what to know @ scene of accident

Firegirl127 · Jul 23, 2007

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 would caution you to think twice about starting an IV on a scene as an RN. I'm not saying that I wouldn't do it, but I'm just saying that you may want to think twice about it...as an RN, you are putting your license at risk anytime you act, and in that situation you don't have an order for an IV, and most nurses are not trained in on scene Emergency nursing. And, keep in mind that you are not acting under your employers protection should you get called on the carpet for your actions. Make sure you check out what an RN can and can't do outside of the hospital/work setting. Yes, an IV is within a nurses scope of practice, but unless that patient is going to die in the few minutes before EMS arrives, and you can do something to increase that patient's chances of survival by starting the IV, then why do it?

cjane · Jul 23, 2007

I saw an accident about 6 months ago and felt helpless. A man hit a pole in his pick up truck, when I got to the truck the man was laying on the back seat because he wasn't wearing his seat belt. There was another lady that opened the other side door where the man was laying. She checked for a pulse and said he was dead like no big deal. To this day it still bothers me when I think about it, would she have acted that way if it was one of her family members. He had no physical trama and wasn't blue, wasn't there something that could have been tried?

rn/writer, RN · Jul 23, 2007

I saw an accident about 6 months ago and felt helpless. A man hit a pole in his pick up truck, when I got to the truck the man was laying on the back seat because he wasn't wearing his seat belt. There was another lady that opened the other side door where the man was laying. She checked for a pulse and said he was dead like no big deal. To this day it still bothers me when I think about it, would she have acted that way if it was one of her family members. He had no physical trama and wasn't blue, wasn't there something that could have been tried?

He may not have had external physical trauma, but if he hit a pole and ended up in the back seat of his pick-up, that indicates sufficient mechanism of injury (MOI) for him to have broken his neck, snapped his spine, or ruptured internal organs. The fact that he wasn't blue suggests that he died on impact.

As far as the lack of emotion, had it been a family member, no doubt, she would have had a more intense reaction. But if this was a total stranger to her, it's entirely believable to me that she would have had a more matter-of-fact approach. Besides, you don't know how she was afterward. She may be one who handles a situation in progress calmly, then reacts more emotionally later.

One thing I would like to add to this discussion (based on 17 years of EMT experience) is this:

Please, please, please think about what you're doing before you do it. Yeah, I know, the adrenalin gets pumping and you develop this enormous sense of urgency, but take a few seconds before you speed off in fear or jump into the fray with the best of intentions.

First, park your car out of harm's way. Don't contribute to a second accident.

It's been said before, but it bears repeating. Make sure the scene is safe enough for you to enter without becoming a liability. You can't help anyone else if you get hurt. You can complicate matters and delay help to the original patient(s) if you turn into a distraction or even another patient. Granted, MVA scenes are usually not ideal conditions, but you really should look out for things like downed wires, extreme traffic hazards, fire, broken glass, twisted metal, etc. If there are other bystanders, perhaps you can ask someone else to direct traffic around the crash.

If you can do so safely, check the vehicle(s). How many patients? What kinds of injuries? This can be helpful for someone else to call in to 911. EMS folks appreciate knowing info like: two-car T-bone impact. Two people walking and talking. One unconscious.

Next, check ABCs. I have to concur with the others on the chance for a good outcome on patients with traumatic asphyxia. Extremely slim to none. However, as another poster said, you really need to take a look at the patient before writing them off. Are they not breathing (or is their breathing so slow and shallow that it seems absent) because of something else? Diabetic problems? MI? Post-ictal state after a seizure? What about positional asphyxia. Are they unable to breathe due to the fact that they're scrunched into an unnatural position? C-spine precautions are important, but an intact spine is small comfort to a dead guy.

Blood is always a concern. I carry gloves in--tada--my glove compartment, purse, work bag. You never know when they'll come in handy.

One thing you can do is keep patients as immobile as possible. Obviously, all bets are off if the vehicle is on fire or some other similar hazard makes movement a good idea. But barring imminent threat, have people stay where they are. The less moving around the better. This goes for double kids in corificeats. Invariably, the parents want to snatch the kid out of the harness, but the restraint system is actually a pretty doggone effective immobilizer for a little one.

