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Thread Title: A new experience for me....
Created On Mon Jan 25, 2010 1:37 PM


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clutzycowgirlEMT
Senior Forum Member

Posts: 972
Joined: Apr 2005

Mon Jan 25, 2010 1:37 PM

I'm going to throw my call out from last week to my fellow denizens of the Village and see if anyone has any ideas or insights~

0100 we received an overhead 911 page to respond to a one vehicle accident with no other information available. Our protocol states that we must respond L/S when it is a 911 page, which we did although I radioed for local LE officers to respond as well as we were leaving the bay. (Local LE doesn't always respond to our 911 page outs.)
While enroute we were passed by LE and from dispatch records it is known that the officer arrived on scene six minutes before we did but due to road conditions, visibility issues, and our safety, this fact is not in question other than in my mind as to the outcome.
As we pulled up on scene the officer is virtually running/crawling up the side of a fairly steep ditch area telling me that there are three kids in the car and they all appear to be dead even tho it looks like the car only "bumped" the tree at the bottom. He is also in the process of calling for Fire/Extrication and I asked him to also dispatch another ALS unit.

Scene size up reveals a four door sedan that has tire tracks straight down an incline with no apparent braking marks. The right side of the car is snugged up against two trees and there is no access on that side. Left side of the car has dents in it from squeezing between some trees on the way down and no 'easy' access. All windshields are intact with front end damage approximately ten inches maybe. Both front airbags are deployed.

We have a window punch on a keyring that the EMT's carry (in case we lock ourselves out of the rig again...diff story) which I used to punch out the drivers side window. Driver had no pulse but no apparent life threatening injuries either. I half crawled in the window to reach the passenger as my driver was punching out the rear window of the vehicle. The passenger did not have a pulse either but my driver was screaming that the back seat passenger had a very weak carotid pulse.
Following triage protocol all attention was turned to the rear passenger who unfortunately was very obese (or maybe this is why he still had a pulse??) and there was going to be no way to get him out until F/R arrived.
To make a long story short~the rear passenger did have a very weak carotid pulse and was subsequently bagged using an OPA and BVM until F/R arrived and extricated the patient. He was then intubated and transported where he was placed on a vent and later found to have no brain activity so was d/c and died.

Since we typically do not get any reports on COD and autopsy's routinely take two weeks to hear the results of, I'm curious as to if anyone has any thoughts on what we encountered? I do know the driver of the vehicle was a heavy meth user.....

And no...the car was not running.........

Okay...after perusing the site and my messages folder~I think I have my answer....next time I will learn to read better.....

-------------------------
EMT&SAR "so others may live"
Clutzy~~the original Village Clown
All I ask is the chance to prove that money can't make me happy.

Edited: Mon Jan 25, 2010 at 2:36 PM by clutzycowgirlEMT

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Mon Jan 25, 2010 2:38 PM

Speaking for myself, I would have been reluctant to break the windows of that car and get it, let HAZMAT deal with it. It's a confined environment, you had no idea what was in the air they were breathing, and whatever it was killed them - mostly like even before they went off the road.

You're very lucky. Have you gone to get yourself checked out yet? If not, WHY?

roblanious
Veteran Villager

Posts: 4098
Joined: May 2006

Mon Jan 25, 2010 3:43 PM

I respectfully disagree Sheerin, in part. Time is of the essense, they were already at the vehicle, it was down an embankment, which means the cause of the crash, unknown, occured on the road, and there was no indication of a source of a hazardous material if the car was just in the edge of woods or in the open. We could get too safe and never respond to calls for fear of getting into an accident, worrying about being struck by a meteorite, or gunned down by a maniac mountain man with an assault rifle who comes out of nowhere. The only indication of anything foul here was the initial assessment of all the patients. In this situation, since she was already there, I think it would be prudent to rapidly extricate the patient and get away from the scene quickly.

clutzy's new name should be the grim reaper.

So I have to admit, I am still stumped. What are you guys suspecting? Clutzy, what was the significance of the LE times, etc. I am sorry if I appear clueless here.

