in the field in a blunt trauma patient equals death.

...betcha that's what he learned! How else do you learn stuff like that? A book can't do it. It's a mistake he won't make again, and it wasn't a mistake. Mistakes kill people.
 

usafmedic45

Forum Deputy Chief
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How else do you learn stuff like that? A book can't do it.

I often wonder how you can be so experienced and so dense at the same time. Of course you can learn from books, otherwise why would be have them. Physicians and every other true medical profession don't learn by letting people realize on their own that blunt trauma arrest resuscitation is futile or other similar well-defined facts.

Your attitude towards non-experiential learning (or rather learning from other's experience without having to repeat it) is just another sign that we have a very long way to go in the growth and maturing of this field.

It's a mistake he won't make again, and it wasn't a mistake. Mistakes kill people

No, not all mistakes are fatal. If you don't learn from the minor mistakes, you eventually make one that does kill someone (or yourself). Relying on your own experience alone simply means you start making the same mistakes with an ever increasing level of confidence. The fact you think the only mistakes are the ones that kill or hurt someone is a sign that you're not nearly as mature and perceptive as you like to believe yourself to be. You have a lot of the attitude characteristics described as those of a "rogue" by Tony Kern in his book, Darker Shades of Blue: The Rogue Pilot. While it pertains with aviation, reading it with EMS in mind will really show just how dangerous that attitudes a lot of the non-progressives in this field actually are.
 

CAOX3

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The fun ones....or not so much fun are the medical arrests that result in an MVA.

Like my buddies Run DMC would say "It's Tricky"
 

LucidResq

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Given the circumstances I think you did fine. Although the guy almost certainly didn't have a chance long before you first laid eyes on him, you didn't exacerbate the situation, and I'm really glad to hear that you didn't go all willy-nilly "I'm a hero" and mouth-to-mouth him with no PPE.... gross....

As a brand spanking new EMT essentially alone on scene, it'd be hard to expect you to make that call that the guy was dead-dead. So put it in your treasure chest of experiences, learn from it, and move on. I wasn't there and I'm not God, but I can almost guarantee there's nothing you could have done even if you were a trauma surgeon rolling up on scene with your brand new mobile OR.
 

Mountain Res-Q

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...rolling up on scene with your brand new mobile OR.

He has only had his cert for 2 months and Galls has recently been experiencing some delays in shipping... give him time... :lol:
 

LucidResq

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He has only had his cert for 2 months and Galls has recently been experiencing some delays in shipping... give him time... :lol:

You know, they have an extension that comes with a neurosurgical suite as well.
 

mycrofft

Still crazy but elsewhere
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Most states allow LE to declare death on scene if like this one.

Coulda gone worse, like facing off the LE and getting buttstroked with a Kellight and/or arrested.

Experience will make things clearer and a little less urgent sometimes*. I applaud your willingness to help, reflects good spirit, you didn't freeze.





*Sometimes MORE urgent, to the puzzlement of the bystanders).
 

usafmedic45

Forum Deputy Chief
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Most states allow LE to declare death on scene if like this one

No they don't. Only physicians and coroners/medical examiners investigators have that authority. California just happens to be one of the few states where deputy sheriffs are also deputy coroners. ;)
 

mycrofft

Still crazy but elsewhere
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Ok

Declaration and securing of the location of a fallen person as a crime scene (murder, manslaughter or other to be determined) is a defacto declaration of death.
 
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Shishkabob

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Unwitnessed arrest from blunt trauma with no signs of life visible by provider at any point = resuscitation isn't even attempted, per my protocols.
 
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