At scene of fatal accident yesterday...

mmutk, BSN, RN, EMT-I · Oct 22, 2012

What did EMS do when they got there? Did they start CPR or just cover her with a blanket.

I made the mistake as a firefighter once doing CPR on a MVA victim who was clearly dead. It created a mess, then EMS had to continue it, then the hospital had to "try" when she got there. A waste a time and resources, all because I started CPR at the scene. If she was already dead, you made the right choice.

Esme12, ASN, BSN, RN · Oct 22, 2012

What a horrible experience. That kind of trauma.......it sounds like she had unsurvivable injuries. You can actually cause more harm than good by moving a trauma victim. Traumatic arrests just don't do well......even if they survive the resuscitation process. There was nothing you could do........you did everything you could have....((BIG HUGS)).

What many people don't understand is that there is very little that medical personnel can do in the face of these situations. Without the benefit of the hospital surgery and blood......it's essentially a gab and run situation. If you save them what are you saving them for? What brain damage has been irreversibly done? Many of the general public see these miracle stories "I was snatched from the hands of death and lived to tell......" Sadly that is not the case at all....they are the rare exception to the rule and there are many wounds medicine can't heal.

Eight years ago there were EMS guideline set forth for the non resuscitation of trauma in the field......traumatic arrest in the field has a less than 2% survival rate. (The Trauma Professional's Blog)

It will take time to forget what you saw......talk to someone. Ask your local EMS if they have any trauma debriefing services in your area. But also remember.....there is only one who holds the strings on life and death. For me I know it is God....for you someone or something else. You did what you could......you responded and you called for help

NAEMSP/ACS-COT Guidelines for Withholding orTermination of Resuscitation in Prehospital Traumatic Cardiopulmonary Arrest
1. Resuscitation efforts may be withheld in any blunt trauma patient who, based on out-of-hospital personnel’s thorough primary patient assessment, is found apneic, pulseless, and without organized ECG activity upon the arrival of EMS at the scene.
2. Victims of penetrating trauma found apneic and pulseless byEMS, based on their patient assessment, should be rapidly assessed for the presence of other signs of life, such as pupillary reflexes, spontaneous movement, or organized ECG activity. If any of these signs are present, the patient should have resuscitation performed and be transported to the nearest emergency department or trauma center. If these signs of life are absent, resuscitation efforts may be withheld.
3. Resuscitation efforts should be withheld in victims of penetrating or blunt trauma with injuries obviously incompatible with life, such as decapitation or hemicorporectomy.
4. Resuscitation efforts should be withheld in victims of penetrating or blunt trauma with evidence of a significance time lapse since pulselessness, including dependent lividity, rigor mortis, and decomposition.
For the rest of the guidelines.....
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You did all that you could.....((HUGS))

Guest343211 · Oct 22, 2012

This is horrible situation to be in, and I have been there myself several times, both while working and as a witness. I am an FNP but have also been a paramedic for 14 years. I think that you did everything you could and it sounds like the outcome would have been the same no matter what. However, as a paramedic, I will say this. If she was pulseless at the scene and lying on her belly, would it have really done more harm to turn her over? I mean she is already pulseless, how much worse off can she be?? As for worsening of internal injuries, remember, nothing really matters unless she is breathing. Always remember, life over limb. Did she have a c-spine injury? Probably. Are you going to make it worse by turning her? No. She is already pulseless. What would I have done? Turn her over and start compressions. It doesn't sound like rescue breathing would have done her any good, but if you had a mask or something I would have done that as well. Like everyone has stated, pulselss traumatic arrests in the field rarely have good outcomes. But don't ever worry about doing more harm to a patient that is already pulseless. The one thing that did catch my eye in your story was the fact that the child was removed from the car before resucers arrived. Unless the child was in imminent danger, he should have been left alone. I know it our natual instinct to pick up the baby, but what if the baby had a spinal injury? A car seat helps but is not 100% effective. Just my 2 cents worth from being a paramedic (which I loved and miss, but the pay sucks).
Also, I just wanted to tell you that after my very first traumatic arrest in the field, I had nightmares for about 2 months and had to sleep with the light on. I kept seeing his body shoved down in the car. It will get better, I promise. If it doesn't, talk to someone about how you are feeling. Don't keep it bottled up inside.

