what to know @ scene of accident

TazziRN, RN · Jul 18, 2007

I truly understand what you're saying and although I do agree I can't help thinking this is somebody's mother, sister, father, brother, husband, wife, etc...what would I want someone to do for my loved one if there was the slightest chance of survival??? I would agree with Eric that priority would have to be considered if there were more than one victim. The most salvagable should be helped first. Unless of course they simply had a cut or a broken bone.

If the arrest is traumatic, unless it literally happens right in front of EMS, there is no chance of survival. Head injuries that cause cessation of body functions is not reversible. Arrests caused by hemorrhage are beyond salvation because there is no more blood to circulate, and you ain't gonna find any in the field to infuse. At this point even colloids won't help.

I understand the need to "do something", but if you choose to initiate CPR for a traumatic arrest, do not be surprised or upset with yourself when nothing happens. The only traumatic arrests I've ever seen survive (two in my entire career) literally happened while EMS was working on them. Even then the chances are extremely slim.

EmmaG, RN · Jul 18, 2007

If the arrest is traumatic, unless it literally happens right in front of EMS, there is no chance of survival. Head injuries that cause cessation of body functions is not reversible. Arrests caused by hemorrhage are beyond salvation because there is no more blood to circulate, and you ain't gonna find any in the field to infuse. At this point even colloids won't help.
I understand the need to "do something", but if you choose to initiate CPR for a traumatic arrest, do not be surprised or upset with yourself when nothing happens. The only traumatic arrests I've ever seen survive (two in my entire career) literally happened while EMS was working on them. Even then the chances are extremely slim.

I witnessed one of those full size Suburban-type SUV's going at least 50 mph hit an older little Honda square on the driver's door. The crash occurred directly in front of the laundry where I was; one of our ICU nurses was next door at an insurance agent. A Paramedic who worked in our ER was at the squad building across from the laundry.

I ran out and was the first to get to her. The drivers' side was completely smashed in, and I reached in the passenger side, laid my hand on her chest and felt her heart flutter its last beat. The ICU nurse came running up and we pulled her out and began CPR while the paramedic attempted to intubate her. With the first compression, blood poured from her nose, mouth and ears. She had 2 nurses and a paramedic working on her, and there was no chance. We knew it, but continued to work on her until the ambulance arrived to take her away. We all were pretty shook up; I had to call in for the first four hours of my shift that night.

God bless EMT's and other emergency responders. No way in hell could I ever do their job.

vamedic4, EMT-P · Jul 18, 2007

Just remember though, that not everyone who arrests does so because of the trauma associated. They could be diabetic, or they could have had some other underlying medical issue that warrants attention. For all we know - this could have been the cause of the accident and not neccesarily the result of it.

We need to be careful when assessing patients at the scene to see if we can determine MOI (mechanism of injury).

If it truly is a traumatic arrest there's little to be done...but all that codes is not trauma...

Just a thought....

vamedic4;)

GilaRRT · Jul 18, 2007

Honestly, what are you going to do? Cram your nursing license into a bleeding wound to control the hemorrhage? I will stick to calling 911 and getting my butt out of the way of the paramedics when they arrive.

On a less sarcastic note: The statement above was simply designed to show you how very little you can do on a bad scene. Your only options will be BLS in nature, so do not loose sleep or worry your self to death over the scene scenario.

I also agree that traumatic arrest equals dead. Sure, you may get them back long enough to die of ARDS, DIC, or MODS in the ICU a couple of days later, but do not expect good outcomes with a traumatic arrest.

ZippyGBR, BSN, RN · Jul 18, 2007

I graduate in May but I feel like I don't know very much, especially about emergency care. If there was a car accident or other trauma before me I don't know what I could do. Stop bleeding, CPR, comfort. That's all I have to offer at this point. Anyone have ideas on what I could search on my own to be prepared if such a situation arises? I really want to be able to help if a situation warrants and I just don't feel educated enough yet.

whole variety of options present here....

if you just want to be confident in your first aid management go and do a first aid course ... if you aren't working in emergency care and don't have specific emergency care skills then good , appropriate basic first aid and make sure approipriate help is coming is more than adequate...

if you want tools to reassure you ...

- a good basic first aid kit ( which everyone should really have in their car anyway)

- a warning triangle

- a Hi vis vest and some leather rigger's gloves

- carry a dressing or two and a pocket mask in your bag

and just be a good first aider who happns to be a nurse

OR

if you want to develop Emergency care skills - find an organisation that you can vwork with / volunteer for and develop yourself a specialist interest in pre-hospital care go through the whole EMT siode of things and have a second string to your bow ( which might also lead to ood future jobs doing flight or land critical care transfer and HEMS)

rclimbr · Jul 18, 2007

I have always stopped at the scene of an accident if no EMS are on the scene. A lot of the post are from people that say they don't know what to do. Most people in the general population don't know what to do. A nurse on the scene can

1. Asses/treat ABC's

2. Keep the victim calm

3. Do an quick assessment and report to EMS

4. Try and prevent further harm by untrained people trying to "help"

one_speed · Jul 18, 2007

Holy crap !! two similiar questions on the forum in one day. I am going to advise the same as the LPN asking about emergencies in an ouitpatient clinic.

