Tell victom or not?

[mikim]

I just re-read my last post - sounded short and harsh - sorry ----- I mean what I say but don't mean to say it to be mean --- something I'm trying to work out of - too many military years maybe-- it's just that --ben there dun that-- ya gotta move on or it will eat you alive.
mike

 

[DocHeb]

Re: Tell victim or not?

It really seems like you did the right thing. I may not know much about tractors, but I know about delivering bad news. As an Emergency Physician for 18 years, I always try to be honest (but not graphic) in my descriptions of how someone is doing. In this case I could see myself saying something like: "Hey Dad!, I know that your worried about your son, but the good thing is he's awake, yelling and making sense. That means the major systems are working. His legs are stuck in the car, but the paramedics will be here soon to get him out. Let's have you lay down to protect yourself so you can take care of him after the hospital." The best thing you can do for a major trauma victim is to keep him warm and have him lay quietly, waiting for help. It sounds like you did this the best you could.

In my profession we take a mixture of book-learning, training, experience, common sense and the information/data available, and make a decision. You can’t always wait, collect more data, or get a second opinion - a decision needs to be made. This applies to the treatment of hangnails as well as major trauma cases. I learned a long time ago that you just have to live with a decision as being the best one that you could make at the time. People will always try to second-guess you after the fact (especially the lawyers), but remain confident in a decision that was made in the heat of the moment with limited data. If you second-guess yourself, do it just enough to have it be a learning situation, and then move on. As long as you were doing the best you could do at the time, keep your head up. If you follow the maxim: "What would I do or want for my family?" you won't go wrong.

A couple years ago there was an exchange of letters in one of our newsletters concerning the question "Should I Stop to Help at an Accident?". It was sad to see the many letters from physicians that wouldn't stop to help, mostly because of legal worries. All the "non-stoppers" clammed up when a co-worker of mine described his story. His letter was titled: “Why I Stop for Accidents”. On the way home from a long shift, he came upon a "fresh" accident. He remembers thinking about driving by so he could get home - his wife and kids were waiting for him. Something convinced him to stop. It wasn't until he was next to the car that he realized the destroyed vehicle was his wife's, and to his horror she was lying unresponsive inside the car. She was not breathing since her head was bent forward - occluding her airway. With a slight repositioning of her head her airway opened up and she started to breath. He had saved her life. Anyone that reads his more detailed account will definitely think twice about driving by an accident.

Stop to help - Keep up the good work - We can always use a few more Good Samaritans.

 

[TWINKLE_TOES]

Re: Tell victim or not?

DocHeb,
Good post/w3tcompact/icons/smile.gif
Al

 

[dmccarty]

Re: Tell victim or not?

DocHeb,

Most excellent post.

One thing I forgot to mention and I'm surpised that it did not come up, are the Good Samaritan laws. This really varies by state but I was told that most states have Good Samaritan laws. I know NC does.

The laws pretty much makes it difficult/impossible to sue at least a "normal" person who stops to help at an accident. A person who stops to help really has to do something very dumb to open up a lawsuit.

I'm not sure how the law works with Doctors and nurses.

Does anyone know any more details?

Shoot. While I'm on the subject. Go take a CPR course. I'm not sure if it was the First Responder class or the CPR classes where I learned how to handle choking incidents. I have had to deal with my 17.5 month old choking twice so far and the training I had 5-6 years ago was back in a flash. I'm still amazed that the rather limited time in class actually came back to me, and in a manner that did not require thought, just allowed me to act to get the obstruction removed. She has twice had the classic gag, red face, and the hands to the throat choke. No air moving in her at all. The last time she did this I jumped over the couch like I was a hurdler at the Olympics, pulled the kid out of the high chair, put her in the position and wacked her on the back. Out popped the food. Looked at the kid. She looked back. Put her on the floor and off she waddled like nothing had happened. Looked at the wife, looked at the kid. We both started to breathe again. /w3tcompact/icons/smile.gif I lost six months off of my life and I think she lost 18 months! /w3tcompact/icons/smile.gif

Take the CPR class.......

Later...
Dan McCarty

 

[Richard]

No harshness/offense taken at all. I think your right. I felt better yesterday after leaving name/number. It was at that point that it seemed to come "full circle". Logic being that if they care/choose to call me fine, if not, that also is fine.

Thanks to all for thoughts/concerns/wisdom.

Richard

 

[Mike_Dumond]

Richard, I've been working as a paramedic for close to 14 years, and all I can say is that when we show up at a scene like you described, and we find someone like you and the teen doing your best to help, we are so very grateful. Thank you for stopping and helping. "You done good"

As for how much to tell, well that's a little harder. Rule number one: Never lie to your patient. If you get caught in a lie once, the patient will never trust you again. That said, the question comes up, "what if the other is deceased?" Then, you fudge, tell them someone else is looking to them. Not lying, but not giving them more than they can handle.

Rule number two: If you have bystanders wailing and screaming that aren't family, then have someone move them back. Pick the biggest calmest looking dude to do it. The patient doesn't need to hear it and almost every time someone will come out with some assinine remark like "I wonder if he died right away?" Heard that once about a man's son while I was working on the father. Almost impossible to handle him after that.

