Question about an accident

elkpark · May 21, 2005

I don't mean to sound harsh, but "missing half her head" is not a very good prognosis ... People with chests going up and down and their lips moving are not dead, but her chances of surviving, with that massive a head injury, were extremely slim unless the accident happened in the parking lot of a Level I trauma center. If it took 60 minutes for the cops to get there and 70 minutes for the EMTs, she really had no chance. There was nothing you could have done, yourself, to save her (besides calling 911, which you did).

Ready · May 21, 2005

I don't mean to sound harsh, but "missing half her head" is not a very good prognosis ... People with chests going up and down and their lips moving are not dead, but her chances of surviving, with that massive a head injury, were extremely slim unless the accident happened in the parking lot of a Level I trauma center. If it took 60 minutes for the cops to get there and 70 minutes for the EMTs, she really had no chance. There was nothing you could have done, yourself, to save her (besides calling 911, which you did).

Well as far as proper prognosis, dont know how else to say it. I mean, there's really no good way of saying it. If your looking for medical words im not the one to give it to you because im only taking basic college courses (Not quite up there with the Big dogs yet). I appreciate your response but i was actually just curious if she was actually dead and her body was just in the process of shuting down, if so, why didnt they check her pulse when they arrived. Did it not matter due to the massive head injury that occured? I realized there was nothing i could do ( I dont even know CPR). :crying2:

gwenith, BSN, RN · May 21, 2005

You did the right thing!!!!

Although the passenger was "breathing" it would have been reflex action because the respiratory centres are so low in the brain near the base. If she had been "missing half her brain" as you describe then there was no hope of survival except as a vegetable.

Trauma Columnist · May 21, 2005

I think you did what you could do. However, I have to question why the extremely long response time? That is unheard of in most parts of the states. I am a pre-hospital RN with a rural squad and even our response times (and we sometimes have to travel 25 miles to the scene) is only 20 minutes.

nurse_wannabe · May 21, 2005

Well as far as proper prognosis, dont know how else to say it. I mean, there's really no good way of saying it. If your looking for medical words im not the one to give it to you because im only taking basic college courses (Not quite up there with the Big dogs yet).

Hi, Ready. I just wanted to say that Elkpark wasn't berating you about proper medical terminology. Prognosis means "chance of surivival or recovery," so what she/he was saying is that someone missing half her head has a very poor prognosis, i.e. a very poor chance of survival. Hope that clears that up.

That being said, I feel just horrible for you. What a horrific thing to have witnessed. I hope you can comfort yourself with the fact that there was nothing you could do, and at least you DID stop, which is more than many would do in this day & age. And, like others have pointed out, even if the passenger was still breathing, she would not have had any semblance of a normal life after that.

I'm also curious as to why it took an hour for the police to get there. If someone HAD been seriously injured but not dead, they surely would have been after waiting so long. :stone

Biffs25 · May 21, 2005

Personally, I would have at least checked for a pulse to ensure the respirations you described weren't true respirations and not agonal respirations as she died, but as previously stated, with such a long response time her prognosis was not good. With a massive head injury such as you described, maybe they could have saved her in the sense of her heart was still beating and she was alive on a ventilator, but it sounds like she would have never been alert and functional ever again.

Another consideration would be how entrapped she was within the vehicle. Even if they were going to attempt to rescucitate her, the lengthy extrication on top of the lengthy response time doesn't give the patient good odds at survival.

Just my thought process at work.

prmenrs, RN · May 21, 2005

I'm with the other posters. What you saw was brainstem activity, not indicative of any reasonable viability.

It'll be hard for you to get over the visual images; if there is a professional you can talk to, I would encourage you to do that.

You did the right thing, you don't need to feel any regret about that. It's normal to feel sorrow about the people who died, just as you would about a pt who passed on. Just the suddenness of witnessing the accident is traumatic.

As for the response time, bad EMS, very bad!! Don't know if you want to file a complaint, but that might be a good thing. After all, you were the one sitting there waiting for them; I think that was pretty bad.

:icon_hug: Best wishes.

meownsmile, BSN, RN · May 21, 2005

I agree in respect to response time. And very unlikely this person would have survived, however, i think there should be some kind of report made. No reasonable person would want to know their loved one sat for over 60 minutes waiting for EMS, with or without a chance at survival.

