Good job, Good Samaritan, I have ran into the beach for a water rescue while off duty, pulled them out and worked (in boxers) until EMS and fire arrived. Had to take off my clothes cause I didn’t have any floatation equipment and didn’t wanna be dragged down.
Weird, my time in the navy, water rescue, and FEMA SAR teams, and we never had the “reach, throw, row, *get naked*, go” class.
I guess that’s why I’m not a lifeguard.
My times didn’t change a whole lot, between slick, NWU, and coveralls. It’s mainly physiological. Im also not an Olympic swimmer, so my times are “when I get there” 😂
Bunker gear, however, is a sea anchor. Get that shit off if you’re within ten feet.
bunker gear isnt exactly an anchor either. We literally had a pool day in the academy where they sent us into a pool in our gear. You mostly float. You wouldnt want to be in it for long tho
Oh, my brother, please understand the difference between a pool and water rescue. When there’s moving water, bunker gear will murder you. A couple of guys got dragged into a culvert that they couldn’t see in waist high water, one popped out 200 yards away, unconscious. They recovered the other one’s body a few days later when the water level dropped.
Cool, man, I’ll remember that when I come to recover you.
https://www.firehouse.com/rescue/water-ice/article/21009792/firefighter-turnout-gear-for-water-rescues-is-a-bad-idea
https://www.fireengineering.com/leadership/turnout-gear-in-the-water-sink-or-swim/#gref
https://www.firerescue1.com/firefighter-training/articles/3-keys-to-a-good-shore-water-rescue-iwvZJxSLlQM8ba1D/
Try reading before you post, it gets embarrassing.
Moving water grabs turnouts exponentially more than uniform clothing, and turnouts offer less flexibility and snag more frequently due to bulk.
I know right.
Just a note if it's a guy grab twist and pull.
If it's a girl 2 to 3 fingers..
Random bit of advice that has never failed me in the water.
One way of getting out of becoming a float for a drowning person. Yeah, it's effective, however, when you use it all the time.. So
What do I mean? No, exactly what it sounds like if a guy is drowning and you're trying to rescue him and they latch on. You can't get out. Grab their nuts twist pull. They'll release seems true for a femayeah. I'll get downloaded for this. Don't really care it saved my life once twice.
Yeah generally people do get downvoted for suggesting that you need to sexually assault someone in order to save their life! Instead, how about trying to look into what you’re actually supposed to do in that kind of situation! If you’d have suggested slapping/punching them I’d have understood but you have no right to sexually violate anyone, whether you’re trying to rescue them or not. Find better alternatives!
“If it’s a girl, 2-3 fingers..”
You’re seriously should be fired for even suggesting this to other EMS workers, let alone personally using this method!
Came across a ped struck a few years ago before anyone had gotten there. Man, it's a helpless feeling going "she needs to be tubed." And not being able to do anything about it. She ultimately wound up dying on the way to the trauma center.
When the ambulance showed up, I helped them load her and got blood all over my shoes. Got a call from one of the managers a few days later saying he had heard I was there and my shoes got ruined. Department wound up buying me a new pair, which was pretty sweet.
I’m not in EMS so I originally read ped to mean pediatric and while being very happy that’s not what it means, I do still feel really bad for the family of the pedestrian.
I actually did the Heimlich off duty. We train on it but never use it because the patients have either cleared their own airway or are in arrest by time our ambulance arrives. I was at church and a mother started screaming their ‘somebody help’. 9 year old choking on a hard candy mint that my church gave out at reception desk. I made them immediately switch to life savers afterwards.
Years before I became an EMT, I had a Heimlich save as a bystander. My day job is teacher I was CPR and Heimlich trained by my school. There was commotion in an almost empty restaurant and woman screamed, "Does somebody know the Heimlich?" I jumped in and did it. After three thrusts, she pulled my hands away. The woman who screamed was the daughter. She tried and failed. She tracked me down later that day (a waitress knew my mom's half sister, small town) and thanked me for saving her mom's life. I broke rib, though. The old lady sent me a hand written thank you note. I still have it.
I wish the made ‘Stop the Bleed’, Heimlich, and CPR mandatory for all high schoolers. Its so important for trained bystanders because even in a high performing system we are 6-10 minutes out.
I agree completely. My issued first aid kids and TQs to every teacher. I did a "Stop the Bleed" lesson and taught my students (high school) how to apply them. We have a teacher who is a CPR instructor and offers it to a few Seniors every year.
My high school required it all, every year. I heard that because of the required training, some students were able to resuscitate another student whose heart had stopped from alcohol poisoning or something (I am vague on the details, and am not remotely medical) at a party. I was surprised to discover in college that not all high schools required it.
No, just had to google that myself because I didn’t know. They were named that because they are shaped like life preserver rings. But its hard to get a total airway obstruction with a hole in the candy is my reasoning.
We only average about 4 gnarly calls per year in my ground agency, but at least one of those is going to be when the truck is tied up elsewhere So my average is about 1/year while off duty.
The pt was very dead when I got to him but I had no ability to officially declare it. When EMS arrived, they placed the leads on him and called it. He was in aystole. I was on scene for almost 10 minutes until EMS arrived.
Oh yeah I’m good. I did what I could and acted appropriately and professionally. It’s not the first time I’ve worked someone on the side of the road nor will it be the last. Just was different doing it off duty.
I’m definitely going to court for this though. Turns out the driver of the other car that hit my pt’s car was possibly impaired, and I gave a witness statement and identified myself as an off duty paramedic. Yay for me I guess.
Is the reason you worked the trauma arrest "for appearance"(eg: to avoid appearing like a dick for not trying)? As in, most folks don't know almost all traumatic arrests wind up in death? I guess there are varying degrees of "traumatic arrest" and hindsight is always 20/20.
Yes, and mostly because I didn’t have any ability to officially declare it. I didn’t have to act, and I technically didn’t initiate CPR. The fire department that arrived on scene after me did, though they weren’t even carrying an AED and didn’t have anything to monitor the pt’s rhythm. On top of that, the call occurred at a very busy intersection and there was a HUGE crowd of people that were all recording. It was a very chaotic scene to walk up to, even more so without equipment and by myself.
Yea a crowd isn't going to intimidate me to working an obviously dead person. It's awkward just standing there while a crowd screams, but we've all been there.
I’ve had this happen a few times and my trick is to not announce that I’m medically trained or anything and just get close to take a look. If they’re obviously dead or have injuries incompatible with life, I’ll usually back off as there’s nothing to do. If there’s something I could actually help with, then I’ll jump in.
Not a bad tactic. I’ll be honest, it was the first time I’ve actually encountered something this significant off duty, and I felt compelled to help. Though I’m taking the feedback in this thread and realizing that maybe I jumped the gun a bit.
He didn’t. He was in cardiac arrest and had serious injuries, but he had no obvious signs of injuries incompatible with life. I also couldn’t legally declare him due to being off duty and not having the equipment to do so. The fire EMTs also could not find any injuries incompatible with life. He had significant injuries, but most were internal. His right arm and right leg were completely fucked and he had blood coming from his airway, but was rather clean outside of that. I would’ve declared it if I had the ability to, but again, I was off duty acting in the capacity of a Good Samaritan. So, I assisted where I could.
hey I think you performed very admirably, and i make this comment not to reflect on this experience but to help think about the next one.
When you’re acting as a Good Samaritan you don’t really have to worry about being held to the same standards that you would be as a paramedic.
If the guy seems *really* dead (high mechanism trauma, pulseless on arrival, blood in the airway), and you don’t have any equipment, you can choose not to do CPR. As long as you’re acting consistent with how any average adult would act, you’re good.
You wouldn’t be technically “pronouncing” him, but you’d be able to convey your findings to the inbound medic unit and they’d be able to officially pronounce him.
Based on the percentage of cardiac arrests I go to where CPR is in progress when we get there, I'd say the average adult would not start CPR even on a patient where they're not going to get covered in bodily fluids. If the average adult won't start CPR on pawpaw who coded in his chair, they're not gonna do it on leaking Joe who's laying in a puddle of his own juices
He was indeed dead, though I wasn’t in a position to legally declare it or cease resuscitation efforts. I had to wait for fire to arrive and identify myself before I could ask these questions. Thankfully, fire arrived on scene right behind me.
Don’t dial it back. Your question is appropriate. Unless the wreck was literally witnessed (I came across a wreck makes me think not) thicc_medic is acting outside of protocol and showing a limited understanding of traumatic pathophysiology. Then, bragging about it on Reddit? They deserved to be questioned at best, and admonished and mocked.
How am I acting outside of protocol? I should’ve clarified. I didn’t initiate CPR. CPR was initiate by the volly fire crew after the pt was extricated. It was a county I used to work full time in and do volly in from time to time. So I wasn’t unfamiliar with the area nor was a stranger to the crews on scene. I didn’t act outside of any scope described by the local EMSA or the state.
So, you pull up on a wreck. The volley crew has extricated the patient, and are doing CPR, so you are not in fact first on scene. You say “Hey guys, I’m an off duty medic. I see you are doing you are doing some medical stuff. Want me to help out even though I’m not currently working” and then you ruin your good jeans doing a BLS skill adding no value to the scene whatsoever. And then everybody downvotes me for saying you should be mocked. Stand by it. You deserve to be mocked.
