Thursday, February 16, 2012

Don't Be Helpless...

Last night on the ride home from work I had an unpleasant experience. Coming up to one of the many stoplights on the ride home, I noticed that traffic was backed up in an unusual manner - rather than being stopped *in* the intersection, the blockage was *after*. I waited a full light cycle - I steadfastly refuse to be one of those morons that proceeds into a backed-up intersection on a yellow light - and then came upon the reason for the back-up.

Somehow, a pedestrian had managed to wedge themselves under the driver's front side of a passing car. It was hard to ascertain exactly what happened, but my WAG is that the driver went around someone turning left at the intersection and didn't see the pedestrian on the side of the road. In any case, when I passed the scene there was a person wedged underneath the car, and sneakers out in the roadway that cars were driving around.

I pulled over to see if there was anything I could do - there were no emergency vehicles on scene at this point - and called 911 as a first option. The calls are routed to the MA State Police, and I was in the process of describing the scene (MVA involving a pedestrian, trapped under vehicle, etc.) when to my relief I saw flashing blue lights approaching. I informed the 911 operator that local PD was on scene and ended the call.

At this point I realized that the best thing I could do was get out of the way - this was going to involve extrication and immediate onsite trauma care - so I put the truck back in gear and started off. I didn't get more than a half-mile away when I saw the firetrucks and an ambulance en route, so I left knowing that the cavalry was almost there and certainly better equipped to handle things than I.

As I continued my drive home, it hit me. The person (who would later turn out to be an adult male) appeared to me to be a school-aged girl somewhere around my own kids' age (hey. It's hard to tell age and gender when there's a 2,500 pound car on top of someone). When I went by, the victim was face down on the ground with their eyes open, and it was the scariest thing I think I've ever seen. I thought about that person's parents getting that call, and just lost it for a moment.

And then I realized: What would I have done if emergency services *hadn't* been moments away?

The last time I had CPR training my son was an infant. I've had basic First Aid recently through Scouting, but that covers minor injuries the likes of which Scouts are likely to encounter - bug bites, cuts, scrapes, broken bones, etc. Not serious injuries requiring CPR and such. Fortunately, Mrs. G. works at the local hospital, which runs CPR and advanced First Aid classes frequently for the employees as well as the public, so she's going to keep an ear out for the next class - which I will be attending. I'm also going to significantly revamp my truck First Aid kit to include a wider range of options (right now it's mainly bandaids and Ace bandages).

I figure it can't hurt to have the training - at the very least I'll be better prepared if something unfortunate happens out in the woods or at the range. I'll have a better idea what to do should I come across another scene like the one I witnessed last night, so that I can do more than call 911 and pray the next time. The feeling of utter helplessness I experienced while sitting in my truck on the phone with the 911 operator is something I hope I never experience again.

And now I have to give up coffee for Lent, because that's the agreement I made with Him when I was praying...

That is all.

18 comments:

Lissa said...

"Breathing, bleeding, bones, burns" is the way I learned it. Of course, you may have to address a few of those simultaneously - not much point in doing just CPR if the person is also in danger of bleeding out.

I've no doubt you'll be better positioned the next time you pass an emergency. More medical / emergency knowledge is always good!

Dave H said...

If you can, check around with some places that do training for law enforcement and other emergency responders and see if they'll do a civilian class. Last summer I took a one day "Injued Operator Care" class given by the same guy (paramedic, police officer, SWAT team medic) who does a 3 day version for professional first responders.

Our civilian class was focused on problems we're likely to encounter at the range or while hunting: gunshot wounds, weather and wildlife exposure, strokes and hear attacks. (Admit it, you see some pretty old guys at the range some days. I hope to be one of them.) The class didn't just cover treatment, it also covered how to make and stock a field kit cheaply. (Hint: everything but Quick Clot and trauma bandages comes from Walgreens or Home Depot.)

You're on the right track - training is the best first aid tool.

DaddyBear said...

Breathing, bleeding, shock, psychological support. Make sure they're breathing, stop any rapid bleeding, keep their temp steady, and hold their hand and talk to them to keep them calm until the cavalry arrives.

Dave has an excellent idea. My BIL is an EMT. I should ask him who does his training, and probably make a copy of his personal first aid kits.

AllenF said...

In your AO:

http://www.sigsaueracademy.com/Courses/ShowCourseDetails.aspx?CourseID=211

They just brought the Pocket Doc from Dark Angel in as an adjunct.

ASM826 said...

I took an EMT course when I was a Scout leader. It's lapsed now, but it was worth the time and effort. Got certified on CPR, got a lifeguard cert too.

A couple of my sons took what is called "backcountry EMT" in college. Because if your on a multi-day trip with a group, you might be all the help there is for what will feel like a very long time.

Anonymous said...

Hmmm...

