what to know @ scene of accident

[NurseNature]

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.

[EricJRN, MSN, RN]

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).

Just to clarify: Do you really believe that most poor trauma patient outcomes are due to errors made by bystanders?

[DutchgirlRN, ASN, RN]

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 not sure why from the beginning of this thread it has been assumed that coming upon the scene of the accident equates to a traumatic arrest??? The vast majority of car accidents are not traumatic arrests. If I come upon an accident and the paramedics are present..I drive on by...absolutely no reason to stop.

If I come upon an accident and no paramedics are present I'm gonna stop. If my actions are ineffective (its happened) fine, at least I cared enough to stop to confirm that. His daughters called me and thanked me for stopping and for trying despite the fact I knew their father was already dead. They were very thankful that someone cared enough about a stranger to stay with him until the authorities arrived. The fact that he was dead was irrelevant. Their father was not alone, that's how they felt.

I know you were not referring to me..."Then you will feel bad and cry..." but I want to respond to that. I did not feel bad nor did I cry, I felt good that I did something and I knew that for sure after I received the phone calls from his daughters.

The woman in the K-mart parking lot did survive for several days. I didn't feel bad that she died. As a nurse I know one thing for sure, some people survive or die no matter what we do to them. I just try to do what I feel is the compassionate thing to do, human to human.

I once responded to a gentleman who fell out at the mall. Assessing him I realized he was probably a diabetic. He was trembling, clammy, sweating, he was having trouble thinking and was very confused and then he passed out completely. He was breathing, he did have a pulse. He was no longer responsive. I had someone run to get sugar and someone else to call 911. I got the sugar in his mouth. He came to. He had taken his insulin that morning and had not eaten. If my assessment had been wrong and he was not a diabetic then the sugar would have done no harm.

[one_speed]

Not exactly, There is often room for improvement with the bystander where they might make a difference to improve the outcomes for an accident victim (not necessarily trauma). In rare cases, bad interventions by bystanders may have contributed to bad outcomes.

sorry , I'm trying to formulate a response that makes sense to others and not just my sleep deprived mind.

I think I am trying to say that in general,

any intervention is generally better than no intervention,

some interventions may accomplish very little,

and there are some interventions that are better than others.

The key is to learn what intervention will help the patient the most.

ie. take a course. too much time can be wasted on ineffective treatments when better things can be done to help the casualty (hence the creation of first aid and prehospital standards of care, trauma care (TNCC, ATLS) CPR, AR, etc.

I know the feeling of at least being there was good, but what if you could be there, do something proven to be useful and improve the outcome. (We can argue specific cases to no end, that's not my intent.)

for example:

Poking an unconscious drunk friend with a stick may be fun and feel good to be supportive (well... at least it feels good), but it probably won't help much. Where as placing them in the recovery position to make sure that the airway stays open so they can breath and they don't drown in their vomit is generally a more effective intervention. The likelyhood of them having a C-spine injury (depending on mechanism of injury and witness accounts of course) is low, so deciding to keep them flat on their back in an effort to protect their neck will generally be a bad intervention and may result in a negative outcome.

clearer ?

[RNperdiem, RN]

Call 911 on the cell phone and do the ABC's if safe. There is a difference in theoretical knowledge learned in the classroom and actual trauma experience.

There have been studies in the military about how many times a soldier has to repeat an action so that it becomes automatic when the bullets fly and the thinking part of the brain checks out. There is a reason soldiers drill.

I think the ABC's and CPR are similar. The experienced and well-drilled perform better.

[FlyingScot, RN]

OK after many months of lurking I actually registered to comment on this subject. There is some good info being given here and then some well... not so much. First of all thank you for bringing up the subject as I firmly believe it is an important one for us both professionally and as human beings. As nurses we are NOT trained to be first responders in school or in practice. Initial care of an accident victim is very different from the nursing care we to which we are accustomed. Even ER nurses know very little about initial treatment of an injured patient. Do we put patients in c-spine protection...sure but my experience has been that not one nurse I have come into contact with knows how to accurately size a collar. They just estimate. Sager or Hare traction splint, you're kidding right? And what's a Thomas Half-Ring?How big is the "danger zone" around an accident scene without evidence of a fuel spill? With a fuel spill? In an up-over type of accident what kind of injuries would you suspect? These aren't things with which we are familiar because they aren't taught in nursing school and we don't usually experience them in our practice. So to have an expectation that you will inherently "know" what to do at the scene of an accident is putting unrealistic expectations on yourself. One person stated that their state's Good Samaritan law only covers lay people. Not true. The Good Samaritan Law was first enacted to cover off-duty physicians and has been expanded to cover other health-care workers as well as lay people in ALL 50 states. Even architects are covered specifically in some state's legislation in the case of building collapse. If you are off-duty and outside of your place of employment and you act prudently with the resources and training you have available without expectation of payment you are absolutely covered. If you are on-duty and outside of your area you are also covered as long as you follow hospital policy. Does this mean you won't get sued? No but it is extremely unlikely that the case would even make it to court and if it did again unless you did something really egregious they won't have a case. I must warn the person who carries IV catheters with them. Our scope of practice does not allow us to place intravenous lines in the field without an MD order even in emergency situations. If you place one and there is a complication from it you will not be covered under the GSL and it could well put your license in jeopardy for practicing medicine without a license. Also, bear this in mind. Many states are working on legislation that would make it a crime to NOT render aid. So the bottom line with this is if you come upon an accident victim and no one is helping them what is the right thing for you to do as a HUMAN not a nurse. Do what you think is right. CPR on an obviously dead person...you're not going to make them any more dead by doing it and maybe then you won't have that question (should I have done it) nagging at you for the rest of your life. Protect yourself, follow the ABC's and intervene if appropriate, and remember sometimes just holding someone's hand is all you can do and is all that is needed.