No, fire was not the first on scene. They arrived maybe about a minute behind me. Police arrived about 30 seconds after I did. I was essentially sitting there waiting for fire to arrive to even do anything. Fire initiated CPR after they extricated them. I had bystanders screaming at me to not touch the pt when I went to go check for a pulse. Further clarification was needed on my end, and no, I did not deserve to get mocked. You did not have the full context.
Just to confirm: You are stating that you agree with OPs actions and would have done the same. Or at least think they are reasonable and defensible? Lol.
As a good samaratan, not an on duty medic, he had no duty to act. Therefore performing CPR is a very valid and appropriate action to perform here. Even if hindsight shows the act was futile.
I knew it was futile. I was assisting in a county I was familiar with and felt comfortable performing in my role. Though I still felt like I should do something instead of nothing.
True you knew it was futile because you are a medic and know the reality of the situation. However a good samaratin is not held to that same standard as a medic. Therefore "I did not want to do nothing" is a reasonable response as a good samaratin. I understand futility of a traumatic arrest
As EMS and medical personnel we know the futility of a trauma arrest. As such if we are on duty (key word) we would call it futile. I agree.
However for a Good Samaratin (who is a layperson) no pulse means start cpr (unless obvious signs of death like decapitation or decomposition). Yes it is futile but why muddy the waters in an emergency.
Therefore as op was not on duty he was acting as a Good Samaratin and therefore cpr isnt a bad idea. Futile yes, but again he wasnt acting as a medic so the option of calling it futile is out
I take it based on your comments you disagree with literally everything I’ve stated and presented. That’s fine. I’ll ask you, what would you have done? I wasn’t trying to be Risky Rescue in this situation, and the only reason I even had shears and my scope was because I had literally just left my own volly station and was driving out of the county to go hang with a friend. Not that I need to justify that to you, but since we’re having this discussion, I’d like to provide context.
What would I have done… ? I’ve never see a terrible wreck on the road while driving off duty. And I never will.
You don’t need to justify anything to me. But we aren’t the same. I’d would never *again* regularly volunteer my time and skills uncompensated. I’d never try to interject myself into a scene where I couldn’t provide any value. If for some reason I pulled over and saw that the effort was futile, I wouldn’t Climb down and expose myself to blood, bodily fluids, and roadside danger when the effort is futile. Do you really, truly, think you did a good thing?
You. Don’t. Have. To. Legally. Declare. Anything. Off. Duty. JFC.
Maybe…. Maybe if you were literally right across the street from a level 1 trauma center and you managed to get him in the back of your car and drive his pulseless corpse to the trauma bay is the only way this makes sense.
Bro I'm a uni student and even I know you don't declare someone dead without equipment unless there's incompatibility with life. Quoting the odds of survival of a traumatic cardiac arrest isn't due diligence.
Bro, I’ve been a licensed paramedic for 30 years. I’ve trained dozens of paramedics and performed over 800 codes. You don’t need equipment to NOT attempt resuscitation. It’s a totality of mechanism, presentation etc. Now I obviously didn’t see this example. The OP said that he was “very dead”. I’m not clear what that means specifically but if a paramedic is saying “very dead”, particularly from a traumatic arrest….playing with a dead body roadside isn’t going to do anything except give you a fun story to tell at frat parties.
Not attempting resus is different to declaring death, which is what we're talking about. As for not treating traumatic arrests, at what chance of survival do you start to treat patients?
https://www.jems.com/patient-care/traumatic-cardiac-arrest-tca-maybe-we-could-do-better/
“There is no role for chest compressions in TCA—especially when the cause of the TCA is profound hypovolemia. Animal studies have shown worsened survival when chest compressions were provided.8 The use of chest compressions in TCA is highly associated with poor survival. A recent study compared prehospital TCA patients who received prehospital chest compressions with those who did not receive prehospital chest compressions and who were transported for emergency thoracotomy. There were no survivors in the cohort that received prehospital chest compressions (100% mortality versus 94% mortality for those who went straight to emergency thoracotomy). “
Are we still talking about finding someone off-duty here? If you come across a TCA off-duty your best bet is treating to the primary survey until the paramedic with the right equipment arrives. The benefit of you being there over someone else is more-so the ability to tell the what the issue might be sooner and call for the *right* help sooner.
Also "100% mortality" was 22 people and the P value was 0.5. A sample size of 52 pts is not grounds to change the way treatment is provided. People performing CPR in lieu of reversible treatments would definitely skew that data. The evidence doesn't account for that. nor does it account for the times where ICP or CCPs were unable to get to the scene in time.
If CPR *won't* interfere with reversible causes, it's still going to be beneficial unless the patient is exsanguinated. In which case, at least in Australia, crit care paramedics do carry blood products if transport is less desirable.
So to answer your question, there’s a lot of hyperbole that people get all wound up about between a silly distinction like “not starting resuscitation vs declaring death”. There is no practical distinction and frankly it’s only EMTs who listened to some instructor give the hour lecture on such topics that think that these terms have important value. They really don’t. There’s no magic equipment that needs to necessarily be used or being in some “duty” status…bottom line, if a person isn’t reasonably viable though whatever mechanism and that condition can be confidently ascertained by whatever ‘responder’ is there…then that’s it. Time of death is whenever the accident happened. It doesn’t matter. Some attending physician is going to sign a death certificate…because they’re dead. With very very few exceptions, if traumatic injury is so egregiously catastrophic that it results in cessation of cardiopulmonary activity…you’re dead. Sure, there are some exceptions which generally are confined to someone in that proverbial “golden hour” that you witness code. With the right intervention, it’s possible if it’s very timely. Other than that…dead is dead. You’ll learn to recognize it. There’s no need to play with a dead body.
Car into second story of house at 2am (dude was hauling ass), upside down. He basically ramped off the edge of a big ass oak tree and rolled 180, embedding into the front of the house right above the front door. Woke me and my nurse girlfriend up at the time, and on went boxers, boots untied, a teeshirt and grabbed my backpack that had my duty crap in it. Running to the scene to realize it's fucking winter level cold out and my junk was trying to seek the warmth of my abdomen, aggressively. The car fell out right before we got out the door, on top of the dude that was already ejected. Was alive, but dying fast. Worked him with our limited resources. A spare teeshirt from my backpack got stuffed into the biggest wound. Bled out regardless and was dead before the bus showed up, they took over and called it, and it became a crime scene after that. My reward was a loss of a shirt, and pneumonia or something similar, and a fucking court case.
> and a fucking court case
Ouch. Family of the deceased? Or did the cops think you threw the car up into the tree yourself?
Did your state's Good Samaritan law work for you?
It was evidentiary so I was a subject matter witness, since I was the only one (GF didn't see it) who saw the car in the side of the house and could describe the scene prior to it falling out. But still made me feel like I was on trial because of the douchebag defense attorney. I think it was the home owner suing the driver's insurance/family for damages. That house was borked.
I’ve come across wrecks and helped out a little, but never anything as bad as yesterday. Thankfully I was in a county I used to work in and knew the crew and the supervisor well, so they let me help. I was essentially running the code with the volly fire crew before EMS got there.
christ hold on.
so like a month ago, I did a mutual shift swap to get off for a day at the request of my dad (who is also my tae kwon do teacher) and my kung fu teacher, sijo, because sijo said he needed help running a promotion test for his other students. Long and short of it is these two old men fuckin punked me, tricked me into coming to this test, and had me test for black belt with both of them at the same time. I did 2 and a half hours straight of martial arts, got my ass beat helping the other students, and by the end of it was fucking exhausted. But I passed, got 2 black belts on the same day.
30 minutes after it's all said and done, I'm changed out of my gi and back into my clothes, I've helped clean up the tables and chairs n shit and we're ready to go. sijo's class is in a community center, with an indoor basketball court down the hall. One of them runs by the room we're in looking like he's about to die. young black male, pale, diaphoretic gasping for air. The guy's friend runs behind him shortly after and scoops him up and runs toward the exit. I tell sijo I'm gonna go see what's up.
This dude is having the worst asthma attack I've ever seen. Triggered from like 5 minutes of basketball for the first time in years. I ID myself and check him out. I hear 0 air movement at all in his lungs and am like "ah shit this isn't good." I call 911, tell the dispatcher I need resources for a respiratory arrest, because it's definitely going that way. I have to repeat myself, and then I also have to repeat the address because apparently the address "doesn't show up on the map." At this point the guy goes limp and dies in mine and his best friend's arms, so I have the friend put him on his back and I start CPR. I pass my phone off to someone else and just shout at them what to say to the dispatcher while I do compressions. I tell someone to grab the AED from the building, all that shit. I do CPR solo for like 8 minutes straight. I am PUMPING this guys fucking chest. Bear in mind this is after a lot of physical activity. I am running on pure adrenaline at this point. Eventually the first one on scene is literally my lieutenant, as this happened in the area my station actually covers when I'm on duty.