In most urban MVAs, help is on the scene within a few minutes, so, unless you actually witness a crash, chances are you won't be needed. Outlying areas can be hugely different.

If you can talk to patients, ask for name, medical history, what hurts, allergies. If there's time, ask for date of birth--this can help the hospital access medical history if they're local. Also ask how many people were in the vehicle. Sometimes people are ejected or hidden in a misshapen vehicle. Speak calmly and quietly, and help the patient to stay still.

With unconscious folks, you're much more limited. ABCs still reign supreme. Common sense, too. Some injuies are obviously so severe that death is inevitable. Time to back away.

When EMS arrives and relieves you, give a brief report, and get out of the way. Leave when you can do so safely.

When you have a chance, give yourself a few minutes to decompress. If you saw disturbing things, talk about them with someone you trust. If, after a few days, you still feel unsettled, you might give the responding department a call and ask if you could talk with someone there. Anyone who has been in EMS for any length of time will understand what you're going through. Don't be surprised or offended, though, if they can't tell you much about the patient.

If you really feel you have something to offer at the scene of an accident, go ahead and participate. If you don't, don't. And don't feel guilty about it. Emergency response in the field is a whole 'nuther ballgame compared to what goes on in a hospital or clinic.

Personal note:

My most exciting "bystander call" happened when my husband took the wrong exit off the freeway to my mother's house. My mother's house. Just as I was about to ask what he was smoking, we saw a motorcycle down and the rider several yards away. We had our EMT kit in the back so we pulled over. Found a heavy-set thirty-something biker dude who had a pulse but was not breathing. We were able to reposition him and open his airway. He let out a big sigh and had pretty decent respirations after that. Just for good measure, I inserted an oral airway. Handed him off to the FD guys a couple of minutes later.

They sent a very nice letter of commendation to our FD, saying that they felt we really made a difference for this man. In that context, the "wrong exit" seemed more like divine intervention.

Donald_LPN · Jul 23, 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.

Airway, Breathing, Circulation. monitor for shock. TLC to aid with fear, and pain. I think the fact that you don't want to run in the opposite direction is the important factor. If I were laying seriously hurt, maybe dying it would be nice to know...that I would not die alone.

teeituptom, BSN, RN · Jul 23, 2007

After one lawsuit and a lengthy deposition at the hands of attorneys.

Call 911 and don't stop driving

EMSnut45, BSN, RN, EMT-P · Jul 23, 2007

This is my pet peeve!

UNLESS YOU HAVE BEEN TRAINED AS A FIELD EMS NURSE, OR HAVE BEEN CROSS TRAINED AS AN EMT/PARAMEDIC, YOU DON'T BELONG ON THE SCENE OF AN ACCIDENT!!!

I have been an EMT for going on six years now, and have seen good-meaning nurses KILL patients who were involved in MVCs. The entire approach to patient care is different (we still use the ABC's, but with a variation-- if it's working, don't change it).

One example that I can share: My mother (also an EMT/nursing student) came accross a serious accident on the side of the interstate. The fire department and EMS had not arrived on location yet. Several bystanders were around the car along with a nurse. The gentleman was "hanging" by his seatbelt (around his chest, and not interfering with his breathing) outside of his rolled truck. The man was unconcious, and obviously had multiple fractures. From the time that it took my mom to walk from the road down to the car, this well-meaning nurse had decided that the man needed to be moved and cut from the seatbelt. Why this is WRONG: 1. C-spine was not considered, 2. He was adequatly breathing in that position, 3. There was not equipment, supplies, or manpower to correct the lack of airway that this caused. Because of this nurse, a patent airway was never reestablished, and the autopsy revield that the man had "survivable" injuries, and died of asphixiation. What SHOULD she have done? She would have been most utilized if she had maintained c-spine, or done nothing until the fire department and EMS arrived.

Please know-- I am not bashing nurses. I want to be one some day, and work with many great ER nurses everyday at work. I just want you to understand that the field is not the same as the hospital, and as the OP said, nurses generally don't know how to handle field trauma situations.

If you want to gain more insight, I suggest that you contact your local fire/EMS department and ask if they do ride-alongs. With this program, you will be able to shadow an EMS crew for a shift. Although you won't be able to do any hands-on patient care, you will be able to better see how the EMS system works. If you are really interested in EMS, join your local fire/EMS department and become an EMT. Most states don't allow you to take the EMT training unless you are affiliated with a department.

