Be they paramedics or EMTs.
Look, I'm an ED nurse. I know how to handle all sorts of medical emergencies--in an ER, with all sorts of equipment and medicines and supplies that I'm familiar with. I'm not going to tell paramedics how to respond to an emergency on the street! I have no idea what their protocols are.
A while ago I was on the phone in my apartment when I heard a sound like a garbage can being dragged on cement. I looked out the window and saw a mini-schoolbus in the middle of the intersection. Uh-oh. I hung up the phone and ran downstairs. A minivan had crashed into the corner of our building, and the schoolbus (with no children on board), which had a dented front end, was sitting in the intersection a few feet away. People were standing around, looking. I yelled, "Has anyone called 911?" Someone had. So I went over to the minivan to see what was going on.
A man was in the front seat, bleeding profusely from his head. He was wearing his seatbelt, but he had no airbags. "Sir, are you all right? Tell me your name! Sir, can you answer me?" He moaned, and opened his eyes.
"What happened to me? What...?" His eyes were rolling around in his head, and his hands were shaking. Blood was dripping down his face and onto his lap. I briefly debated running upstairs for some towels or something, and then I saw one of the local Hatzolah volunteers pulling a kit out of his car. He handed me gloves and some bandages, and told me he was going to check on the people in the schoolbus.
As I bandaged the man's head, he suddenly became unresponsive. I felt a fast, thready pulse in his wrist and at his throat, and immediately though, oh shit. I have never felt more helpless in my life. If we were in my hospital, I would know what to do. But out here on the street? Are you kidding me? "SIR! SIR, can you open your eyes?!" I yelled. His skin was cold and clammy.
A bystander came by and said, "We have to get him out of there," and started trying to pull the door open and undo the seatbelt. I said, "NO! He needs a board and collar! We can't pull him out of there until EMS shows up." He was still breathing, and had a pulse, although it wasn't great, so I didn't feel like we had to drag him out and start CPR. The bystander was pushing me out of the way to get the guy out of the car. I asked him if he was a medical professional and he said, "I know CPR!! He needs to come out of there!!"
Thank goodness an ambulance showed up, and double thank goodness: it was paramedics I knew from work. I told them what had happened and in two seconds they had him out and on a board and in a collar--all while supporting his c-spine. They did it a lot faster and easier than I could have with the help of some CPR-knowing bystander. The CPR dude followed them to the ambulance, saying, "You gotta get going now! This guy is in trouble" (uh duh) and "Where you taking him? He needs TRAUMA!! Are you gonna give him oxygen? Need any help?"
Holy crap. I'm sure this guy meant well, but dude! STEP BACK and let them work! Even I know when I'm out of my element.
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In reverse, there are times when we turn people over to you all and I think "oh my god I'm glad that's over, because I would have no idea what to do from here." I'm sure you would have done great if you had had the proper equipment and some partners!
Oh, God. I have had the dubious pleasure, waaaay too many times, of encountering the Self-Important Bystander With The First Aid Card in the wild, who wants to second-guess everything you're doing--and who will later tell anyone within earshot that you were "doing it wrong."
I'd like to give them the benefit of the doubt and assume they just want to help, but I strongly suspect that a statistically significant subgroup really just want to be the rescuing hero. And they will blame you for ruining their dream of aw-shucks-ing their way through an interview with Matt Lauer on the Today show tomorrow morning.
I hate it when people have a little basic training and try to butt in. I mean, the EMS would be trained, so why would dude keep bothering them?
I am a pharmacist and often will be counselling someone ont he floor about cold medication etc. And some [person walks up and starts in on how their grandkid had that and they should do this...When it is often not just wrong, but harmful! Granted, not as bad a situation as the accident you saw, but really, why interrupt a conversation of 2 people you don't know?
Been there, done that. Different outcome.
A few years ago I heard a thundering "crunch" come from behind my home. My home backed up to a highway, and I immediately knew it was an accident (or "collision" for you folks that insist on accuracy in statements). I ran around the side of the house and saw a pickup truck that had rear-ended a fuel truck. I ran to the vehicles and noticed fuel was pouring out from the back of the fuel truck, and I was standing in it while I assessed the driver of the pickup truck, while smoke was billowing out from under the pickup's hood. She had not been wearing a seatbelt, and there was no air bag. I estimate she was doing 55 mph when she hit the back of the fuel truck, which had come to a dead stop because of construction traffic.
The steering wheel of the pickup was deformed, the woman had a flail chest, she wasn't breathing well, and to complicate matters she had knocked out just about every tooth in her mouth. I'm sure the blood in her mouth and nose wasn't making the breathing any easier for her.
I managed to get the door open and was trying to figure out how I was going to get her out of the truck, when some lady came running up to the scene saying, "I'm a nurse, I can help." I said, "Great. I need you to stabilize her head and neck while I get her out of the car." She replied, "We can't do that. She needs a backboard and collar! We need to wait for the paramedics to arrive."