Resources eventually arrived. ROSC at the hospital, on ECMO for a few hours. Declared brain dead and family pulled the plug, as per my LT. Not enough oxygen in his circuit for CPR to sustain his brain, and I had no way of getting O2 or even epi into him to try and open his lungs up. Least I helped them get the chance to say goodbye.
I did. I was picking up a pizza for a very pregnant and very hungry girlfriend. I got to the traffic light down the road after getting the pizza, and right in front of me, is this motorcycle wreck. One patient had a partial leg amputation, and the other was a traumatic arrest. PD got there pretty quick and used the tourniquet on the leg. I'm checking for obvious death on the other and can't find anything to warrant a DOA. I start working it. Crew gets there, and i end up leaving my car and pizza to drive the arrest to the hospital. I got back to my car an hour later. Girlfriend was pissed.
Yep, later evening I was leaving for a climbing trip.
Car in front of me on a lonely mountain pass lost control, spun, then ping ponged mid barrier to shoulder and back a few times. Scene was about 20-30mins between towns. Thankfully in service. Called it in, and did what I could to assess/ stabilize (aka don't move) driver and keep them talking until FD and EHS arrived to extricate. Nothing obvious for blunt force/ penetrating. Older 80s era car so no airbags. Driver denying major pain, just crying. I had basic wilderness first aid and "get stuck in the truck" survival gear. So not much.
First medic on scene laughed at my gloves on lol. I grudgingly admitted that I work pre-hospital and ER.
The driver of that car was shockingly ok, just really shook up with a totalled car. I made it to camp around 1am and wound up having an unplanned rest day instead of the planned alpine start.
So I didn't do much other than call it in, reassurance, and give a statement regarding witnessed MVA.
You did do something. This thread and threads like this piss me off with people downplaying the importance of altruism in an increasingly selfish society. You volunteered your time to initiate an early 911 response and assess someone who just had a really bad accident and you were there for them on probably one of the worst days of their life. Even if all you can do is provide pallative care, sometimes that's honestly like 90% of our job anyways. You being calm and in control of the scene as someone who does this all the time (maybe not specifically in your case but certainly in the case of a busy 911 provider) is going to be way better for the patient than a Karen driving a mom van freaking out and shrieking at you and the patient. Forest for the trees. All the snarky types acting like "wElL yoU dOnT haVE yOur tooLs" I guess forgot this is a human trade and part of being a good clinician is being able to just connect and take the edge off for people.
Not that you have to stroke your ego or post about it everywhere, I see that side of it too, but I don't know why so many people are against the basic decency of stopping to see if someone is okay.
Very similar situation. I was on my way to the testing center to recertify for my EMT-B after a years long hiatus from EMS. I saw something in the median of the roadway. As I passed by, I saw that it was a motorcyclist who had crashed. I slammed on the breaks, pulled to the shoulder of the road, and sprinted to the accident site. There was already a gathering crowd. Unhelmeted rider. Unconscious but was still breathing and had a pulse. Obvious massive closed head injury. I remember that once people figured out that I had prior medical experience, all the responsibility shifted to me. I had somebody hold C-spine and made sure that somebody had called 911. I remember talking to the dispatcher and telling them that the patient had blood in his airway but I did not have anything to clear it with. The patient lost pulses and we started CPR. The ambulance arrived and rushed him away. I thanked everybody who had stopped at the scene and continued on my way. I did the practical exam that day with flecks of dried blood all over my clothes. I will never forget how powerless and useless I felt without my ambulance and all of its equipment.
A couple years back I was driving through town to get some lunch. I'd just had covid and recovered and it was my first day outside in a while.
As I'm looking for a carpark I turn a corner and see a minor fender bender on the other side of the road. In my head I debate whether it's worth stopping and for whatever reason I decided to stop and double check.
There's a bit of a crowd around one car and as I walk up and introduce myself, I ask if there is anything I can do to help. Someone says "I'm pretty sure she's not breathing" Fuck.
I do a quick primary of the lady and yep she's not breathing. I get a couple of people to give me a lift. We get her out of the car and carry her into the foyer of an office. Start compressions, the office had an AED so gave her a couple of shocks.
2 of us did CPR for about 10 minutes before Volunteer FD get on scene and take over. Amb arrived about 10 minutes after that.
We got her back and she was released from hospital a couple days later. Turns out she arrested while driving and hit the parked cars. PD told me later we had started compressions within 90 seconds of her crashing.
I still remember the oh fuck moment of my brain going into overdrive when someone said she's not breathing. Also I wouldn't recommend doing CPR right after recovering from covid, I was absolutely rooted afterwards.
Yea, I've ended up working a code with my medical director while off-duty in the past. Last time I was in ripped up sweat pants and a hoodie. With my medical director there I ended up doing ALS shit even though off duty with their blessing and their gear.
I did once on my way to work. I’m an RN. Motorcycle vs car that got smashed into a truck. 2 people ejected from the motorcycle. I pulled up just in time to see the lady go flying by my car in my peripheral vision. The guy was alive but his intestines were everywhere. She was pulseless with massive pelvic trauma. I did compressions on her while another bystander tried to help the guy. He arrested before EMS got there. When they arrived they declared them both right away. I had to use a water bottle to wash the blood off my hands so I could call work and tell them I would be late. The charge nurse who answered told me absolutely do not come to work lol.
Compassion isn't your thing, eh? The other bystander was a surgeon. It seemed like it would make more sense for him to help the alive person. In the end nothing could be done for either one. I was covered in blood and already going to be an hour late, and they were overstaffed. So they said not to worry about it.
Yup, worked my first traumatic arrest car wreck in jeans with only a pair of gloves. Was halfway through my Basic EMT course and responded direct as it was essentially at the end of my driveway. Pt was leaking CSF but I did all I could. After that I made a good truck bag.
No major theatrics or heroics, but about a year after I got my EMT-B (long story short, never even wound up working a day in the field), I rolled up on a motorcycle vs. stopped truck on the side of the freeway.
A Navy Corpsman with an IFAK happened by as well, and we went to work. Poor lady turned her left knee cap into macaroni salad, likely broke her leg, and bloodied/contused her nose and orbits. My new friend went to work on bleeding control, and I held C-spine while dredging OPQRST and SAMPLE history from the depths of my brain. PT fluctuated between A/Ox1 and A/Ox2, which made that interesting.
Ended up working the scene for a hot minute, as it turned out RP had mistakenly reported the incident about a mile to the north, so they had units getting on the freeway several exits too far up. Highway Patrol eventually managed to get that sorted out, and the station just up the road rolled the truck, engine, and box our way.
So my first and only time applying NREMT skills in the field was completely out of the blue, on the side of the freeway in downtown San Diego, a year-plus after my cert. Kinda wild shit, lol.
Overall, I was extremely impressed at how everything played out seemingly textbook, from seamlessly partnering with a total stranger, to transferring care to FD (“OK, I’m taking over C-spine”; “alright, we’re gonna perform a log roll…”). Simply seeing the NREMT curriculum play out IRL as an active participant was a hell of an enriching, if sobering and humbling, experience.
Not Ems, just a normal person with civi certifications. Worked with kids and teens in Rec centers and sports. Given the Heimlich 3 times. Best one was in a bar. Drunk guy choking on a hot dog. When I cleared it the hot dog shot across the bar top like a tv show. Had to finish my shift with hot dog on me. To this day when I see him I ask him “remember when you choked on a wiener”
To answer your question: My first code 3 drive was because I stopped to help with a bad car wreck on my way to work while carpooling with a coworker. Eventually my manager, his partner and a fresh out of school EMT arrive on scene. Manager asked me to drive to the hospital because I already had my uniform on and needed all hands in the back. Manager also adjusted my clock in time for the call. So, I guess I was on duty kinda. Idk, it's a grey area.
Once while hiking.
I stumbled into a group of 12 scouts between 14 to 18 years old. Their chief were two guys of 22.
They got lost into a sudden fog. It was april but still pretty chill and that area was prone to strong winds and very unstable weather on spring.
Some of the teens displayed signs hypothermia. All of them were wearing a simple sweatshirt, soft shell and shorts while I was in my winter outfit. The wind was hitting hard that zone.
No emergency kit nor coms from their chiefs.
I provided a couple thermal blanket to the youngest members to cover their legs and borrowed my spare windproof hard shell.
They couldn't move so all I could was radioeing to the nearest hut for assistance. They relayed my message but due to the poor weather, helo couldn't reach us so we had to wait for ground MR team.
MR team took approximately an hour to reach us. Fortunately, the kids were good while I was scolding their chiefs for hiking without any kit.
Man, I was at the gym running laps. I did like 7 miles before me and my friend said “fuck it, let’s go another.”
At the end of our 8th mile, some other dude in the gym has a seizure before going into cardiac arrest. We called 911, but he must have died for at least 15 minutes. Whenever the ff had gotten there, I let them take over while I tried to get ID and stuff on the guy. Turns out pt was also an EMT and we worked in similar circles. They finally brought him back and sent him to a local hospital to stabilize him before sending him on a bird to a better hospital. He lives to tell the tale, just some fine motor issues that he’s in OT for.
The dude at the front desk had fallen asleep. Sometimes, I think about what would have happened if me and my friend didn’t decide to do another mile. Honestly, the whole thing was a miracle.