Rule three: This one is controversal. If family are on scene, do not prevent them from seeing loved ones if they want to. Using common sense, of course. You won't let them view a decapitation, or similar injury. But, this may be the last chance for them to see the loved ones. It's a matter of closure for them.

Rule number four: Once EMS arrives, don't be too quick to leave. They will probably want/need your assistance. And they will be grateful for it, even if they don't mention it right away. But don't be insulted if we ask you to step away. We have alot on our plates just then and the patient always comes first.

Rule number five: Don't be afraid to go see them later. You have no idea how many times a patient will ask me later, "Who was holding my head", or "Who stayed with me till you got there?" They want to know, and will appreciate the visit. They will ask questions about the accident, answer them. In your case, you are the one who knows what happened. And they need to know.

You'll get alot of advice from hospital personel, probably telling you that you shouldn't visit. Well, take it from a pre-hospital provider, go if you feel you need to. Or even if you're not sure. The pre-hospital setting is totally different, you see your patient for a short time, then nothing. No chance for closure there. If you are having trouble with it, check out the local EMS personel, they'll help you through it, or direct you to the right counseling services.

Again, thank you for helping. Visit them. And don't be afraid to be proud of what you did.

Keep the greasy side down.
Mike<P ID="edit"><FONT SIZE=-1>Edited by Mike_Dumond on 10/19/01 10:30 AM (server time).</FONT></P>

 

[Richard]

That was an awfully thoughtful and helpful post Mike.

To be clear, "I" have no paticular emotional issues here. I say that in a form of general statement of fact, not addressing what you say defensively.

I did what I "had" to do, I would in fact, do it again.

I had some formative experiences when I was young that taught me what the meaning of life was (or at least, the meaning of life, for me)

Simply put, to help each other.

It dawned on me that if every soul on the planet vanished (ala the Twilight zone episode) then your life is meaningless. It is the people in your life, your loved ones, and the greater circles of people around you after your loved ones, that are what make up ones life. To do anyting to those circles of people other than to cherish them for all their worth, to me, nullifies any reason for existence.

Bin Laden excepted /w3tcompact/icons/laugh.gif

Richard

 

[bpence]

Re: Tell victim or not?

I don't think many folks could have said things better. As a weekend EMT riding shotgun on an advanced life support truck, I've dealt with a lot of folks with some serious injuries, and you're exactly right about what to say and how to say it.

Bob Pence

 

[StoneHeartFarm]

Richard,

To tell or not to tell. I've been in that exact same situation.

The first time, the young man was obviously dead. I told his sister "I don't know". She sent me to find out. I went, came back and said "they're working on it, and I don't know."

The second time was my mother in laws heart attack. She was already in the hospital when it happened and woke up with the tubes already out. She didn't know where she was, how she got there or what happened. She kept asking how she got there and seemed aleart, but was very weak. My wife wanted to know if we should tell her what happened. I said "No" and warned the nursing staff not to say anything either. 3 days later, when she could sit up by herself and was starting to make noises about "alzheimers" (sp?) we told her. Turns out it wouldn't have done any good to tell her earlier since she couldn't remember anything prior to that day anyway.

I think you did the right thing. I believe in truth, but there is a time and place for cold hard reality.

SHF

 

[Richard]

/w3tcompact/icons/smile.gif /w3tcompact/icons/smile.gif /w3tcompact/icons/smile.gif /w3tcompact/icons/smile.gif /w3tcompact/icons/smile.gif /w3tcompact/icons/smile.gif /w3tcompact/icons/smile.gif

Ok all...

Update.
Just received phone call from Wife of accident victim.

Son: has broken pelvis, leg and many facial lacerations. Today, he is at home recovering. When he woke up he wanted his glasses. Mom said "we'll replace them” and they did. HE however, wanted his OLD glasses, the ones I picked up off street so they wouldn't get crushed and put in back of vehicle. Evidently, he was VERY happy to get them back, though he can't wear them yet because his face is still very swollen.

Father: Right foot ripped off, left ankle crushed, left leg broken, multiple internal injuries, faciel lacerations, broken nose. He has been under an induced "coma" for lack of better word (maybe that is the right word too!). He has already had 5 operations in attempts to salvage both feet. He is (also) a heart patient so THAT reality is still a concern that his body may not be able to handle all this stress. He has yet to awaken from the accident, as the pain levels will obviously be quite high, they have kept him under.

Mom has just recently taken both sons to hospital to see dad. She thinks Dad needs to hear their voices to help keep him strong. Evidently the Dr.'s told her that "it's up to him" to decide to make it. (I asked her if the major concern now was his legs, not him dying) I infer from what she said that as each day passes, the concerns of his passing diminish.

She was obviously VERY thankful & happy I did what I did (which was really, very little) She left me her home number and I told her that down the road, if Dad wants to "talk about this", I would be happy to be of any service I could. She appreciated that as evidently her SON has already asked about "the guy with my glasses" and she thinks that the day will come when Dad will need to discuss this, figure out what happen and come to his own terms with the ordeal.

Life can introduce you to the nicest people in the strangest ways sometimes.

The saga is now over!

Richard