The very best thing you can do for yourself, your family and anyone else is take a first aid course.

No offence to any of the posters who took the time to respond to your question, but throwing comments out into the ether isn't going to help when the **** hits the fan so to speak.

I have been an ER nurse x 5 years, (studied for another 4 years) but I have been a volunteer ski patrollers and first aid / CPR instructor x 10 years.

Working as a "nurse" in the hospital or even the ER is more often than not totally different from stepping up at the scene of an accident (MVC, fall, what have you) and helping effectively. Different bag of tricks is how it has been described in the past.

Taking the time to take a more advanced first aid course will fill you in on alll you need to know. Things you might not think about in a controlled ER / hospital environment can bite you in the ass if you aren't careful. Triage is different, priorities go back to the basic ABC's, and personal safety is key.

IT IS OBVIOUS TO ME THAT ALL THE POSTERS THINK THE SAME WAY ABOUT THIS... THE ONLY ETHICAL THING THAT YOU CAN DO NOW IS FIND A GOOD FIRST AID COURSE AND EDUCATE YOURSELF !!

A partial list of tips to keep on the top of your head in case you stop on the way to registering for that training...

#1 - Look for Further Danger to yourself or the victim (you do no good if you get hurt or killed going to help someone don't put yourself in the position to get hurt yourself).

#2 - Look for the number of People injured (You will definitely need help, and it sucks to miss someone).

#3 - Look for the mechanism of Injury (sometimes the best thing you can do for the injured person is stay with them and keep them from moving -- see rule #1).

Call the Red Cross, HEart and Stroke, NSP, CSPS (In Canada) and trhey can hook you up.

Cheers, Ian

CSPS PAtroller

ER RN

Cheers, Ian

ZippyGBR, BSN, RN · Jul 18, 2007

I truly understand what you're saying and although I do agree I can't help thinking this is somebody's mother, sister, father, brother, husband, wife, etc...what would I want someone to do for my loved one if there was the slightest chance of survival??? I would agree with Eric that priority would have to be considered if there were more than one victim. The most salvagable should be helped first. Unless of course they simply had a cut or a broken bone.

multiple casualties - do the least for the most to prevent deterioration

traumatic arrest ABC = amen, bag'em, call the florist... , seriously, traumtic arrests have a really dismal prognosis even if you have a wonderful EMS sysyem, HEMS on tap and field physicians who know what they are doing ( and don't play silly cheese eating surrender monkey games atthe road side trying to 'stabilise' - the best pre-hopsital provider is the one who identifies the that second fluid many trauma patients need (after oxygen) is diesel / avtur )

one_speed · Jul 18, 2007

An addendum to the last post I made...

Graduating as an RN does not a first aider make.

Please don't use the "Good samaritan law" or ignorance as an excuse not to help someone in need. any help is better than no help and sometimes two cluelessheads are better than one (at least for supporting one another).

On that note... please take the time to educate yourself... inevitably someone will come looking for the "nurse" to step up and save a life.

Nothing irks me more than the call for "Is there a doctor in the house ?"

They are in the same boat... Grauating as an MD does not a first aider make.

I've said it before and I'll say it again (consider it a challenge if you must - this is a passion of mine. I pay to volunteer as a first-aider in my spare time. It's what I do for fun)

IT IS OBVIOUS TO ME THAT ALL THE POSTERS THINK THE SAME WAY ABOUT THIS... THE ONLY ETHICAL THING THAT YOU CAN DO NOW IS FIND A GOOD FIRST AID COURSE AND EDUCATE YOURSELF !!

Yes, I know. The bold capital means I am yelling (pleading really) because someday soon the situation will arise and you can make a difference in saving someone or them dying.

Ian

TazziRN, RN · Jul 18, 2007

traumatic arrest ABC = amen, bag'em, call the florist... , seriously, traumtic arrests have a really dismal prognosis even if you have a wonderful EMS sysyem, HEMS on tap and field physicians who know what they are doing ( and don't play silly cheese eating surrender monkey games atthe road side trying to 'stabilise' - the best pre-hopsital provider is the one who identifies the that second fluid many trauma patients need (after oxygen) is diesel / avtur )

Thank you for starting my day with a laugh!!!!! So true, and I absolutely love your choice of words!!!!!

Christie RN2006 · Jul 18, 2007

Nothing irks me more than the call for "Is there a doctor in the house ?"
They are in the same boat... Grauating as an MD does not a first aider make.

Forget yelling "is there is a doctor in the house"... we need to tell people to yell "is there a nurse or paramedic in the house" I have been involved in several situations recently that involved things that happened outside the hospital. The first was a guy at church that passed out... Someone yelled the typical "is there a doctor in the house" and my dad and I looked at each other like "oh brother" and we both ran over (my dad is a paramedic) We have a doctor in the church that happened to be there that day and to be honest, he was more of a hindrance than a help. He just stood there in the way...my dad had to push him out of the way to get vitals on the guy.