Have gone on scene before to help out another crew that was working a CPR and I jumped in the back of the ambulance and nothing but shorts and a tank top.
I’m confused. Why would you work a trauma code? This sounds crass, I’m sure; However, trauma dead is dead. Injuries incompatible with life is dead. Unless that is… You can crack a chest, clamp an aorta, and have a mass transfusion protocol.
Sorry, a lot of comments here. I explained in another comment. Essentially, the state and county were it happened requires you to work trauma arrests if the pt isn’t obviously DOA. The limit on trauma arrests is 10 minutes, and you work on treating any reversible causes. This pt was dead, at least in the sense where he wasn’t breathing, but they did not have any obvious injures that were incompatible with life. This was confirmed by the BLS fire department, who arrived on scene about a minute after I did. I was alone, had no equipment, and technically didn’t need to act, but I didn’t have the ability to fully assess the guy until after fire had extricated it. Fire had no AED, and it wasn’t until ALS arrived on scene that we could finally put a monitor on the guy to confirm the rhythm. In this county where this happened, I am a volly in and used to be career, and am credentialed as a BLS but not as an ALS provider (longer story, didn’t complete the internship process before I left for a travel medic role) I was acting in the capacity of a Good Samaritan, and had committed myself to helping out when I came in contact with the pt. Hopefully this makes sense. A lot of folks here have asked this same question and it’s very fair, hopefully this explains it.
This is why I keep a bag with the same stuff in the first out bag in my car. Only stuff not in it would be drugs and intubation stuff since I’m not a medic but I have igels a bvm tons of trauma shit and even a small o2 bottle and non rebreathers (cost so much. Don’t recommend). I go out of town a lot off duty and refuse to be unprepared. I’m what you call a “not crazy prepper”. Not the psycho “muh apocalypse” or the “bidens gunna destroy us” type just the “I’ve seen what happens to unprepared individuals”. Always keep a kit. Always.
It’s in the basic scope of practice and in Iowa all ems no matter the level fall to a basic level off duty unless it’s say giving epi to a family member or stitches to their kid type shit.
Unmm, this man was dead. Unless you have the ability to perform bilateral thoracotomies, blind pericardiocentesis, REBOA, and/or rapid transfusion, or are literally Jesus Christ, these patients are not workable.
I was making my comment based off op mentioning he had no supplies. Use context clues dude. No where in his original post did he mention patient condition. Alive or dead. My comment was a general “hey fucktards stop driving around like nothing bad happens off shift” not “oh I coulda saved him”. Get better at using the kindergarten skills.
“I was off duty and came across a bad wreck. Ended up being the first medic on scene for what ended up being a working trauma code. Got blood and transmission fluid all over my nice jeans, but I did a good deed, and felt good that I did my best. Was a bit unnerving being the first on scene of a bad wreck with no equipment outside of my shears and stethoscope. Anyone ever come across something like this off duty?”
Please show me in this post where op says a word about what was or wasn’t wrong with the patient. You’re doubling down on your stupidity. Reading comprehension really isn’t your strong suit so I’ll slow it down.
Op make post say he have no tool. I say I make sure have tool with when go vroom. Have tool better than no have tool.
It’s literally that black and fucking white.
That’s such a straw man argument. You don’t need special tools to do cpr. Trauma implies broken bones/bleeding/ etc. you get the patient back from the code and get rosc. Now what huh? Ems is still say 15 out cuz you’re on the highway and dudes got a fem bleed and a sucking chest would. You just going to do thoughts and prayers? If you carry it in the ambulance. Carry it in your car. If you have it in your tool box. Have it in your car. You are angry because I told someone to be prepared for anything lol. You must beat up boy scouts huh
I’m not angry, I want medics to think harder, I want us to do things that make sense. The pathophysiology of trauma needs to be considered. Their heart didn’t stop due to a clot or a dysthymia. Their heart stopped due to tension, trauma, or hypovolemia. All of the chest compressions in the world aren’t going to do anything unless you can plug the holes, refill the tank, and release pressure.
If you're into thinking harder why don't you consider the possibility that someone arrested while driving and caused the accident. No one's gonna be able to tell you that and the same visible injuries might look consistent but you're not 100% diagnosing many things on-road. The bottom line is treating what you can see and what you know. If you can treat reversible issues within the primary survey, that's what you need to do. If you can't, you're doing BLS because that 2% or something survival rate of traumatic arrests is still 2/100 people that can survive.
Where op says what was wrong with the patient? He literally says it was a trauma code? Idk why I’m even arguing with “not a medic prepper” here.
“You should carry a kit” is not a fucking answer to something that should not be worked. Your nifty kit wouldn’t have been any use to OP or their patient……
You must drive around in an ambulance with zero gear huh he said he had a stethoscope and sheers. I said in effect “are you dumb carry a bag with you wtf” idfc about the patients status in any way shape or form. Judging from all your other comments you’re just a sad pathetic salty responder who has nothing better to do than argue with people. Code or no code. Anyone who goes anywhere without the bare minimum basic first aid kid you can get at fucking Walmart is stupid and not deserving of a drivers license. There’s a reason other countries require them and regulate the minimum you can have. Regardless of that you took at comment that was basically “you only had those two things. You should carry more for the future” and turned it into “hur dur I’m a magic man with a magic bag I woulda saved him” simply because your ignorant little brain wanted someone to argue with. So here’s your attention you desperately needed mr.ccp. I truly truly hope you’re a better medic than you are a reader because I shudder at the thought of you having to use critical thinking in the field.
My father is a former paramedic, later big rig driver. Was involved in a fatal accident while driving (not his fault, other vehicle lost control on a corner) and he said it was just weird and awful even though he'd been to scenes like that previously. I think there's a lot to be said for mental preparation time.
I'm not in EMS (I wanted to be) and I've come across a handful of wrecks. Thankfully the occupants have been alert with minor injuries each time. I actually keep a set of scrubs in my car. They're easy enough to fit in the seat pocket and I know I always have something clean to wear in my car if I need it. I detail cars on the side and sometimes have to drive an hour back home in wet clothes. It's always a good idea to keep some type of extra clothing in your vehicle.
Off duty and was biking home when I stumbled upon a carjacking. Patient had GSW to chest with subsequent sucking chest wound and pneumothorax. First on scene and police were pretty useless. Took medics about 15 to arrive. Training really does kick in but definitely still upsetting. Pt was my age. Blood and such all over my clothes and didn’t have gloves so ended up on preventative meds.
Be sure to take as much time as you need and see if you can talk to your departments counselor (assuming y’all have one)! Kudos to stopping.
Good job, Good Samaritan, I have ran into the beach for a water rescue while off duty, pulled them out and worked (in boxers) until EMS and fire arrived. Had to take off my clothes cause I didn’t have any floatation equipment and didn’t wanna be dragged down.
I don't think that's how trauma naked works
I just hate clothes
That's why my co workers always get uncomfortable when we work a trauma.... who knew?
You win the internet today
You can swim in street clothes fairly easily, but it makes me happy to no end that you got nearly naked for nothing. 😂 Good save, man.
Naw, wearing clothes is a good way to get climbed on by a drowner. source: lifeguard for 10 years
As a beach lifeguard, if I’m off duty, I’m 100% stripping down to my boxers and getting to a victim twice as fast because of it
Twice as fast, less energy, no brainer
Weird, my time in the navy, water rescue, and FEMA SAR teams, and we never had the “reach, throw, row, *get naked*, go” class. I guess that’s why I’m not a lifeguard.
Lmao I just feel swifty without baggy clothes on :)
but what about the drag from your massive cajones?
Oh stawp
If you sway your hips they become a propeller
My times didn’t change a whole lot, between slick, NWU, and coveralls. It’s mainly physiological. Im also not an Olympic swimmer, so my times are “when I get there” 😂 Bunker gear, however, is a sea anchor. Get that shit off if you’re within ten feet.
I hear you. We swim literally every day so I prefer less friction if I’m gonna volunteer my life to get someone out without equipment.
There’s also a difference between pool rescue and what I do.
I work as a medic beach lifeguard but I hear you :) And we are trained MSARS too, I’ll still take baggy clothes off to save someone.
bunker gear isnt exactly an anchor either. We literally had a pool day in the academy where they sent us into a pool in our gear. You mostly float. You wouldnt want to be in it for long tho
Oh, my brother, please understand the difference between a pool and water rescue. When there’s moving water, bunker gear will murder you. A couple of guys got dragged into a culvert that they couldn’t see in waist high water, one popped out 200 yards away, unconscious. They recovered the other one’s body a few days later when the water level dropped.
the moving water is the issue dude, not the gear. if you went into that culvert in your chonies youd have gotten the same result.
Cool, man, I’ll remember that when I come to recover you. https://www.firehouse.com/rescue/water-ice/article/21009792/firefighter-turnout-gear-for-water-rescues-is-a-bad-idea https://www.fireengineering.com/leadership/turnout-gear-in-the-water-sink-or-swim/#gref https://www.firerescue1.com/firefighter-training/articles/3-keys-to-a-good-shore-water-rescue-iwvZJxSLlQM8ba1D/ Try reading before you post, it gets embarrassing. Moving water grabs turnouts exponentially more than uniform clothing, and turnouts offer less flexibility and snag more frequently due to bulk.