The above makes much sense to me. Guess it depends on you POV. Pulseless = will become brain dead. Seems very probable that death would have ensued, but I am of the ilk where you must try. OTOH, maybe something in you just assessed that it was beyond any one human being. My mom is not the healthiest retired nurse, and she came upon a motorcycle accident--she witnessed it. The police, no one would help her. She work ED for years. She did CPR, finally got the police person to help her, but the young man didn't survive. As she says, she can't read a crystal ball, so she tried. Stranger things in life have happened. Lord knows we've seen that. She didn't worry about a mess or getting sued. She just concerned herself with doing basic CPR, and she figured, at the very least, as he was dying, she was there, and he wasn't alone. So in her mind, she couldn't lose.

She also had nightmares that followed, and she has had traumatic experiences up the whazoo throughout her WHOLE life--starting as a child. She also witnessed many as a nurse. So, no matter what, it is still a big shock to your system, regardless. I agree that if you think you need to debrief with someone, you should. Just don't feel guilty about it. It's not like you jumped into your car and went to McDonalds.

OP I am guessing that when you rolled her you might have thought, "At this point, what can be done effectively to help her?" And that is not at all unreasonable. Your nursing skills and experience probably formulated it's own rapid assessment.

So, making your best judgmental call, you did what you knew you could, and at the very least, you were near her as she was leaving this earth. That's the way I'd look at it.

Just wondering if the teen and mom were wearing seat belts? I know it doesn't always save people, but I sure learned that it can go a good way toward preventing more serious injuries. I would have had major brain damage if I hadn't been wearing mine when I had my car accident.

I know working trauma is really tough; but I feel the worst for those out on the scene that have to scrap the poor people up as they are--whatever their condition.

OP, please, don't feel badly at all. It's a horrifying thing to experience, and I truly hope you get some peace over it.

ChaseZ · Oct 22, 2012

Do not feel bad. As others have mentioned there is a pretty much a nonexistent chance of survival from blunt traumatic arrest. On the ambulance we do not even attempt resuscitation we just call it in the field. If you did by chance get ROSC through CPR there would be little hope for meaningful survival to discharge. You did the right thing.

nurseprnRN, BSN, RN · Oct 22, 2012

Wear your seat belts, don't drive too fast for conditions, car seats for the small ones, and be careful out there.

:redbeathe

CrufflerJJ, BSN, RN, EMT-P · Oct 22, 2012

jamieslovingmom -

I'm sorry that you had to experience this. It is never easy to see people suffer or die.

Even for people with lots of EMS experience (19 years in my case), it can be rough.

Two weeks ago, I had a similar event happen close to my house. A family (mom/dad/3/6/10 year old kids) were on their way to a local corn maze. Somebody went through a stop sign, and the family's car was krunched badly by a pickup truck going 50-60 MPH. I took the time to put on a pair of gloves & call 911, then ran to the scene (right across form my home).

The 3 year old baby was in trauma arrest. I'm still amazed at how quickly I made the decision to "triage her out", and focus on the 6 year old baby. The 10 year old child had walked out of the car, and somebody else was taking care of her. The 6 year old was unconscious, and had a mouth full of blood & broken teeth, which I kept having to sweep out to maintain an airway.

It's 2 weeks later, and I still have memories of the 3 year old, wrapped up in her coat & scarf, tucked in her car seat, blood running out of her mouth. Nasty stuff, mixed in with feelings of guilt (could I have...should I..?).

It's not easy. Even knowing that blunt trauma arrest pts are typically not salvageable, it's still hard to make a deliberate decision to ignore a young child in trauma arrest to focus efforts on a less injured child.

Sometimes, life just plain sucks.

Please take care of yourself, and talk over your feelings with somebody you trust.

DawnJ · Oct 22, 2012

This is a timely discussion for me. I witnessed the immediate aftermath of a motorcycle accident on my way to school this morning. I'm a second semester student, but CERT trained for triage and first aid. The man was on the road, helmet pretty dented and quite a way down the road.