The second incident was a 2 year old that fell and hit his head and had a seizure. I yelled for someone to call 911 while I ran to help. The mom picked the kids up and was trying to stick her finger in his mouth to "stop him from swallowing his tongue" and she was trying to hold him tight to stop him from seizing. I very firmly instructed her to give him to me and she did and I immediately laid him on the floor in the recovery position...by this time he had stopped seizing. It took him a few minutes, but he finally came to, but had the classic postictal symptoms. I kept the mom calm and did what I could for the boy until EMS got there and I gave them a quick report of what happened.

The third incident actually happened in the cafeteria at my hospital. Someone came over and tapped me on the shoulder (we wear color coded uniforms, so nurses are easy to spot) and the lady said "I think that lady needs some help over there" I look over and she was face down in her food tray... my response was "oh crap" as I was shoving my chair back. This lady was in full arrest!! I was the only nurse in the cafeteria at this time too!?! and of course when they started paging for a code blue in the cafeteria everyone thought it was just someone choking... when the first RT came around the corner and saw me doing chest compressions she started screaming down the hall "its real, its real" we had people coming from all over to help with that one :) One of the anesthesiologist came in and intubated her right there on the cafeteria floor and by that point we had a heart rhythm back. By the time we had her back boarded and on the way to ER her eyes were open and she was responding :) Turns out this lady was a good friend of my parents mom and she is home doing great!

There was a 4th incident, but its a really boring one, so I won't bore you with it :)

My theory is, when something happens, #1 get help (you can't do it alone), then do whatever you can to help the person(s) as long as you are not going to put yourself in danger. I am yet to witness a MVA with injuries, but my mom threatens not to go anywhere with my both my dad and I at the same time because we tend to attract drama.. we can never go on a plane together, etc without the "is there a doctor on board" call going out :lol2:

Oh and I agree with the traumatic code responses... I am yet to see a person with a traumatic injuries that goes into full arrest actually survive.

one_speed · Jul 18, 2007

Should I witness anything else I will only do compressions. I would definately try to stop any bleeding. I keep gloves in my glove compartment and a regular tournaquet like we use to start IV's. Also IV supplies enough to access a vein. Fluids would have to wait on the amblance. I've thought of getting an ambu bag. You may think, why...? Those supplies are in my car when I'm at my parents home and at other family and friends homes. That's the reason I carry them. However, when faced with a chance to save a life I would do so. When it happens you don't think you just do whatever it is that you can with what you have available. When EMS arrives, back off, it's then all up to them.

I think that while your intentions are noble, they will prove to be ineffective and cause more harm than good. Then you will feel bad and cry...

( A general comment on many of the interventions described here, not you in particular, just using your case as a common example)

I'm headed to bed after a particulaily crazy night shift in our adult rescusc room in the ER I work at. So I apoligise if this comes off sounding a little disjointed or sarcastic.

Found this thread this am. Like I mentioned earlier this issue is a hot point for myself. I want to send a special thankyou to posting this where the most people can see it... obviously most nurses think about this issue alot. The sad thing is, in spite of this most will revel in their ignorance and say "what can I do? I'm just a nurse". :angryfire

My hope is that this discussion might prompt someone (RN, RPN, lay person, whoever) to educate themselves and actually help someone some day.

Granted the OP was referring to an MVC as an example, but I think that there is a lot of BAD advice, anecdotes being posted here.

Please consider looking into taking a proper first aid class.

Traumatic VSA is rare, 99 % of the time (random percent thrown out there to make a point) when some body is VSA at an MVC is that the person probably passed out before hand and ended up crashing the car... bystander CPR is what saves lives, not dagnosing cardiac tamponade, internal bleeding with your x-ray vision.

In day to day life someone collapses in front of you, gets hit by a car, falls off their bike. There are simple steps you can take to maximise their chances of surviving without lasting harm.

In my experience bystanders can do many things at an incident.

Most of what they can do may be good for the patient or just not make them worse,

In rare instances their actions can make things worse (bad c-spine injries, etc.)

The majority of time when a person has a poor outcome in an accident is that the bystander tried something and it was ineffective d/t improper technique, or just not the best action they could have done with their energy. (Think a person chokes and goes hypoxic while someone is trying to get an IV started).

ABCD !!!!

A- Support the airway (literaly hold it open if you need to)

B -Make sure they are breathing (breath for them if needed)

C- Can you actually find a pulse ?? Do they look dead ??? start CPR...

D- Disability (Are they uncoscious ? can you safeky put them into the recovery position ?

B- Is there any major bleeding ? put direct pressure on it if you can, have the patient put direct pressure on it.

Fumbling around trying to get the BVM you borrowed from work and that old 22 IV cannula is wasting time and asking for trouble. IV's never saved anyone, and a BVM never saved a choking victim.

Hopefully my rant can have some effect and get some nurses off of their butt and do something for themsleves and their families, friends, and neighbours. Educate your selves in these simple measures.

I'm going to bed.

Cheers, Ian