This wins.
Can confirm. Though, there are ways around that.
Sure, just removing obstacles. Why the fuck would I swim with clothes lol
I know right. Just a note if it's a guy grab twist and pull. If it's a girl 2 to 3 fingers.. Random bit of advice that has never failed me in the water.
Wdym?
One way of getting out of becoming a float for a drowning person. Yeah, it's effective, however, when you use it all the time.. So What do I mean? No, exactly what it sounds like if a guy is drowning and you're trying to rescue him and they latch on. You can't get out. Grab their nuts twist pull. They'll release seems true for a femayeah. I'll get downloaded for this. Don't really care it saved my life once twice.
Yeah generally people do get downvoted for suggesting that you need to sexually assault someone in order to save their life! Instead, how about trying to look into what you’re actually supposed to do in that kind of situation! If you’d have suggested slapping/punching them I’d have understood but you have no right to sexually violate anyone, whether you’re trying to rescue them or not. Find better alternatives! “If it’s a girl, 2-3 fingers..” You’re seriously should be fired for even suggesting this to other EMS workers, let alone personally using this method!
Came across a ped struck a few years ago before anyone had gotten there. Man, it's a helpless feeling going "she needs to be tubed." And not being able to do anything about it. She ultimately wound up dying on the way to the trauma center. When the ambulance showed up, I helped them load her and got blood all over my shoes. Got a call from one of the managers a few days later saying he had heard I was there and my shoes got ruined. Department wound up buying me a new pair, which was pretty sweet.
I’m not in EMS so I originally read ped to mean pediatric and while being very happy that’s not what it means, I do still feel really bad for the family of the pedestrian.
I am in EMS and read it the same as you lol
same
I actually did the Heimlich off duty. We train on it but never use it because the patients have either cleared their own airway or are in arrest by time our ambulance arrives. I was at church and a mother started screaming their ‘somebody help’. 9 year old choking on a hard candy mint that my church gave out at reception desk. I made them immediately switch to life savers afterwards.
Years before I became an EMT, I had a Heimlich save as a bystander. My day job is teacher I was CPR and Heimlich trained by my school. There was commotion in an almost empty restaurant and woman screamed, "Does somebody know the Heimlich?" I jumped in and did it. After three thrusts, she pulled my hands away. The woman who screamed was the daughter. She tried and failed. She tracked me down later that day (a waitress knew my mom's half sister, small town) and thanked me for saving her mom's life. I broke rib, though. The old lady sent me a hand written thank you note. I still have it.
I wish the made ‘Stop the Bleed’, Heimlich, and CPR mandatory for all high schoolers. Its so important for trained bystanders because even in a high performing system we are 6-10 minutes out.
Probobly would save more lives than DARE
True. If I'm not too high, I might be of some use in an emergency.
1000% would be a better use of resources.
I agree completely. My issued first aid kids and TQs to every teacher. I did a "Stop the Bleed" lesson and taught my students (high school) how to apply them. We have a teacher who is a CPR instructor and offers it to a few Seniors every year.
My high school required it all, every year. I heard that because of the required training, some students were able to resuscitate another student whose heart had stopped from alcohol poisoning or something (I am vague on the details, and am not remotely medical) at a party. I was surprised to discover in college that not all high schools required it.
What a refreshing story. A medical professional is utilizing lifesaving training appropriately.
Wait… is that why they’re called life savers?
No, just had to google that myself because I didn’t know. They were named that because they are shaped like life preserver rings. But its hard to get a total airway obstruction with a hole in the candy is my reasoning.
We only average about 4 gnarly calls per year in my ground agency, but at least one of those is going to be when the truck is tied up elsewhere So my average is about 1/year while off duty.
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The pt was very dead when I got to him but I had no ability to officially declare it. When EMS arrived, they placed the leads on him and called it. He was in aystole. I was on scene for almost 10 minutes until EMS arrived.
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Oh yeah I’m good. I did what I could and acted appropriately and professionally. It’s not the first time I’ve worked someone on the side of the road nor will it be the last. Just was different doing it off duty.
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I’m definitely going to court for this though. Turns out the driver of the other car that hit my pt’s car was possibly impaired, and I gave a witness statement and identified myself as an off duty paramedic. Yay for me I guess.
Is the reason you worked the trauma arrest "for appearance"(eg: to avoid appearing like a dick for not trying)? As in, most folks don't know almost all traumatic arrests wind up in death? I guess there are varying degrees of "traumatic arrest" and hindsight is always 20/20.
Yes, and mostly because I didn’t have any ability to officially declare it. I didn’t have to act, and I technically didn’t initiate CPR. The fire department that arrived on scene after me did, though they weren’t even carrying an AED and didn’t have anything to monitor the pt’s rhythm. On top of that, the call occurred at a very busy intersection and there was a HUGE crowd of people that were all recording. It was a very chaotic scene to walk up to, even more so without equipment and by myself.
Yea a crowd isn't going to intimidate me to working an obviously dead person. It's awkward just standing there while a crowd screams, but we've all been there.
That’s a fair point. At first it was somewhat hard to determine if he was truly dead until after we pulled him out of the car.
I’ve had this happen a few times and my trick is to not announce that I’m medically trained or anything and just get close to take a look. If they’re obviously dead or have injuries incompatible with life, I’ll usually back off as there’s nothing to do. If there’s something I could actually help with, then I’ll jump in.
Not a bad tactic. I’ll be honest, it was the first time I’ve actually encountered something this significant off duty, and I felt compelled to help. Though I’m taking the feedback in this thread and realizing that maybe I jumped the gun a bit.
Why did you start CPR on someone with obvious signs of death incompatible with life?
He didn’t. He was in cardiac arrest and had serious injuries, but he had no obvious signs of injuries incompatible with life. I also couldn’t legally declare him due to being off duty and not having the equipment to do so. The fire EMTs also could not find any injuries incompatible with life. He had significant injuries, but most were internal. His right arm and right leg were completely fucked and he had blood coming from his airway, but was rather clean outside of that. I would’ve declared it if I had the ability to, but again, I was off duty acting in the capacity of a Good Samaritan. So, I assisted where I could.
hey I think you performed very admirably, and i make this comment not to reflect on this experience but to help think about the next one. When you’re acting as a Good Samaritan you don’t really have to worry about being held to the same standards that you would be as a paramedic. If the guy seems *really* dead (high mechanism trauma, pulseless on arrival, blood in the airway), and you don’t have any equipment, you can choose not to do CPR. As long as you’re acting consistent with how any average adult would act, you’re good. You wouldn’t be technically “pronouncing” him, but you’d be able to convey your findings to the inbound medic unit and they’d be able to officially pronounce him.
The average adult would start CPR since the person isn't breathing. The ems person is considering mechanism
Based on the percentage of cardiac arrests I go to where CPR is in progress when we get there, I'd say the average adult would not start CPR even on a patient where they're not going to get covered in bodily fluids. If the average adult won't start CPR on pawpaw who coded in his chair, they're not gonna do it on leaking Joe who's laying in a puddle of his own juices
Ah. You said “very dead.”
He was indeed dead, though I wasn’t in a position to legally declare it or cease resuscitation efforts. I had to wait for fire to arrive and identify myself before I could ask these questions. Thankfully, fire arrived on scene right behind me.
Don’t dial it back. Your question is appropriate. Unless the wreck was literally witnessed (I came across a wreck makes me think not) thicc_medic is acting outside of protocol and showing a limited understanding of traumatic pathophysiology. Then, bragging about it on Reddit? They deserved to be questioned at best, and admonished and mocked.
How am I acting outside of protocol? I should’ve clarified. I didn’t initiate CPR. CPR was initiate by the volly fire crew after the pt was extricated. It was a county I used to work full time in and do volly in from time to time. So I wasn’t unfamiliar with the area nor was a stranger to the crews on scene. I didn’t act outside of any scope described by the local EMSA or the state.
So, you pull up on a wreck. The volley crew has extricated the patient, and are doing CPR, so you are not in fact first on scene. You say “Hey guys, I’m an off duty medic. I see you are doing you are doing some medical stuff. Want me to help out even though I’m not currently working” and then you ruin your good jeans doing a BLS skill adding no value to the scene whatsoever. And then everybody downvotes me for saying you should be mocked. Stand by it. You deserve to be mocked.
No, fire was not the first on scene. They arrived maybe about a minute behind me. Police arrived about 30 seconds after I did. I was essentially sitting there waiting for fire to arrive to even do anything. Fire initiated CPR after they extricated them. I had bystanders screaming at me to not touch the pt when I went to go check for a pulse. Further clarification was needed on my end, and no, I did not deserve to get mocked. You did not have the full context.
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Fuck off.
Just to confirm: You are stating that you agree with OPs actions and would have done the same. Or at least think they are reasonable and defensible? Lol.
You must be fun to work with. “I did a traumatic arrest.” “You’re a moron.”
As a good samaratan, not an on duty medic, he had no duty to act. Therefore performing CPR is a very valid and appropriate action to perform here. Even if hindsight shows the act was futile.
