Trial by Fire (well, car crash actually)

My family and I left our home Friday to drive down to Philly to have some more in-law time. At least this time the purported purpose was to celebrate the birthdays of my son and his cousin.

About an hour away from home we are headed south, still on two lane highway (one lane north, one south), when a pleasant sunny drive gets really interesting. The second car in front of us (i.e., there is a car between us and the car in question) crosses the double yellow lines. It crosses again, this time forcing some cars coming north to go onto the shoulder. As we approach a bridge I am about to ask my wife to grab the cell phone and call 911 when it happens. The car swerves right, hits the guardrail on the southbound side (our side), crosses both lanes of traffic, and SLAMS into the other guardrail. Seeing this about to happen the car in front of us slows, as do we. After the crash, the car in front moves around the crash (I figure the guy is just moving on) and I decide I’ve got to help but I can’t leave my family as the first car to be hit by someone coming from behind, so I too pull around the crashed car and park on the shoulder about 50 feet beyond the wrecked car. The person who was in front of me pulls over and we both get out at about the same time, waving our arms trying to get traffic to slow around us.

I start running towards the wrecked car, which is now on the shoulder and in the southbound lane, sitting at a 90 degree angle to the road. The guy who also got out starts yelling at me not to touch anything. I run around the car to the driver’s side and look in. The driver is supine, across both seats with his head resting on the passenger door. There is a star shaped pattern in the windshield on the passenger side, along with a huge dent in the dash. The car was older with a two-part seat belt system (the shoulder strap connects to the door frame and is on a motorized track and the lap belt is separate). The driver is unresponsive and isn’t moving. Thankfully his door is unlocked. As I open it, the shoulder belt moves with the door, and I have to unhook it to get into the car (the driver was not wearing his lap belt). I switch the ignition off (the car was not running – there was coolant and oil everywhere on the ground). At first he is breathing, but he suddenly begins snoring respirations and then stops breathing altogether. I realize that I can’t help him from the driver’s side of the car (as I am effectively at his feet), and if I open the passenger door to get to him his head will move a LOT. So, I reach across the car and his broken and bleeding body, roll down the passenger side window, and then get out and run around the car to the passenger side. Reaching down to stabilize his head (and C-Spine), I perform a modified jaw thrust. BIG GASP. He hyperventilates for 20 seconds or so and then settles into a reasonable reparatory rate. During this time I have to tell the guy who was in front of me, who has been yelling “DON’T TOUCH HIM, YOU’LL PARALIZE HIM!”, that if I don’t touch him he is going to die right in front of us. This pretty much shuts the guy up and he (to his credit) thankfully focuses on keeping traffic under control. As I was maintaining the patient’s C-spine and airway a woman CPR certified showed up and parked her car in the southbound lane such that it would get smacked instead of us. The first words out of her mouth when she saw me (I was wearing a t-shirt, shorts, open-toed shoes and NO gloves) were “Shit, I left my gloves and first aid kit in my other car”. Perhaps obviously the injured driver is bleeding all over my ungloved hands and I begin to replay in my mind our instructor’s admonition that we keep gloves in all of our cars. I ask the woman to check the guys radial pulse – it is there. The patient begins to moan, and takes a few swipes at my hands on his head. I tell him what I am doing, and ask him to hold still. He does. I ask him to wiggle his fingers without moving anything else – fingers on both hands begin to wiggle. I can’t see his feet, and he has shoes on anyway. I tell him I know it hurts a lot, but he needs to hold still until the ambulance comes, and that they will be here soon. He complies.
We were, of course, in the middle of nowhere. With two people calling 911 (my wife and the wife of the driver who was directly in front of us) 911 dispatch got the message and the ambulance showed up about 8 minutes after I opened the guys airway.

The ambulance shows up before rescue. A women wheels a stretcher to the car, looks at me, and begins to open the passenger’s side door to the car. What was missing here? A) I could not have held C-spine as the door opened, so SOMEONE should have been there to take-over head stabilization. B) I’m bare handed, in shorts and t-shirt. I should be nowhere near an extrication. C) Don’t you want a backboard and neck brace? D) Wouldn’t you like to ask me what has been done, what the guy’s mental status has been, ABCs, etc?

I’ll admit that I got a little snippy at this point. I asked the lady if she realized that opening the door would prevent me from maintaining head stabilization and the open airway I had established. She looked at me like a deer in headlights. I asked if she might rather maintain head stabilization and wait for rescue. She did, and I went and drowned my hands in sanitizer and then got my family out of there (there where 10 rescue vehicles on the scene when we left). I never did have anyone ask me who I was, what I saw or did, or how the patient was doing when I found him.




Lessons learned:

-Keep BSI in both cars.

-Spend the $8 and get a window hammer (if this guys door had been locked I would have been screwed)

-The cell phone is worth every penny we pay for it.

-This is just a prediction, but it seems to me that it is easier to deal with an emergency if you are the senior person there, you have no duty to act, and you don’t have time to worry about what you’ll do. I am sure that if I had come on this scene with an ambulance it would have freaked me out. Things happened so fast I had no time to stress, worry or even think. I just DID. If this were a situation where I had been paged to a one-car MVA with personal injury, I would have had the whole trip to the station, and then from the station to the scene, to worry about what I should be doing. When we got there, being so inexperienced, I likely would have stood around and waited for orders. In this case, it was ME or this guy would have been without O2 to his brain for 8 minutes. I did a scene size-up and initial assessment without even thinking about it. It made me feel like all the time I put into the EMT class has already paid for itself.

-When you arrive at a scene with people already giving some kind of care, introduce who you are, what agency you are with, and what level of training you have. Then, politely ask the person who they are, what their credentials are, and what has happened so far. In this instance the responding ambulance could have learned a lot from this exercise (never mind the fact that I have no idea who you are when you have no clothing on to identify yourself).

The rest of my weekend was relatively uneventful.

DJ