I couldn't believe how clueless this nurse was. She understood how to protect the patient's spine, but she was completely overlooking a couple of other issues--namely, the fact that the lady couldn't breath and the fact that we were standing in a river of gasoline. I said, "Lady, would you look where you're standing?" The lady looks down at her feet, then looks at the smoke coming out from beneath the hood, and says, "I'll stabilize her neck. You drag her out of the car."
Great. Thanks, genius.
It’s like the old story that I used to hear passed around the squad house, come on, you know what I’m talking about… ok… it goes like this:
A man and his wife are traveling on the road when they come upon a motor vehicle accident. Getting caught up in the moment, the man jumps out of his car and runs up to the accident. As he’s approaching, there is another guy running up, who seems to have come out of the building that the accident happened in front of. The first man shouts to the second, “You call 911, I’m trained in first aid, I’ll help them.” About that time the first man’s wife catches up to him and smacks him on the said saying “You idiot, he’s a firefighter, he is 911!”
Then again, I’ve been on both sides of that coin. Was on a routine transport one afternoon, transporting a BLS patient from one hospital to another. The truck I was working on was staffed with 2x EMT-B and an RN. Because the transport was BLS only, the RN was riding as a passenger. As we moved from one highway to another, we were flagged down in traffic by a state trooper, who wanted our help in treating a drug OD on the side of the road. We stopped, and were then cancelled by the trooper’s partner, because the local squad was pulling up, and there was nothing we could do that they couldn’t do.
I’ve also had people show up on my ambulance runs that were definitely not welcome. Had a night were we had four squad members show up for the pediatric trauma call, in a campground. After we had gotten the patient out of the woods, a nurse from the local small town rural ER, tried to commandeer the EMS run, including jumping into reports and updates that my partner was giving the medics. Even after the paramedics arrived on location she refused to leave. Then she tried to demand that the ambulance give her a ride back to camp if she rode with us. We kicked her out of the bus in a real hurry.
Thanks for sharing a story I can understand and support!
Even us docs know:
Every paramedic is awesome. No way we could do our job without them.
The Dr. Wife and I were on one of our local interstates a couple years ago (both of us were new grads at that point, but doctors, nonetheless), and we saw a guy ditch his Harley going about 70mph. His backside swerved something fierce, and then he was down. The bike flipped and kept going another hundred feet or so, and this guy went about 40 feet in the air, landing face down in ankle deep mud in the median (he was wearing a half helmet, thank god)
Of course, the two of us stop (I was getting ready to start my EM residency, so of course, I had a pretty good idea of what to do), and we get out , running towards this guy.
There were 2 other passers-by that stopped, and they just stood there, looking dumb. My wife held inline, and I did like the ultra-rapid, yet super limited ABCDE's, with a brief neuro exam. I hear my wife saying "could someone kindly call 911 instead of standing there?"
Well, about 4 minutes later, EMS showed up, the traffic was stopped dead on the highway, and we're in the middle doing all this. I gave the EMS the rundown, and told them that the guy needed to go to the trauma center a few miles down the road, and they happily obliged. They were even uber-cool about things and let me talk to the hospital instead of them, to give the report from the scene while they were packaging the guy up, so that they could motivate the trauma team together.
Ultimately, we heard the guy had a couple broken bones in his face, broke a wrist, and had some broken ribs and a mild pulmonary contusion, but shit, he was a lucky fucker.
guitargirl? You rock.
I suppose jason was selling stuff to methadonians?
Next time you are dealing with something outside of the ED it will feel much more comfortable.
In many places, even a doctor cannot take over control of the scene without permission from on line medical command. When I tell them that they need to accompany the patient to the hospital and write a chart, they often find that they have other things to do.
There is usually not much that a doctor, nurse, medic, . . . can do on a scene that the 911 crew cannot. Some doctors do carry their own gear, but without that they need to use the EMS supplies. EMS can do that.
I do stop at scenes and help until 911 arrives. When they arrive, I give EMS a report and ask if they need any help - lifting, whatever. Usually they are polite and grateful for any help, but some have a different approach.
Yes, a lot of bad things happen around me. Even without help from me. :-)
You did GREAT, GuitarGirl!!!
Someone sees these folks before they come to the ED.
Over worked, abused and underpaid.
Thanks all of you for what you do, I don't think I could.
You did GREAT, GuitarGirl!!!
Someone sees these folks before they come to the ED.
Over worked, abused and underpaid.
Thanks all of you for what you do, I don't think I could.
"Helpful" bystanders are a frequent problem. Why they think that they know something we don't, I can never figure out. Not to mention the people that impersonate doctors. That's a whole different breed of weirdo.
Hehe, you rock GG.
As bad, if not worse than the "I know First Aid" are the "I'm a doctor." folks that are well out of their element.
"Sorry, your fellowship in obstetrics or dermatology is of no use for this street emergency. Thank you muchly."
At least pathologists are smart enough to stay in their vehicles.
Brian and Jennifer: Wasn't there an episode of "ER" that had the blonde female "trying to help" on the way to her first day in her EM residency?
First years are so cute.
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