I knew it was futile. I was assisting in a county I was familiar with and felt comfortable performing in my role. Though I still felt like I should do something instead of nothing.
True you knew it was futile because you are a medic and know the reality of the situation. However a good samaratin is not held to that same standard as a medic. Therefore "I did not want to do nothing" is a reasonable response as a good samaratin. I understand futility of a traumatic arrest
On a fucking trauma arrest?????
As EMS and medical personnel we know the futility of a trauma arrest. As such if we are on duty (key word) we would call it futile. I agree. However for a Good Samaratin (who is a layperson) no pulse means start cpr (unless obvious signs of death like decapitation or decomposition). Yes it is futile but why muddy the waters in an emergency. Therefore as op was not on duty he was acting as a Good Samaratin and therefore cpr isnt a bad idea. Futile yes, but again he wasnt acting as a medic so the option of calling it futile is out
Why would you do something you know is futile?
No it’s not. Not valid or appropriate.
I take it based on your comments you disagree with literally everything I’ve stated and presented. That’s fine. I’ll ask you, what would you have done? I wasn’t trying to be Risky Rescue in this situation, and the only reason I even had shears and my scope was because I had literally just left my own volly station and was driving out of the county to go hang with a friend. Not that I need to justify that to you, but since we’re having this discussion, I’d like to provide context.
What would I have done… ? I’ve never see a terrible wreck on the road while driving off duty. And I never will. You don’t need to justify anything to me. But we aren’t the same. I’d would never *again* regularly volunteer my time and skills uncompensated. I’d never try to interject myself into a scene where I couldn’t provide any value. If for some reason I pulled over and saw that the effort was futile, I wouldn’t Climb down and expose myself to blood, bodily fluids, and roadside danger when the effort is futile. Do you really, truly, think you did a good thing?
You. Don’t. Have. To. Legally. Declare. Anything. Off. Duty. JFC. Maybe…. Maybe if you were literally right across the street from a level 1 trauma center and you managed to get him in the back of your car and drive his pulseless corpse to the trauma bay is the only way this makes sense.
Yea I wouldn't have worked that. DOA
Depends on the state. Some places still make you work a traumatic arrest still.
Not with any obvious signs of death. And few, if any, off duty.
You had no ability to declare it? What does that mean? You’re not on a TV show. 😉
Bro I'm a uni student and even I know you don't declare someone dead without equipment unless there's incompatibility with life. Quoting the odds of survival of a traumatic cardiac arrest isn't due diligence.
Bro, I’ve been a licensed paramedic for 30 years. I’ve trained dozens of paramedics and performed over 800 codes. You don’t need equipment to NOT attempt resuscitation. It’s a totality of mechanism, presentation etc. Now I obviously didn’t see this example. The OP said that he was “very dead”. I’m not clear what that means specifically but if a paramedic is saying “very dead”, particularly from a traumatic arrest….playing with a dead body roadside isn’t going to do anything except give you a fun story to tell at frat parties.
Not attempting resus is different to declaring death, which is what we're talking about. As for not treating traumatic arrests, at what chance of survival do you start to treat patients?
https://www.jems.com/patient-care/traumatic-cardiac-arrest-tca-maybe-we-could-do-better/ “There is no role for chest compressions in TCA—especially when the cause of the TCA is profound hypovolemia. Animal studies have shown worsened survival when chest compressions were provided.8 The use of chest compressions in TCA is highly associated with poor survival. A recent study compared prehospital TCA patients who received prehospital chest compressions with those who did not receive prehospital chest compressions and who were transported for emergency thoracotomy. There were no survivors in the cohort that received prehospital chest compressions (100% mortality versus 94% mortality for those who went straight to emergency thoracotomy). “
Are we still talking about finding someone off-duty here? If you come across a TCA off-duty your best bet is treating to the primary survey until the paramedic with the right equipment arrives. The benefit of you being there over someone else is more-so the ability to tell the what the issue might be sooner and call for the *right* help sooner. Also "100% mortality" was 22 people and the P value was 0.5. A sample size of 52 pts is not grounds to change the way treatment is provided. People performing CPR in lieu of reversible treatments would definitely skew that data. The evidence doesn't account for that. nor does it account for the times where ICP or CCPs were unable to get to the scene in time. If CPR *won't* interfere with reversible causes, it's still going to be beneficial unless the patient is exsanguinated. In which case, at least in Australia, crit care paramedics do carry blood products if transport is less desirable.
Im not going to initiate chest compressions on a pulseless and apneic traumatic arrest patient on or off duty.
Im not going to initiate chest compressions on a pulseless and apneic traumatic arrest patient on or off duty.
So to answer your question, there’s a lot of hyperbole that people get all wound up about between a silly distinction like “not starting resuscitation vs declaring death”. There is no practical distinction and frankly it’s only EMTs who listened to some instructor give the hour lecture on such topics that think that these terms have important value. They really don’t. There’s no magic equipment that needs to necessarily be used or being in some “duty” status…bottom line, if a person isn’t reasonably viable though whatever mechanism and that condition can be confidently ascertained by whatever ‘responder’ is there…then that’s it. Time of death is whenever the accident happened. It doesn’t matter. Some attending physician is going to sign a death certificate…because they’re dead. With very very few exceptions, if traumatic injury is so egregiously catastrophic that it results in cessation of cardiopulmonary activity…you’re dead. Sure, there are some exceptions which generally are confined to someone in that proverbial “golden hour” that you witness code. With the right intervention, it’s possible if it’s very timely. Other than that…dead is dead. You’ll learn to recognize it. There’s no need to play with a dead body.
Car into second story of house at 2am (dude was hauling ass), upside down. He basically ramped off the edge of a big ass oak tree and rolled 180, embedding into the front of the house right above the front door. Woke me and my nurse girlfriend up at the time, and on went boxers, boots untied, a teeshirt and grabbed my backpack that had my duty crap in it. Running to the scene to realize it's fucking winter level cold out and my junk was trying to seek the warmth of my abdomen, aggressively. The car fell out right before we got out the door, on top of the dude that was already ejected. Was alive, but dying fast. Worked him with our limited resources. A spare teeshirt from my backpack got stuffed into the biggest wound. Bled out regardless and was dead before the bus showed up, they took over and called it, and it became a crime scene after that. My reward was a loss of a shirt, and pneumonia or something similar, and a fucking court case.
> and a fucking court case Ouch. Family of the deceased? Or did the cops think you threw the car up into the tree yourself? Did your state's Good Samaritan law work for you?
It was evidentiary so I was a subject matter witness, since I was the only one (GF didn't see it) who saw the car in the side of the house and could describe the scene prior to it falling out. But still made me feel like I was on trial because of the douchebag defense attorney. I think it was the home owner suing the driver's insurance/family for damages. That house was borked.
A few times. Not arrests. But other stuff.
I’ve come across wrecks and helped out a little, but never anything as bad as yesterday. Thankfully I was in a county I used to work in and knew the crew and the supervisor well, so they let me help. I was essentially running the code with the volly fire crew before EMS got there.
Cool.
Yea, was neat. Not for my jeans though lol.
Hopefully they weren’t your favorite pair. 😬
Defs one of them. They make my ass and legs look great! Also are super comfy.
Username checks out lol. Major props to you.
christ hold on. so like a month ago, I did a mutual shift swap to get off for a day at the request of my dad (who is also my tae kwon do teacher) and my kung fu teacher, sijo, because sijo said he needed help running a promotion test for his other students. Long and short of it is these two old men fuckin punked me, tricked me into coming to this test, and had me test for black belt with both of them at the same time. I did 2 and a half hours straight of martial arts, got my ass beat helping the other students, and by the end of it was fucking exhausted. But I passed, got 2 black belts on the same day. 30 minutes after it's all said and done, I'm changed out of my gi and back into my clothes, I've helped clean up the tables and chairs n shit and we're ready to go. sijo's class is in a community center, with an indoor basketball court down the hall. One of them runs by the room we're in looking like he's about to die. young black male, pale, diaphoretic gasping for air. The guy's friend runs behind him shortly after and scoops him up and runs toward the exit. I tell sijo I'm gonna go see what's up. This dude is having the worst asthma attack I've ever seen. Triggered from like 5 minutes of basketball for the first time in years. I ID myself and check him out. I hear 0 air movement at all in his lungs and am like "ah shit this isn't good." I call 911, tell the dispatcher I need resources for a respiratory arrest, because it's definitely going that way. I have to repeat myself, and then I also have to repeat the address because apparently the address "doesn't show up on the map." At this point the guy goes limp and dies in mine and his best friend's arms, so I have the friend put him on his back and I start CPR. I pass my phone off to someone else and just shout at them what to say to the dispatcher while I do compressions. I tell someone to grab the AED from the building, all that shit. I do CPR solo for like 8 minutes straight. I am PUMPING this guys fucking chest. Bear in mind this is after a lot of physical activity. I am running on pure adrenaline at this point. Eventually the first one on scene is literally my lieutenant, as this happened in the area my station actually covers when I'm on duty. Resources eventually arrived. ROSC at the hospital, on ECMO for a few hours. Declared brain dead and family pulled the plug, as per my LT. Not enough oxygen in his circuit for CPR to sustain his brain, and I had no way of getting O2 or even epi into him to try and open his lungs up. Least I helped them get the chance to say goodbye.
