Still pretty green

[Peak_Oil]

I came up on a multiple vehicle collision last night. I'm still counting up all the stuff I did wrong. I work in LA County as an EMT, and have been on the job for about a year and a half. 99% of the time it's boring dialysis runs... it's not like the East coast at all. The only time we see trauma is either through the glass in the ER or off duty.

It was a four-car pileup, one car flipped. I pulled in, jumped out, and headed for the smoke. Left my fire extinguisher in the trunk. Got to the scene and there were a bunch of people huddled around the car. I started asking people, Are you medical? As they said No one by one, they moved aside to give me room. One occupant in the car, nice big laceration on the top of his head. Another guy was on the other side of the car trying to unstick his leg from between teh dash and the steering wheel. His leg looked a little bent, I figured a simple fracture to the tibia and fibula. The guy manipulating the leg said he was a lifeguard.

The lifeguard was trying to get the guy out of the car. I kept telling him to let the guy lay down on the roof and wait for the paramedics to come and extract with a spine board but couldn't get him to listen. I did get the guy to take a doralis pedis and extend/flex his foot, so that was good. He was A&Ox4... good again... no neck pain, PERL, the blood had pretty much stopped running. I headed back to my car for... what's in my trunk again? I had a hospital blanket that I figured would make a pillow until FF got on scene. The lifeguard tossed it in the car and the guy was like, what's this for?

I heard the fire trucks coming and saw that my car was kind of in the way, so I headed back to the car. I saw one FF approach on foot and tried to give a quick report but he just wanted to make his way to the scene.

Not so good last night. My lack of experience on an accident scene was showing up how much I need to learn yet.

The last time I stopped at an accident I was on the spot. Held inline stabilization and talked the LEO through doing a quick assessment, the fire chief shook my hand and said I did fine.

Well, I guess there's always a next time. Tomorrow I pick up a box of road flares, a couple more blankets, and I'll throw a SOL hat in the trunk so I can be identified as medical easily. I guess a Hawaiian shirt and sandals doesn't do the same thing.

I took off when I got back to the car. Was that abandoning my patient, or was he the lifeguard's patient? I'll talk to the medic at work when I get back on Sunday.

Bottom line though is that I should have told the lifeguard that the patient isn't in a pool, we don't have to drag him out.

[hotpig]

I learned years ago just to keep on truckin. If my wife is with me she makes me stop.

[D25]

I figure that it's best to just keep going, especially if I'm in a place where I don't personally know the people who will be responding.
The people who are most helpful to me when I'm working are applying direct pressure or holding c-spine. There is just too much information that needs to be absorbed on a scene like the one you describe to be listening to much other than the pt. and team members. Furthermore, on scenes like this it seems like there are often many well-intentioned medical folks who do have observations or advice. For the most part, these people, who are usually clinically oriented (surgeons are the worst!), have not the first idea about anything prehospital, let alone the intracicies of extrication or rapid trauma assessments, so fire guys and paramedics have an automatic selective hearing thing going on. The more FUBAR the scene, and the more bystanders, the more selective the hearing.
But no, you didn't do bad. Do hold c-spine though, unless that would expose you to yuckies, don't let a lifeguard tell you what to do (see my previous paragraph), and chalk it up to a learning experience- they all are.:thumbsup:

[RyanNREMTP]

Just remember your ABCs. Triage and find the most serious patient and keep moving. Make the bystanders think you know what you are doing.

Don't worry about it too much. It sounds like you did a good job to me.

[akulahawk]

Originally posted by RyanNREMTP
Just remember your ABCs. Triage and find the most serious patient and keep moving. Make the bystanders think you know what you are doing.

Don't worry about it too much. It sounds like you did a good job to me.

Yep. What he said!

You did fine. Just remember something... You're an EMT. Even if you're off duty and there aren't too many positions above you that can give orders to you. Had I chosen to stop, I would probably would have directed that Lifeguard to stop his activity and do something more useful - in a less than polite manner if necessary.

You did fine. Only if you don't learn from this, will you have done something bad.

[Peak_Oil]

Originally posted by akulahawk
Yep. What he said!

You did fine. Just remember something... You're an EMT. Even if you're off duty and there aren't too many positions above you that can give orders to you. Had I chosen to stop, I would probably would have directed that Lifeguard to stop his activity and do something more useful - in a less than polite manner if necessary.

You did fine. Only if you don't learn from this, will you have done something bad.

I did learn a couple things. One is to make sure the lifeguard knows that he's not dragging somebody out of a pool. He shouldn't have moved the patient. I should have been more firm in my direction to stop moving the pt. Among other things.

[Parmaboy]

Sounds like you did pretty well. Its pretty hard to be an authority on scene without a EMS/FF uniform on. THe only thing that I see is what you already recognized, Dont move the patient. Leave the patient where he is unless he is in danger, or ABCs are compromised severely. I didnt understand what you were saying about abandoning the patient. When you went back to your car it was to get supplies, or after the FF took over the scene.

Over all it sounds like you did a good job. We all live and learn. Dont be too hard on yourself, you are off duty, entering a chaotic situation, things are not going to go text book.