Now then what do we do as a response to this discussion. EVERYONE should take at the very least a first aid course (offered by the American Red Cross and other organizations) maybe even an EMT course. Make sure your BLS card is up to date. Consider taking BTLS (Basic Trauma Life Support), TNCC (Trauma Nursing Core Curriculum). That way you won't have to wonder what to do at the scene of an accident because you''l know!!!!

Lynne RN, EMT-B

National Ski Patrol-Senior Alpine Patroller

Pediatric Flight Nurse

[James Huffman]

An addendum to the last post I made...

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 was on a plane (from Los Angeles to Hong Kong) in April, when they interrupted the movie to ask "if there is a medical professional on board, will you please identify yourself." Me and a nurse-midwife did so, and were asked to check out a child (maybe 3 years old) who had vomited some blood. We agreed that it was some old blood, and the kid was fine by that point, and had actually fallen asleep.

Later, on the same flight, the flight attendant got me because "a woman is having chest pains!" I practically jumped out of my seat to find that the woman in question was maybe 25 years old and was oddly calm for someone I thought was in cardiac arrest. After some health history and a minimal exam (they did have a first aid kit on board) turns out that the woman had had a month-long URI, so every time she breathed deep, it was hurting. I finally reassured her that I didn't think she was going to die tonight, and went back to my seat. I couldn't figure out why her boyfriend kept smirking and finally realized: he's seen this behavior before. The flight attendants asked if she wanted a doctor when she got to Hong Kong, but told her that it would cost $500, and she was not enthusiastic. She was flying on to Manila, where her sister-in-law -- a physician -- was picking her up at the airport, and I suggested that she might be well enough to make it there, where she could bug her sister-in-law.

I guess the point I'm trying to make is that I haven't been in critical care in years. And while I'm glad -- for example -- that one of these cases wasn't a woman giving birth -- most nurses have enough knowledge to do some minimal care.

[oramar]

I felt very uncomfortable about this very question when I was new nurse. I went through EMT training. I took it in order to know better what to do at an accident. It turned out to a lot of impact on my function at bedside. It helped a lot.

[pagandeva2000, LPN]

Hearing this information has been very helpful, I feel like less of an idiot. I do wish to help to the best of my ability; it is my job as a nurse (even as an LPN ) to do so, but yes, it is true, we cannot do it all alone. We MUST call for help; CPR even says to activate the emergency response system. Thanks guys!

[Super Nurf]

Do not try to maintain c-spine if you haven't learned how to do it. Well-meaning people can actually do more harm than good because of unintentional misalignment. Best thing to do: call 911, then see who needs help NOW: active arterial bleeding, for example. Otherwise just try to keep the victims still and wait for help to arrive.

I have always wondered about the c-spine part. What if you could help by doing compressions, but you would have to move the victim to do them effectively? Is it the lesser of the two evils then?

[ERNP]

If there is anyone at the scene (meaning the last 6 cars that have stopped and are clogging up the works) I keep driving. I have no tools to do much that would be useful anyway. I don't carry around the emergency bag. Now if you need a bandaid and I am on my bicycle, I can manage a bandaid and antiseptic. Roadside miracles with nothing but a tire iron and a few CDs are not possible.

If there is absolutely no one else to witness the event, I will stop, call 911, walk around and report whatever injuries I see then attempt a little crowd control. I agree with the others that dead on the side of the road is dead (doesn't usually matter what the cause is -trauma vs. medical).

When the appropriate authorities feel like I have given enough contact information and details of what I saw, I hit the road. By then I am late to where I was going anyway. Usually this happens to me on the way to work.

[ksrose1]

thanks it makes me feel so much better hearing from other nurses that I was not supposed to know everything....even though I pushed myself to learn as fast as I could and beat myself up for not knowing. Even now tweleve years later when I am floated to another floor, I still beat myself for not knowing the specifics of that floor. I work med/surg and urology....

[stunt]

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.

This made me laugh. :)

To the OP: honestly, there isn't much you can do aside from BLS and manage ABC's. The fact remains that if you're off duty you're not carrying the supplies and tools you need (most likely). Manage ABC's, Do a quick assessment, try to get a history if possible and when EMS arrives tell them what you've found and see if they need an extra hand. If they do, they'll tell you what to do. If not, just let them do their thing. If you're truly interested in the prehospital emergency side of things, I highly recommend taking an EMT basic course. Most community colleges offer them as a 1 semester course. Even if you don't learn much that you didnt know before, it will help give you the confidence you need.

While not trying to generalize nursing (because its scope is so vast), remember, EMS is all about emergent short term care, while nursing tends to be geared towards longer term care. They are equal yet different components of a patient's well being. My point is, I wouldn't be comfortable knowing how to treat a patient from a long term perspective, so don't feel bad about not feeling confident what to do on the scene of a MVA. :)