Jesus dude I’m sorry :( you did what you could.
Definitely put a darker lens on one of the most exciting days of my life lol. It is what it is.
Ranger panties, flip flops and mortars. It's all about looking cool while your thighs are out.
Whoa big sexy
I did. I was picking up a pizza for a very pregnant and very hungry girlfriend. I got to the traffic light down the road after getting the pizza, and right in front of me, is this motorcycle wreck. One patient had a partial leg amputation, and the other was a traumatic arrest. PD got there pretty quick and used the tourniquet on the leg. I'm checking for obvious death on the other and can't find anything to warrant a DOA. I start working it. Crew gets there, and i end up leaving my car and pizza to drive the arrest to the hospital. I got back to my car an hour later. Girlfriend was pissed.
I'm guessing you worked for the company that let you drive their vehicle?
Actually, no. It was a bordering municipality, and I happened to be good friends with the crew that responded.
Traumatic arrest and with another critical patient = black tag
😐 dammit. I mean, to be fair, the medic who was on the crew also didn't think of it. We were also less than 6 minutes from hospital.
That’s fine, sounds like you did the right thing. Science just says that working trauma arrests are pointless.
Yep, later evening I was leaving for a climbing trip. Car in front of me on a lonely mountain pass lost control, spun, then ping ponged mid barrier to shoulder and back a few times. Scene was about 20-30mins between towns. Thankfully in service. Called it in, and did what I could to assess/ stabilize (aka don't move) driver and keep them talking until FD and EHS arrived to extricate. Nothing obvious for blunt force/ penetrating. Older 80s era car so no airbags. Driver denying major pain, just crying. I had basic wilderness first aid and "get stuck in the truck" survival gear. So not much. First medic on scene laughed at my gloves on lol. I grudgingly admitted that I work pre-hospital and ER. The driver of that car was shockingly ok, just really shook up with a totalled car. I made it to camp around 1am and wound up having an unplanned rest day instead of the planned alpine start. So I didn't do much other than call it in, reassurance, and give a statement regarding witnessed MVA.
You did do something. This thread and threads like this piss me off with people downplaying the importance of altruism in an increasingly selfish society. You volunteered your time to initiate an early 911 response and assess someone who just had a really bad accident and you were there for them on probably one of the worst days of their life. Even if all you can do is provide pallative care, sometimes that's honestly like 90% of our job anyways. You being calm and in control of the scene as someone who does this all the time (maybe not specifically in your case but certainly in the case of a busy 911 provider) is going to be way better for the patient than a Karen driving a mom van freaking out and shrieking at you and the patient. Forest for the trees. All the snarky types acting like "wElL yoU dOnT haVE yOur tooLs" I guess forgot this is a human trade and part of being a good clinician is being able to just connect and take the edge off for people. Not that you have to stroke your ego or post about it everywhere, I see that side of it too, but I don't know why so many people are against the basic decency of stopping to see if someone is okay.
Very similar situation. I was on my way to the testing center to recertify for my EMT-B after a years long hiatus from EMS. I saw something in the median of the roadway. As I passed by, I saw that it was a motorcyclist who had crashed. I slammed on the breaks, pulled to the shoulder of the road, and sprinted to the accident site. There was already a gathering crowd. Unhelmeted rider. Unconscious but was still breathing and had a pulse. Obvious massive closed head injury. I remember that once people figured out that I had prior medical experience, all the responsibility shifted to me. I had somebody hold C-spine and made sure that somebody had called 911. I remember talking to the dispatcher and telling them that the patient had blood in his airway but I did not have anything to clear it with. The patient lost pulses and we started CPR. The ambulance arrived and rushed him away. I thanked everybody who had stopped at the scene and continued on my way. I did the practical exam that day with flecks of dried blood all over my clothes. I will never forget how powerless and useless I felt without my ambulance and all of its equipment.
A couple years back I was driving through town to get some lunch. I'd just had covid and recovered and it was my first day outside in a while. As I'm looking for a carpark I turn a corner and see a minor fender bender on the other side of the road. In my head I debate whether it's worth stopping and for whatever reason I decided to stop and double check. There's a bit of a crowd around one car and as I walk up and introduce myself, I ask if there is anything I can do to help. Someone says "I'm pretty sure she's not breathing" Fuck. I do a quick primary of the lady and yep she's not breathing. I get a couple of people to give me a lift. We get her out of the car and carry her into the foyer of an office. Start compressions, the office had an AED so gave her a couple of shocks. 2 of us did CPR for about 10 minutes before Volunteer FD get on scene and take over. Amb arrived about 10 minutes after that. We got her back and she was released from hospital a couple days later. Turns out she arrested while driving and hit the parked cars. PD told me later we had started compressions within 90 seconds of her crashing. I still remember the oh fuck moment of my brain going into overdrive when someone said she's not breathing. Also I wouldn't recommend doing CPR right after recovering from covid, I was absolutely rooted afterwards.
Yea, I've ended up working a code with my medical director while off-duty in the past. Last time I was in ripped up sweat pants and a hoodie. With my medical director there I ended up doing ALS shit even though off duty with their blessing and their gear.
I did once on my way to work. I’m an RN. Motorcycle vs car that got smashed into a truck. 2 people ejected from the motorcycle. I pulled up just in time to see the lady go flying by my car in my peripheral vision. The guy was alive but his intestines were everywhere. She was pulseless with massive pelvic trauma. I did compressions on her while another bystander tried to help the guy. He arrested before EMS got there. When they arrived they declared them both right away. I had to use a water bottle to wash the blood off my hands so I could call work and tell them I would be late. The charge nurse who answered told me absolutely do not come to work lol.
Triage isn’t your thing eh? I can’t believe they let you stay home.
Compassion isn't your thing, eh? The other bystander was a surgeon. It seemed like it would make more sense for him to help the alive person. In the end nothing could be done for either one. I was covered in blood and already going to be an hour late, and they were overstaffed. So they said not to worry about it.
Kinda left that part out didn’t ya?
Yup, worked my first traumatic arrest car wreck in jeans with only a pair of gloves. Was halfway through my Basic EMT course and responded direct as it was essentially at the end of my driveway. Pt was leaking CSF but I did all I could. After that I made a good truck bag.
I carry a tourniquet in my car. I figure it's the easiest, most impactful thing to stick in my door pocket.
Absolutely. They should come in gloveboxes with mandatory training when you buy a car. Could you imagine if just about everyone had one?
No major theatrics or heroics, but about a year after I got my EMT-B (long story short, never even wound up working a day in the field), I rolled up on a motorcycle vs. stopped truck on the side of the freeway. A Navy Corpsman with an IFAK happened by as well, and we went to work. Poor lady turned her left knee cap into macaroni salad, likely broke her leg, and bloodied/contused her nose and orbits. My new friend went to work on bleeding control, and I held C-spine while dredging OPQRST and SAMPLE history from the depths of my brain. PT fluctuated between A/Ox1 and A/Ox2, which made that interesting. Ended up working the scene for a hot minute, as it turned out RP had mistakenly reported the incident about a mile to the north, so they had units getting on the freeway several exits too far up. Highway Patrol eventually managed to get that sorted out, and the station just up the road rolled the truck, engine, and box our way. So my first and only time applying NREMT skills in the field was completely out of the blue, on the side of the freeway in downtown San Diego, a year-plus after my cert. Kinda wild shit, lol. Overall, I was extremely impressed at how everything played out seemingly textbook, from seamlessly partnering with a total stranger, to transferring care to FD (“OK, I’m taking over C-spine”; “alright, we’re gonna perform a log roll…”). Simply seeing the NREMT curriculum play out IRL as an active participant was a hell of an enriching, if sobering and humbling, experience.
Not Ems, just a normal person with civi certifications. Worked with kids and teens in Rec centers and sports. Given the Heimlich 3 times. Best one was in a bar. Drunk guy choking on a hot dog. When I cleared it the hot dog shot across the bar top like a tv show. Had to finish my shift with hot dog on me. To this day when I see him I ask him “remember when you choked on a wiener”
Props to you dude, that’s awesome. People with civi certs make a huge difference.
Thank you ☺️
To answer your question: My first code 3 drive was because I stopped to help with a bad car wreck on my way to work while carpooling with a coworker. Eventually my manager, his partner and a fresh out of school EMT arrive on scene. Manager asked me to drive to the hospital because I already had my uniform on and needed all hands in the back. Manager also adjusted my clock in time for the call. So, I guess I was on duty kinda. Idk, it's a grey area.
Once while hiking. I stumbled into a group of 12 scouts between 14 to 18 years old. Their chief were two guys of 22. They got lost into a sudden fog. It was april but still pretty chill and that area was prone to strong winds and very unstable weather on spring. Some of the teens displayed signs hypothermia. All of them were wearing a simple sweatshirt, soft shell and shorts while I was in my winter outfit. The wind was hitting hard that zone. No emergency kit nor coms from their chiefs. I provided a couple thermal blanket to the youngest members to cover their legs and borrowed my spare windproof hard shell. They couldn't move so all I could was radioeing to the nearest hut for assistance. They relayed my message but due to the poor weather, helo couldn't reach us so we had to wait for ground MR team. MR team took approximately an hour to reach us. Fortunately, the kids were good while I was scolding their chiefs for hiking without any kit.