Be safe!

Dalzac, LPN, LVN, RN · Jul 23, 2007

A few year ago my DH and I were going thru Barstow and Needles CA. There was a truckload of people that had 10 people in it and one of their tires blew. The truck rolled about 6 times and everyone that was in it were thrown every where. Dh and a semi driver pulled over immediately and I jumped out of our truck along with hubby and the guy driving the semi.

I could not believe the mess that was at the site. Thank God I was an ICU and ER nurse. There were bodies everywhere, and none of them spoke English.Several other folks stopped as well. all of them had been hurt some worse than others. I do remember how first it took me to find the worst. and try to get him help first. The CHP had been called when it happened and I knew it was going to take a while for them to get there. I was amazed at how fast I went into nurse mode. and started some triage there. When the CHP got there I told him which was the worst and what I saw. and he ordered 3 choppers and some ambulences.

Any way to make a long story short. It takes a while to learn what to do in a true emergency. I know the OP will get that experience with time. It never hurts to stop if there are no first responders at the site. You may not know what to do exactly for them but a nurse should always compassionant and at least try to help, if they can. I never stop if there are 1st responders because I can remember how much an innocent bystander can get in your way. btw I worked as an emt on an ambulance for several years before I went to nursing school.

FlyingScot, RN · Jul 25, 2007

Most states don't allow you to take the EMT training unless you are affiliated with a department.
Be safe!

Just so none of you nurses who are thinking about starting EMT training get discouraged this may be true in some states but definitely not "most" states. There may be some pre-requisites if you take it through a college but I've checked with numerous schools on this one and affiliation with a department is usually not necessary.

DutchgirlRN, ASN, RN · Jul 25, 2007

Airway, Breathing, Circulation. monitor for shock. TLC to aid with fear, and pain. I think the fact that you don't want to run in the opposite direction is the important factor. If I were laying seriously hurt, maybe dying it would be nice to know...that I would not die alone.

FranEMTnurse, CNA, LPN, EMT-I · Jul 26, 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.

the main thing to remember is to always check the environment to see if there is anything that will be a compromising situation for you as a caregiver, like poisonous snakes, spiders, downed electric lines, chemical leaks etc. there are some situations where it's safer if you don't even approach a victim unless the area has been stabilized, and you know it's safe. i was an emt for 18 years, and during those years i have taken care of all kinds of cases from infants with a brain tumor, to a college student on his way home for spring break. i was the second person, but the first ems person on the scene. when i saw red all over him, i of course automatically checked for bleeding, when he told me the jar that contained his spaghetti sauce broke and spilled all over him, to decapitations, to relatives who were killed by motor vehicles.

one relative was the victim of what we then called a bumper injury. that's when the bumper hits the individual full-force in the legs, creating open fractures of the tibulas and fibulas, and he also suffered internal injuries that made him swell up so much he was unrecognizable by any of us. he was my uncle. those are by far the most traumatic ones, because they are relatives.

[color=#483d8b]the main thing in any accident or other situation is to remember the abcdes. airway, making sure during the primary survey the patient is breathing. if your patient can't breathe nothing else is necessary because he/she will die.

[color=#483d8b]b goes with breathing,

[color=#483d8b]c is for circulation to see if the patient has normal perfusion of blood when squeezing a finger, etc.

[color=#483d8b]b and c also go along with checking for bleeders. make sure to turn the patient (especially if there is a gunshot victim) and look for an exit wound. if there are, then of course you take care of the bleeding so your patient doesn't bleed out.

[color=#483d8b]d is for disrobing the patient if necessary,

[color=#483d8b]and

[color=#483d8b]e is for exposing the body to check for any life threatening injuries.

[color=#483d8b]after that then comes the secondary survey that can be done in the er if it has to be. i did this as a volunteer all that time, because it made me feel good to help others feel better. during those years i did what i loved, and i loved what i did.

woody62, RN · Jul 26, 2007

I have been a nurse since 1968. I have stopped and rendered care six times between 1968 and 2007. I also worked in an ER, in NYC. A ER in one of the largest city hospitals there. When I have stopped by the roadside, I park my car off the road, away from the accident. I assess the injuried parties, checking their breathing,, their pulse and any obvious injuries. Unless the person is in immediate danger, in his car, such as it catching fire, I never move anyone. Major cuts, I apply pressure, using a DSD. Fractures I leave alone. When the Paramedics arrive, I tell them what I know. I talk to the police and I leave.