First---I'm a PA with 20 years experience in Emergency, Urgent Care, and Primary Care.

A couple years ago I was the 2nd car to stop at a multi vehicle highway accident.

Vehicle 1 was a full size pickup that had rolled multiple times, the rear axle was detached and 150 yards from the remainder of the rig.

It had an adult male, conscious, with a compound tib/fib, compound left femur fracture, extending through the open drivers window and laying on the door. He had obvious multiple lacerations, with his belt still in place. I got the next couple people there to keep him calm. There was no significant arterial type bleeding from the leg, and he was very conscious, so I went to triage Vehicle 2.

Vehicle 2 had a very pissed off 50ish lady who turned out to be a Registered Nurse, but who had nothing much but some bruises from her air bag deployment and a deire to beat the snot out of the guy doing 90 + who had done a "bump to pass" on her.

Back in vehicle one the guys appeared stable. While I was triaging vehicle 2, a few more cars had stopped. One driver was an active duty trauma surgeon from the Navy, one driver was an ER RN, and one driver was a rural practice GP.

And what did all that accumulated knowledge do....We hung around monitoring vital signs until the guys with extraction equipment got there!

The truth is that you really can't carry enough equipment to do any good in your rig, unless you dedicate your rig to being a rolling trauma rig, and then it is useless for anything else.

Under different circumstances we might have been able to help...Say he had been tossed and unconscious and having respiratory problems, but....you can't have everything.

My bag has tubes, bag/valve mask, etc.

BUT...you can't have everything!

Roy said...

Anonymous - What is a "bump to pass"?

David said...

Before cell phones, I was the first vehicle at a single car roll over on the freeway in WY at 4:40 AM. As I stopped, with my car blocking both lanes of the interstate, I told my Mom to tell the Semi that was slowing behind us to block the highway also, and have him radio the accident in. I told my aunt to come with me. She refused.

I worked my way through the debris field that was car parts, personal belongings and bodies that covered about 150 ft of interstate highway.

First body - dead, missing everything from bridge of the nose upwards.

second body - 16 year old girl (the driver) crawling about on the roadway calling for her mother. Severe shock and bleeding from leg injury. I called to my Aunt, to tell Mom that we needed ambulance for 2 or 3. There was another body 12 feet away that I could hear moaning. Then I yelled that she should grab the blanket and box from the trunk, walk through the ditch, but get over here NOW!

third body - still alive (somehow) just had a "broken" look about him. legs were bent and twisted in places and ways they are not supposed to bend or twist. Left upper arm and wrist broken. Wrist was compound fracture. No signs of major blood loss, just lots of little scrapes. Eyes closed but he was breathing and moaning.

Fourth body (in the car) - dead, head crushed between the roof and the dashboard. (only body wearing a seatbelt)

I went back to the girl. Got her to lay down, tried to talk to her - unresponsive, just kept calling for her Mommy. Aunt arrived - not looking well. I grabbed the cleanest rags I had from the box in her hands, covered the leg wound and told my aunt to keep pressure on it. Wrapped the blanket around the girl, elevated her knees, positioned my aunt so her back was to the scene around us, and told her "Don't faint, talk to her, don't let her move. Keep pressure on that leg."

I went back to the guy. He was really jacked up. I was getting by with 20 year old boy scout first aid training and a CPR class from 3 years earlier. But this guy was so far out of my league.

He was trying to sit-up but couldn't move anything except his head and right shoulder. I knelt down by his head and admonished him not to move. He demanded that I help him sit up. I refused. I knew that I wasn't supposed to move him, but regardless of physical condition, the last thing this guy needed to see was the condition he was in, or the condition his family was in.

We argued for a few minutes. I ended up holding his right hand which already felt like cold dead flesh. Eventually he stopped arguing with me and started asking about his family. I avoided giving him any details. He told me his name, talked about his job, bragged about his kid. We talked for 40 minutes until the ambulance showed up. He died as the EMT knelt down on the other side of him. The EMT immediatately asked me "Was he breathing? Talking?" I said yes. He leaned over, did one chest compression and stopped. I looked at him and asked "Whats wrong?" He said "that felt like trying to do chest compressions on a bag of potato chips."

I stood around for a while while they treated the girl and got everyone off the road, then I helped the highway patrol clear the debris off the road. I asked the EMT before I left "What should I have done for him?" He told me "Nothing you could have done. Hell, there was nothing I could have done. There was nothing that a trauma surgeon could have done. The guy was broken - all of him. Rib cage is shattered, he was bleeding out internally. I don't know how he managed to live long enough to talk to you for 40 minutes."

So get your training. Have equipment in your car. But be ready to accept that when it comes to accidents involving large fast heavy vehicles, sometimes there will be nothing you can do. Except maybe call for help, then just sit there and listen.

Paul, Dammit! said...