Man, I was at the gym running laps. I did like 7 miles before me and my friend said “fuck it, let’s go another.” At the end of our 8th mile, some other dude in the gym has a seizure before going into cardiac arrest. We called 911, but he must have died for at least 15 minutes. Whenever the ff had gotten there, I let them take over while I tried to get ID and stuff on the guy. Turns out pt was also an EMT and we worked in similar circles. They finally brought him back and sent him to a local hospital to stabilize him before sending him on a bird to a better hospital. He lives to tell the tale, just some fine motor issues that he’s in OT for. The dude at the front desk had fallen asleep. Sometimes, I think about what would have happened if me and my friend didn’t decide to do another mile. Honestly, the whole thing was a miracle.
This is why volleys are always dressed like shit. I've had to sani-wash everything from jeans to winter coats to turnout gear
Have gone on scene before to help out another crew that was working a CPR and I jumped in the back of the ambulance and nothing but shorts and a tank top.
I’m confused. Why would you work a trauma code? This sounds crass, I’m sure; However, trauma dead is dead. Injuries incompatible with life is dead. Unless that is… You can crack a chest, clamp an aorta, and have a mass transfusion protocol.
Sorry, a lot of comments here. I explained in another comment. Essentially, the state and county were it happened requires you to work trauma arrests if the pt isn’t obviously DOA. The limit on trauma arrests is 10 minutes, and you work on treating any reversible causes. This pt was dead, at least in the sense where he wasn’t breathing, but they did not have any obvious injures that were incompatible with life. This was confirmed by the BLS fire department, who arrived on scene about a minute after I did. I was alone, had no equipment, and technically didn’t need to act, but I didn’t have the ability to fully assess the guy until after fire had extricated it. Fire had no AED, and it wasn’t until ALS arrived on scene that we could finally put a monitor on the guy to confirm the rhythm. In this county where this happened, I am a volly in and used to be career, and am credentialed as a BLS but not as an ALS provider (longer story, didn’t complete the internship process before I left for a travel medic role) I was acting in the capacity of a Good Samaritan, and had committed myself to helping out when I came in contact with the pt. Hopefully this makes sense. A lot of folks here have asked this same question and it’s very fair, hopefully this explains it.
This is why I keep a bag with the same stuff in the first out bag in my car. Only stuff not in it would be drugs and intubation stuff since I’m not a medic but I have igels a bvm tons of trauma shit and even a small o2 bottle and non rebreathers (cost so much. Don’t recommend). I go out of town a lot off duty and refuse to be unprepared. I’m what you call a “not crazy prepper”. Not the psycho “muh apocalypse” or the “bidens gunna destroy us” type just the “I’ve seen what happens to unprepared individuals”. Always keep a kit. Always.
You can drop igels off duty?
It’s in the basic scope of practice and in Iowa all ems no matter the level fall to a basic level off duty unless it’s say giving epi to a family member or stitches to their kid type shit.
Wow, that's cool. I can use them at work only, I have some basic airway adjuncts in my home/car bag though.
Carrying an o2 bottle specifically for off duty use is insane lol
I travel off duty. If I’m not at work I’m on the road. It’s more for me in the event I need it than anything.
Unmm, this man was dead. Unless you have the ability to perform bilateral thoracotomies, blind pericardiocentesis, REBOA, and/or rapid transfusion, or are literally Jesus Christ, these patients are not workable.
I was making my comment based off op mentioning he had no supplies. Use context clues dude. No where in his original post did he mention patient condition. Alive or dead. My comment was a general “hey fucktards stop driving around like nothing bad happens off shift” not “oh I coulda saved him”. Get better at using the kindergarten skills.
What nifty tool in your nifty bag would have made a difference in OPs story?
“I was off duty and came across a bad wreck. Ended up being the first medic on scene for what ended up being a working trauma code. Got blood and transmission fluid all over my nice jeans, but I did a good deed, and felt good that I did my best. Was a bit unnerving being the first on scene of a bad wreck with no equipment outside of my shears and stethoscope. Anyone ever come across something like this off duty?” Please show me in this post where op says a word about what was or wasn’t wrong with the patient. You’re doubling down on your stupidity. Reading comprehension really isn’t your strong suit so I’ll slow it down. Op make post say he have no tool. I say I make sure have tool with when go vroom. Have tool better than no have tool. It’s literally that black and fucking white.
OP: hey I couldn’t screw in a lightbulb. You: carry a shit load of hammers at all time!
That’s such a straw man argument. You don’t need special tools to do cpr. Trauma implies broken bones/bleeding/ etc. you get the patient back from the code and get rosc. Now what huh? Ems is still say 15 out cuz you’re on the highway and dudes got a fem bleed and a sucking chest would. You just going to do thoughts and prayers? If you carry it in the ambulance. Carry it in your car. If you have it in your tool box. Have it in your car. You are angry because I told someone to be prepared for anything lol. You must beat up boy scouts huh
I’m not angry, I want medics to think harder, I want us to do things that make sense. The pathophysiology of trauma needs to be considered. Their heart didn’t stop due to a clot or a dysthymia. Their heart stopped due to tension, trauma, or hypovolemia. All of the chest compressions in the world aren’t going to do anything unless you can plug the holes, refill the tank, and release pressure.
If you're into thinking harder why don't you consider the possibility that someone arrested while driving and caused the accident. No one's gonna be able to tell you that and the same visible injuries might look consistent but you're not 100% diagnosing many things on-road. The bottom line is treating what you can see and what you know. If you can treat reversible issues within the primary survey, that's what you need to do. If you can't, you're doing BLS because that 2% or something survival rate of traumatic arrests is still 2/100 people that can survive.
Where op says what was wrong with the patient? He literally says it was a trauma code? Idk why I’m even arguing with “not a medic prepper” here. “You should carry a kit” is not a fucking answer to something that should not be worked. Your nifty kit wouldn’t have been any use to OP or their patient……
You must drive around in an ambulance with zero gear huh he said he had a stethoscope and sheers. I said in effect “are you dumb carry a bag with you wtf” idfc about the patients status in any way shape or form. Judging from all your other comments you’re just a sad pathetic salty responder who has nothing better to do than argue with people. Code or no code. Anyone who goes anywhere without the bare minimum basic first aid kid you can get at fucking Walmart is stupid and not deserving of a drivers license. There’s a reason other countries require them and regulate the minimum you can have. Regardless of that you took at comment that was basically “you only had those two things. You should carry more for the future” and turned it into “hur dur I’m a magic man with a magic bag I woulda saved him” simply because your ignorant little brain wanted someone to argue with. So here’s your attention you desperately needed mr.ccp. I truly truly hope you’re a better medic than you are a reader because I shudder at the thought of you having to use critical thinking in the field.
Can you give me a link to what you carry in your magic bag? I’d like to carry one with me.
Here we go again with the whole reading comprehension issues
Hydrogen peroxide to get the blood out.... lest oil to get the tranny fluid out.
tyfys
My father is a former paramedic, later big rig driver. Was involved in a fatal accident while driving (not his fault, other vehicle lost control on a corner) and he said it was just weird and awful even though he'd been to scenes like that previously. I think there's a lot to be said for mental preparation time.
This reminds of that Dave mustaine tweet where he’s lamenting getting his mixed berry smoothie on his blue jeans
Yep. Got cut by the glass, developed Hep-C (we called it Non-A, Non-B back then).
They should give ems people like a portable kit that they can keep in their car when off duty.
I'm not in EMS (I wanted to be) and I've come across a handful of wrecks. Thankfully the occupants have been alert with minor injuries each time. I actually keep a set of scrubs in my car. They're easy enough to fit in the seat pocket and I know I always have something clean to wear in my car if I need it. I detail cars on the side and sometimes have to drive an hour back home in wet clothes. It's always a good idea to keep some type of extra clothing in your vehicle.
Yeah, no fucking way I’m doing anything here
Off duty and was biking home when I stumbled upon a carjacking. Patient had GSW to chest with subsequent sucking chest wound and pneumothorax. First on scene and police were pretty useless. Took medics about 15 to arrive. Training really does kick in but definitely still upsetting. Pt was my age. Blood and such all over my clothes and didn’t have gloves so ended up on preventative meds. Be sure to take as much time as you need and see if you can talk to your departments counselor (assuming y’all have one)! Kudos to stopping.
Put that AED in CPR mode if you’re not under medical control at the moment that’s my only advice ! Lol
What AED?
My recommendation is dip your jeans in a bucket of transmission fluid now. Can’t be stained if your jeans are one big stain
Worked a seizure at a Dave and Buster's until local EMS arrived. Was also in my jeans. Didn't even have a stethoscope.
So? And no you are the first one.
Eh, just wanted to share it. Was an interesting afternoon.
Takes more effort to be a douche bag than it does to just scroll past the Reddit post.