I watched two young men being transported to a community hospital-the one I worked at, despite a state trooper and myself telling the paramedics they need to be life flighted. They both died, after being seen in the ER, on their way to a Level One trauma center. I blamed the paramedics and the ER physician.

On the other hand, I was once on an Eastern Airlines flight from Ft. Myers, Florida, going nonstop to NYC. A first class passenger had a heart attack and arrested while I was assessing him. Thankfully, there was a Ft. Myers Paramedic on the flight as well. He and I did CPR until we could land at Charlotte. N.C. air port. We were later notified, thru our employers, that the gentleman had made it.

My point is that there are nurses who know their limitations. And we do know what to do and what not to do. And there are bad paramedics who don't appear to have a clue. If someone would not paint nurses with a broad brush, I would forget about the paramedics who cost two young men their lives.

Woody

rn/writer, RN · Jul 26, 2007

the main thing to remember is to always check the environment to see if there is anything that will be a compromising situation for you as a caregiver, like poisonous snakes, spiders, downed electric lines, chemical leaks etc. there are some situations where it's safer if you don't even approach a victim unless the area has been stabilized, and you know it's safe. i was an emt for 18 years, and during those years i have taken care of all kinds of cases from infants with a brain tumor, to a college student on his way home for spring break. i was the second person, but the first ems person on the scene. when i saw red all over him, i of course automatically checked for bleeding, when he told me the jar that contained his spaghetti sauce broke and spilled all over him, to decapitations, to relatives who were killed by motor vehicles.
one relative was the victim of what we then called a bumper injury. that's when the bumper hits the individual full-force in the legs, creating open fractures of the tibulas and fibulas, and he also suffered internal injuries that made him swell up so much he was unrecognizable by any of us. he was my uncle. those are by far the most traumatic ones, because they are relatives.
[color=#483d8b]the main thing in any accident or other situation is to remember the abcdes. airway, making sure during the primary survey the patient is breathing. if your patient can't breathe nothing else is necessary because he/she will die.
[color=#483d8b]b goes with breathing,
[color=#483d8b]c is for circulation to see if the patient has normal perfusion of blood when squeezing a finger, etc.
[color=#483d8b]b and c also go along with checking for bleeders. make sure to turn the patient (especially if there is a gunshot victim) and look for an exit wound. if there are, then of course you take care of the bleeding so your patient doesn't bleed out.
[color=#483d8b]d is for disrobing the patient if necessary,
[color=#483d8b]and
[color=#483d8b]e is for exposing the body to check for any life threatening injuries.
[color=#483d8b]after that then comes the secondary survey that can be done in the er if it has to be. i did this as a volunteer all that time, because it made me feel good to help others feel better. during those years i did what i loved, and i loved what i did.

i totally agree with the abcs. i would not, however, recommend disrobing or exposing a patient as a bystander unless help is going to be a long time coming. even then, i'd proceed with extreme caution, reliable witnesses, and due care to protect the patient's temperature and modesty.

such procedures involve a lot of patient movement (ems folks carry heavy duty trauma shears to make the job easier). in addition, patients often have a distorted view of what is going on around them. if they're hypoxic, they can misinterpret what's happening (even though you'd probably be explaining your actions), and try to fight you, further stressing and possibly damaging themselves. you could end up being on the defensive, both in the moment and again later as the patient "remembers" being assaulted.

you might also have other bystanders to contend with. trying to undress someone at the scene can look inappropriate. it can also invite the wrong kind of attention from those who want an eyeful.

one more consideration. in many situations, patient care can be complicated by exposure to the elements. even on summer days, injured people are more vulnerable to hypothermia, and this can hasten or aggravate shock.

ems folks definitely have to remove clothing to assess serious trauma patients, especially when there is an altered level of consciousness. but this is best done away from prying eyes, using proper equipment on a properly restrained patient, in the back of a temperature-controlled rig.