That said, and not to redirect the thread, but with that hour delay how many others have they denyed a full life, when this could have been a very viable organ donar if they had responded within reasonable time?

Happy-ER-RN, RN · May 21, 2005

Before I had ever even thought about going to nursing school about 5 years ago I also witnessed a horrifying (gory) event involving a young man who died. It was very hard to deal with and looking back I wish I had gone to talk to a professional. I was in shock for about a month and it actually took almost two years before the incident no longer haunted me. You could have Post Traumtic Stress Syndrome from the incident. Your brain simply cannot process the information because it doesn't fit into any "cognitive schema" you may have had before. In other words, your mind knows that people's heads are not supposed to look like that, and it can't deal with what you saw. You are likely to keep seeing the images and keep wondering if the person could have lived. Seeing a professional can really help you get past all of that. The feelings you are having about the situation are completely normal. If you are in school there is probably a counseling center, GO! And I promise you that the way you are feeling will pass and you will feel normal again, it just takes time.

mariedoreen · May 21, 2005

As for the response time, bad EMS, very bad!! Don't know if you want to file a complaint, but that might be a good thing. After all, you were the one sitting there waiting for them; I think that was pretty bad.
Well, let's not be too hasty here... I haven't spent much time in more congested areas of the country (ie the eastern US) but I'm starting to wonder if y'all live in the back yard of hospitals. Where I live you can certainly travel to many areas of the state that would necessitate a long response time.
We're all pretty familiar with how EMS and police operates, they get a call, they race to get there. After all half of them go into the profession just to run the lights and sirens :chuckle If we think logically about this, the fact that it took both the police AND the ambulance that long to respond (both are separate agencies responding from their respective bases) tells you that the accident happened in an area away from where emergency professionals are based.
I'm sure the officer AND the paramedics were not BOTH sitting in their respective stations watching TV and drinking coffee an extra half hour before deciding to get up and get out

mommatrauma, RN · May 21, 2005

As for the response time, bad EMS, very bad!! Don't know if you want to file a complaint, but that might be a good thing. After all, you were the one sitting there waiting for them; I think that was pretty bad.
Well, let's not be too hasty here... I haven't spent much time in more congested areas of the country (ie the eastern US) but I'm starting to wonder if y'all live in the back yard of hospitals. Where I live you can certainly travel to many areas of the state that would necessitate a long response time.
We're all pretty familiar with how EMS and police operates, they get a call, they race to get there. After all half of them go into the profession just to run the lights and sirens :chuckle If we think logically about this, the fact that it took both the police AND the ambulance that long to respond (both are separate agencies responding from their respective bases) tells you that the accident happened in an area away from where emergency professionals are based.
I'm sure the officer AND the paramedics were not BOTH sitting in their respective stations watching TV and drinking coffee an extra half hour before deciding to get up and get out
I absolutely agree..being a PHRN and also living with a paramedic...I can tell you that when they get calls like that..they are tripping over each other to get out the door...even the most jaded medics..because these are the calls they live for...not the 4am earache...so I agree that possibly that is truly the response time...sad but true..not everywhere in the country is lucky enough to have a ALS or even BLS unit every few miles...where I live there are so many medics and emts they could trip over each other...so our response times are alot less...Also, you have to take into consideration if the ambulance company they are responding from are paid staff or volunteers...because not all volunteer companies require their staff to stay at the place the ambulance is located..so if they had to respond first from home then get the ambulance out, it could also prolong response time...As for prognosis...didn't sound good..and the thought that someones head was half off and the other person was already dead, definitely doesn't sound like the "breathing" person still had any chance...I think its not unreasonable what the police did when they got to the scene...you can pretty much believe that the person had no idea what hit them and I'm sure they weren't suffering...hopefully that will help set your mind at ease...Even being a nurse for 10 years, there are still some things that I see that simply haunt me...I remember one day last year I was riding with one of our local flight services and we got a call for a car accident with entrapment...Its very eerie when you pull up on a bad accident, but its a whole new meaning when you can see everything as you hover over it before you land...It was a car carrier that tried to get in the left lane and didn't see the car next to it..small little honda type car and the car was pushed up onto the center concrete barrier sideways so that the passenger side windows were on the ground and the driver's were in the air...The passenger died in that accident and we flew out the driver, who miraculously got himself out of the car....Some things just stay with you for a long time, and you relive it like it was yesterday...but know you did what you could have done under the circumstances....that's the best you can do...