Ugh. I've had that happen twice. After I took an EMT-Advanced equivalent (I think that's what it's called, anyhow) class to get a shipboard medical person-in-charge certificate, I ended up being the first responder to an unresponsive old-timer in the first class section of the flight I was on. The walk up to first class was the longest walk ever.
Funny, though; my mind blanked for about 10 seconds and my brain worked just fine on autopilot- muscle memory.

I've seen one nasty car crash since. It made me turn around and go home. Knowing that you know nothing is one thing; knowing that you don't know anywhere near enough to help is even worse. I'd say you did very well.

Will Brown said...

"Bump to pass"; in NASCAR racing it is permitted for drivers of faster cars to bump the rear bumper of slower cars that won't move aside to allow the faster car to pass during the race. I've never actually seen anyone do this on the street - especially at any speed - since doing so anywhere but a NASCAR race track is ADW. For the record, to successfully pull off the maneuver you must first match speed with the slower vehicle in front, then slightly accelerate so that both bumpers touch without forcing the leading car into a violent spin that will almost certainly involve the bumping car as well.

More than likely, the speeding pick-up driver simply misjudged his approach speed and hit the slower car instead of cleanly passing. Along with both cars spinning out, the high center-of-gravity pick-up also flipped apparently.

There's a good reason those professional race drivers get paid so well; not only is what they do extremely dangerous, it's also extremely expensive to learn how to do it "safely".

Anonymous said...

Will Brown, a perfect explanation, and exactly what I believe to have happened.

****** Happens, its tough to have a big enough shovel to pick it all up!

Julie said...

mmm,you've been reading my mail again! I was just debating with myself whether or not i was going to renew my Senior First Aid cert & CPR ... thanks, i'm off to book the course.

Stithjim said...

CPR and First Aid training is nothing more than a dither in common sense. And nobody ever agrees on CPR training anyway. 30 compressions and 2 breaths one year, 20 and 1 the next, and I've even been told that the breaths are useless and pumping will do the job fine.

If you want real training, get it. I don't see how rehashing the RICE or ABCs of First Aid will help you in that situation.

See if there is a local CERT chapter or EMT Trauma course that you can take (sometimes even free). It will take some time, but is a lot less demeaning. I remember in my (state mandated) First Aid course that a pressure wrap will stop all bleeding and a tourniquet is outdated.

Moreover, trauma care is about having the tools handy, training abound, a cool head, and above all, common sense. Being able to properly turn over (or exfiltrate if there is a danger of leaking fuels) a victim with a possible back injury is fairly key.

I don't expect everyone to be able to reinflate a collapsed lung on the side of the road, but improvise with what you can. You're roadside triage. Stabilize, minimize blood loss, and let them be taken to the hospital.

Ross said...

And no one noticed that Jay - "American rage boy" - is going to give up coffee for several weeks? ("How long is Lent, anyway?", asked Jay's token Jewish reader.)

This is going to be interesting to watch...

MedicMatthew said...

Jay,
I've often advocated that anyone with any sort of common sense should take a first responder or EMT-basic class if they have a desire to come out on top during any sort of disaster, natural or otherwise.

We stockpile stuff and fancy ourselves as being prepared for any sort of crisis that may come along but we tend to overlook simple things such as emergency medical care. What I do for a living certainly isn't rocket science, but it is the most basic of care that can have the most significant impact.

If nothing else you can show off some mad bandaging skills the next time one of the G kids takes a spill. Plus, chicks dig a guy that can take control of such situations (or so I'm told, I've never really paid attention to such things).

Anonymous said...

Ross, I suspect Lent is going to be very, very long in the G household! And you're not the only Jewish reader

LittleRed1

Mikael said...

Take a first aid & CPR course. Things change, what they'll teach you will be different on several points to what you once learned. Also it's prudent to refresh your skills at least every other year.

(As an example of things changing: the look, listen and feel for breathing part of CPR is GONE, just go straight to compressions).

firefighter4884 said...

Stithjim,

The reason the changes in the CPR guidelines keep happening is that the science of CPR is evolving. The current model has layperson CPR being compressions only. The studies are showing that victims of sudden cardiac arrest have a better chance of ROSC (return of spontaneous circulation) if they are given uninterrupted compressions in order to raise their blood pressure. Even healthcare providers (who should know better) have a hard time meeting this standard, and the lungs have some residual oxygen in them, so the AHA has changed their guidelines.

Jay, as far as your kit goes, let me know if you want some help / ideas? I play as a medic for work, and carry a fairly stocked kit in my personal truck for making runs with the fire department.

Now, like a bunch of other people have said, be prepared for the scenes you can't fix.... I had the misfortune of running a really nasty car wreck 2 weeks ago, and it wouldn't have mattered if the truck had rolled into a trauma surgeons OR the shape that the patient was in...