I didn't stop since he was in the recovery position, had someone with him and the ambulance was behind me--so I just got out of the way. But I was thinking about what I could have done if circumstances had been different (no responders seconds away). I asked at school and my instructor said the only thing to do was not move him and put pressure on bleeds, and CPR if needed.

I had been thinking that I could have possibly gotten some early vital signs for the hospital, but she said that they wouldn't need that. I'm wishing him the best and watching the papers. The EMTs scooped him up right away and were passing me on the way to the hosptial within 5 minutes, so he must have been pretty bad off.

Esme12, ASN, BSN, RN · Oct 22, 2012

This is a timely discussion for me. I witnessed the immediate aftermath of a motorcycle accident on my way to school this morning. I'm a second semester student, but CERT trained for triage and first aid. The man was on the road, helmet pretty dented and quite a way down the road.
I didn't stop since he was in the recovery position, had someone with him and the ambulance was behind me--so I just got out of the way. But I was thinking about what I could have done if circumstances had been different (no responders seconds away). I asked at school and my instructor said the only thing to do was not move him and put pressure on bleeds, and CPR if needed.
I had been thinking that I could have possibly gotten some early vital signs for the hospital, but she said that they wouldn't need that. I'm wishing him the best and watching the papers. The EMTs scooped him up right away and were passing me on the way to the hosptial within 5 minutes, so he must have been pretty bad off.

The biggest help you can give EMS is call 911......activate the system! It just isn't safe to move an accident victim without proper training or c-spine immobilization. They can be fine and when you move them you kill them or paralyze them forever. Do a little as possible check for a patent airway, maintain c-spine.

I am a trauma nurse. I had my daughter in the car as we saw a van roll over and watch a passenger be ejected out the windshield and thrown a few hundred feet down the highway land face first and roll. My roll was to call for help.....and I activated the helicopter for I knew them. I blocked traffic (with some helpful truckers) to ensure the victims safety.....his facial trauma/head trauma was obvious that it will probably not be survivable. A chin thrust open his airway.....all I ever have with me are gloves and a pocket CPR mask. He ultimately did not survive.

When my friends and co-workers arrived.....I told them he's got a weak pulse, good luck and went on my merry way.....taking vitals really isn't information they need. All they need is whether or not there is a pulse and are they breathing.....the rest they take from there and isn't important.

Your instructor is right.....vitals are information they medics don't need. Keep others from moving the victim and CALL FOR HELP!

Activate the EMS system.....the quicker they get there the better the chance of survival.

RNewbie · Oct 22, 2012

For those of you with more trauma experience: When is it okay to move a person in order to start CPR? I always hear to not move people because it can cause more damage, so how can you do CPR unless they land on their back? I guess I'm wondering how do you determine the risks vs benefits of moving them?

hiddencatRN, BSN, RN · Oct 22, 2012

If they're pulse less, they're dead. Can't do more damage than dead, although I'd definitely argue that there are worse things than death. OP probably wouldn't have caused more harm to the patient by starting compression only CPR....but it sounds like that wouldn't have been much help either. Either way, this poor girl had unsurvivable injuries: high speed impact, thrown from the car, another death within the same compartment...OP, what a hard thing to go through. It sounds like you did everything that you could.

wannabecnl · Oct 23, 2012

As others have said, TALK TO SOMEONE. Do not go through this alone. Find a professional counselor, an EAP person at your workplace, or someone like that to help you with this. I am sure that your husband will want to help, but I would still encourage you to find a professional.

I lost my mother in December and have seen a grief counselor since January. She has been a lifesaver to help with all of the "I'm a nurse; why didn't I (fill in the blank)?" questions. My husband has been my rock at home, but it is not the same as a professional who can help you deal with questions you will have about what happened.

allnurses Guide · Oct 23, 2012

jameslovingmom, Dawn just want to add (((hugs))) It takes a while for your spirit to recover from witnessing scenes like those. Hope you take all the excellent advice here to heart. ♥