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.

[santhony44, MSN, RN, NP]

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"

A number of years ago I took a Basic Trauma Life Support course just in case. The one time since I've had to stop at the scene, I did just these things I've quoted, above.

I saw the pickup truck skid and flip, right in front of me. By the time I got across the road the driver was sitting on the side of the road.

I was going home from clinicals (grad student) and there was another nurse who stopped. By the time we got to the driver, someone else had already called 911 and had an ambulance on the way.

We persuaded the driver not to get up and to wait for EMS to check her out. (No visible injuries). We also persuaded her not to listen to the well-meaning LOL who kept saying "If she doesn't want the ambulance, maybe she can just go to her doctor later." "No ma'am, that's really not a good idea!!"

When EMS arrived we gave about a two sentence report and left.

The BTLS course at least gave me a better idea of what not to do, and an appreciation for what's involved in getting someone to the hospital.

[EricJRN, MSN, RN]

I have been an EMT for going on six years now

I learn something here every day. I didn't realize that there were any states certifying EMS personnel less than 18 years old. (In Texas, our high school students can take the course, test, and then receive the cert upon turning 18.)

[vamedic4, EMT-P]

I learn something here every day. I didn't realize that there were any states certifying EMS personnel less than 18 years old. (In Texas, our high school students can take the course, test, and then receive the cert upon turning 18.)

They sure do, Eric! I was an EMT at the ripe young age of 17...now, NREMT rules are much more stringent than states...they are absolute in the minimum age of 18, but each state writes its own laws or guidelines. I had to get special permission from the medical director to take the course at 16, but I got it.

vamedic4

Lonnnnng day today

[ZippyGBR, BSN, RN]

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!!!

Have you actually read this thread?

all the way through posters have suggested to the OP that either they

1. do a first aid course and stick to first aid but apply a bit of Nursing knowledge if they come across a situation which requires emergency care outside of work

2. get involved with EMS and get trained ( and outside the US educated as well ) in pre-hospital care

from the point of view of who 'belongs' at scene

people who stick to sensible first aid protocols will allways be welocme at scenes until professional help arrives

[TazziRN, RN]

They sure do, Eric! I was an EMT at the ripe young age of 17...now, NREMT rules are much more stringent than states...they are absolute in the minimum age of 18, but each state writes its own laws or guidelines. I had to get special permission from the medical director to take the course at 16, but I got it.

vamedic4

Lonnnnng day today

21-6=15.

15-yr-olds being allowed to take an EMT course? I thought you at least had to be old enough to drive?

[vamedic4, EMT-P]

21-6=15.

15-yr-olds being allowed to take an EMT course? I thought you at least had to be old enough to drive?

Hey Tazzi!! I had been riding along as a "third person observer" with a rescue squad since I was 14, and I told my father that EMT was something I definitely wanted to pursue. He talked to the medical director and I was granted admission to the program. It really all depends on where you are and whom you know...or how medically underserved your area is. There are actually many rescue squads with teens who are trained at the EMT Basic level, complemented by ALS personnel when necessary.

vamedic4

That was over half a lifetime ago...wow, I'm getting old.

[FranEMTnurse, CNA, LPN, EMT-I]

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. that all goes with the emt training. i didn't think i had to post all details, but now that i know i should have, i will.

when i was in my car, i always carried a fully prepared first aid kit with scissors, pen lite, pen and paper, etc. i also carried a wool blanket to not only protect the victim from exposure, but also to place between the victim and (in cold weather)the frozen ground.

as far as full exposure goes, and if there are bystanders at the scene, i would immediately recruit someone as a go getter, and someone else to help me put direct pressure on a rapidly bleeding wound to control bleeding, which always goes under breathing. if bleeding isn't controlled, the victim will rapidly lapse into no breathing and no circulation.

such procedures involve a lot of patient movement (ems folks carry heavy duty trauma shears to make the job easier). yes they do, and i did too, in addition to my regular bandage scissors, and items to make slings and swathes. 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. that is why you need to tell the patient what you are doing or about to do. communication, if possible, is extremely important.

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.

true, if there is a place for temperature control. sometimes there is only you and the victim. then what would you do?

i would remove my ems jacket if i saw it was necessary, and cover the victim. i never went out with my car without my ems equipment.

[FranEMTnurse, CNA, LPN, EMT-I]

hey tazzi!! i had been riding along as a "third person observer" with a rescue squad since i was 14, and i told my father that emt was something i definitely wanted to pursue. he talked to the medical director and i was granted admission to the program. it really all depends on where you are and whom you know...or how medically underserved your area is.

there are actually many rescue squads with teens who are trained at the emt basic level, complemented by als personnel when necessary.and they are called the junior squad. we had membership start at age 16 in our area.

vamedic4

that was over half a lifetime ago...wow, i'm getting old.

yeh, and honey, i'm old too. and a bit decrepid to boot.

[FranEMTnurse, CNA, LPN, EMT-I]

21-6=15.

15-yr-olds being allowed to take an emt course? i thought you at least had to be old enough to drive?

they had to be 18 to be an active emt in our area.

[FranEMTnurse, CNA, LPN, EMT-I]

i have very little knowledge about current regs and bylaws, but back when i was active, a nurse and even a physician was allowed to treat at the scene as long as he/she was not on duty. they were then acting only as a volunteer doing basic first aid.

several years ago, i was returning home from church and ran into a reverse ice storm. what i mean by that is the freezing rain was coming from the valley areas instead of the mountains. it was a 4 lane highway with a lot of traffic. the highway was closed for a couple hours until everyone was taken care of. all injuries were minor thankfully. one victim who i attended with another first aid person who i later learned was a physician, had a fractured ankle. i stabilized while he did the bandaging after applying a ladder splint. i got my picture in the paper that day.

about a year ago, i had passed out from reintroduction of my pain meds too rapidly, and the ems was called. i was given too much narcan, and fought the paramedic. when she took me out, she used my standard wheelchair. unbelievably, she pushed me forward over the door sill, and broke the frame of my chair. i couldn't believe she was so dumb as to not turn my chair around and take me over the sill backwards.:trout:

[FranEMTnurse, CNA, LPN, EMT-I]

that is one of the unfortunate things about being a nurse; people automatically assume that you are supposed to know everything and that is not true. we usually master our particular practice, but there is no way to know or remember all of that information. what they provide is basic information for us in class, and from there, what we gain is where to look for the resources we need to answer questions, may it be a drug guide, policy and procedure, the computer or periodicals. i am at a point where i don't always mention that i am a nurse as the first topic of conversation because then, many like to test and see what we know.

just as my nursing instructor used to say, "there's the book way, and then there's the real world way."

and while i'm at it, i know we used to be told a nurse is a nurse is a nurse is a nurse.

[FranEMTnurse, CNA, LPN, EMT-I]

dutchinggirl i've thought of getting an ambu bag. excellent idea. there are some really great disposable ones on the market now at a reasonable price.