At scene of fatal accident yesterday...

Nurses General Nursing

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Yesterday afternoon, I heard a bang outside my window and soon hubby came into the house to let me know that there had been a head-on collision outside of our house. I went outside immediately to offer assistance. When I arrived on scene, I saw a badly crushed small SUV on the side of the road with a young woman lying beside the vehicle. I didn't realize it at the time, but she was a passenger... her mother (driver) was killed on impact and trapped in the vehicle.

My neighbor was already out there and on the phone with the 911 dispatch. There was also a young boy in the car, but other drivers that had stopped when they saw the accident had him out pretty quick...he was not badly injured as he had been strapped in his corificeat in the rear seat. I went to the young woman on the ground, assuming she had been ejected from the vehicle. She was face down on the ground, not moving. I shook her and tried to rouse her...I saw her back move slightly twice...about 30 seconds apart...as though she was trying to breathe, but when I checked her pulse, there was nothing and she didn't move at all after that.

The neighbor handed me the phone and I spoke with the dispatch who asked me if I could do CPR. The girl was on her belly and when I tried to find her face, all I could see was blood and dirt. At that time, our local dentist came on scene and also checked the girl's pulse and couldn't find anything. I asked him if we should do CPR and he said he didn't think it would help...she looked beyond saving to him.

Today I feel awful...I feel like I should have tried to do CPR anyways. This girl was a young teenager and a member of our church and high school. I just didn't see how I could roll her over without making her injuries worse...I suspect she had a broken neck and/or severe internal injuries. The vehicle that hit them was a large pickup and the combined impact was at least 120 mph. It didn't help either with my neighbor hovering over me saying "You're a nurse right?" (I'm an LPN). I have just been second guessing myself all day and didn't sleep last night...kept having flashbacks every time I closed my eyes.

Thanks for letting me vent.

Specializes in Medsurg/ICU, Mental Health, Home Health.

I am the "go-to" nurse for codes and emergencies on my floor, but that is a very controlled environment. I think I would have been in such shock that I wouldn't have even had the wherewithal to check accurately for a pulse. You did awesome!

Don't beat yourself up, there is NOTHING you could have done, sounds like. The best thing you can do is find out what can be done for this devastated family. And, of course, talk to someone about this, maybe even a professional. Being a witness to an event like this is traumatizing.

Will be praying for you and the family.

Specializes in Acute Care Psych, DNP Student.
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.

I agree. I've performed CPR on someone with a fractured neck. It's terrifying to turn someone who is lifeless and literally broken, but if the person isn't breathing, you've got nothing to lose.

Specializes in Acute Care Psych, DNP Student.
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?

If they do not have any respirations or pulse and you do not have the proper equipment to stabilize their spine, you move them the best you can, trying to keep their spine in neutral position. You just do the best you can.

Another thing to keep in mind is depending on the trauma, be careful with chest compressions because what penetrated their torso could penetrate you when you compress the chest.

Specializes in Acute Care Psych, DNP Student.

The problem is nursing education and BLS does not prepare nurses for this sort of action, yet some nurses will encounter these situations.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.

I am so sorry for you loss ((BIG HUGS))I lost my Dad 3 years ago.....there were days I didn't think I'd survive the sadness, it hurt so much. You will always miss them....but I promise it does get better.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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?

The car is on fire.....they are lying on the ground in gasoline and the car is in fire. Remember a face down blunt force trauma probably has multiple chest/facial fractures and performing CPR will be......difficult and disturbing, it feels like you are pressing on an abdomen. The rib cage is crushed.

The possibility of survival is less that 2% and those who do survive have REALLY bad out comes......in that 2% are the trauma's that live past 24 hours of admission and subsequently suffered brain death.

I posted yesterday the NAEMSP/ACS-COT Guidelines for Withholding or Termination of Resuscitation in Prehospital Traumatic Cardiopulmonary Arrest

PLEASE READ!

1. Resuscitation efforts may be withheld in ANY (that was 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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These are accepted EMS guidelines and standard of care. There was nothing the OP could have done.

OP you did great.....

Specializes in Acute Care Psych, DNP Student.

Nurses working in jails and correctional facilities where violence occurs had better be clear on when they move someone to start CPR and when they don't. This could also arise in psych and residential facilities.

For example, my former employer required me to perform CPR until EMS showed up in all instances - except when decapitation, livor mortis/rigor mortis, or decomposition were present.

Some nurses will find themselves in non-hospital environments where this comes up. It's very difficult if you don't have paramedic training.

Specializes in ICU.
...snip...

Some nurses will find themselves in non-hospital environments where this comes up. It's very difficult if you don't have paramedic training.

Dealing with people in CP arrest can be difficult, paramedic training or not.

Do the best you can.

If in doubt, given a pt in arrest, DO SOMETHING.

Darned if you do, darned if you don't. There will always be hyenas nipping at your heels, offering useless thoughts along the lines of "why didn't you do...".

The "hyenas" weren't at the scene...you were. Make a decision based on your training/personal experiences...Then act.

Realize that no matter how you act in this messy situation, you may incur personal emotional damage. Thoughts of woulda/shoulda/coulda. Be prepared to seek emotional/spiritual "first aid" for yourself after the event.

((((hugs)))))

((((Hugs)))) to you....... I have been in your shoes a couple times, and it's tough. You get this gut-wrenching feeling that you could have done more, or should have done more, etc. Just know that you did everything you could do, and you kept yourself safe, which is the priority.

So very sorry for your loss.

The vehicle that hit them was a large pickup and the combined impact was at least 120 mph.

^ This. It's why, when everyone else went big, I went big, too. I now drive a Ford Crown Vic car, and a Chevy 2500HD diesel. People need to consider the big picture, not just the MPGs, when they choose a vehicle.

Sending a huge hug your way!!!!! I am also a ER/ICU nurse, and irregardless of what we "think" we can do (just because we are nurses), isn't always the RIGHT thing to do):-) I have also been at the scene of several accidents, but not the severity of what you witnessed. As nurses, we feel as if we want to try and save everyone, but we can't. YOU did the absolute right thing. It would/could have more than likely been more harm done. Calling 911 was the correct thing to do. So sorry for their loss. Take care:shy:

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