-------------------------
Greatness is not standing above our fellows and ordering them around, it is standing with them and helping them to be all they can be.
G.Arthur Keough (1909-1989) Educator

Zorfox
Junior Forum Member

Posts: 174
Joined: Jun 2009

Mon Jan 25, 2010 7:19 PM

In retrospect maybe some can say it was a “toxic” environment. I may be wrong but you would have seen my rear end hanging from the window if it were me. What was wrong with the patients? No idea. Many reasons for death from deceleration, drugs, driver suicide, asteroids, who knows lol. It's hard to speculate when I was not there. Occasionally we encounter dangerous situations and miss small clues as I have apparently done. Live and learn I suppose. I know that is not what you wanted to hear. Unfortunately people die, we may never know why and we can't change the former.

-------------------------

Don't follow the pack. Go your own way and leave a trail !

foxtrotdelta
Junior Forum Member

Posts: 122
Joined: Oct 2009

Mon Jan 25, 2010 9:53 PM

Sounds like a toxicology issue to me. Speculating they all used the same stuff and it was no good or laced and the accident was secondary.

You'd have to consider any gas that could potentially be inside the vehicle and cause unconsciousness and eventually cardiac arrest. CO would have to be present in significant quantities but is not ruled out. H2S is another one we see quite a bit of but its usually a deliberate attempt at suicide and that usually doesn't involve driving, they park, roll up the windows, cause the reaction and never wake up.

ESPARKS
Veteran Villager

Posts: 2339
Joined: May 2003

Mon Jan 25, 2010 10:49 PM

Quote
Originally posted by: clutzycowgirlEMT
I'm going to throw my call out from last week to my fellow denizens of the Village and see if anyone has any ideas or insights~

We have a window punch on a keyring that the EMT's carry (in case we lock ourselves out of the rig again...diff story) which I used to punch out the drivers side window.

Since we typically do not get any reports on COD and autopsy's routinely take two weeks to hear the results of, I'm curious as to if anyone has any thoughts on what we encountered? I do know the driver of the vehicle was a heavy meth user.....

Okay...after perusing the site and my messages folder~I think I have my answer....next time I will learn to read better.....

Did you or any of the others that were in or near the car have any side effects,ie headache, NVD blurry vision afterwards?
My first thought in retrospect: Were they cold cooking a batch in the trunk? The latest methods of cold cooking meth can be done in small batches and have been found in many mobile types of vehicle trunks or u=haul vans. A lot harder for the LEO's to track down. Toxic fumes from meth manufacture could very well be the culprit.
The next thought would be the toxic gas suicide thread I posted elsewhere.

Now Clutzy: You really need to share the story of the window punch in more detail. That sounds like a classic. :-}
Ed

-------------------------
Take care and play safe out there !!!
The dean of common sense

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Mon Jan 25, 2010 11:33 PM

Quote
Originally posted by: roblanious
I respectfully disagree Sheerin, in part. Time is of the essense, they were already at the vehicle, it was down an embankment, which means the cause of the crash, unknown, occured on the road, and there was no indication of a source of a hazardous material if the car was just in the edge of woods or in the open. We could get too safe and never respond to calls for fear of getting into an accident, worrying about being struck by a meteorite, or gunned down by a maniac mountain man with an assault rifle who comes out of nowhere. The only indication of anything foul here was the initial assessment of all the patients. In this situation, since she was already there, I think it would be prudent to rapidly extricate the patient and get away from the scene quickly.

clutzy's new name should be the grim reaper.

So I have to admit, I am still stumped. What are you guys suspecting? Clutzy, what was the significance of the LE times, etc. I am sorry if I appear clueless here.

I highlighted the most relevant part of your post. The car was off the road, and all passengers were unconscious. There was no apparent reason for the car to be off the road, and the lack break marks would indicate that the driver was already unconscious/dead when the car left the road. That right there is setting off so many warning bells.

It's a dangerous job and I fully understand it. I, too, have been in many potentially dangerous situations, some because of rookie mistakes, others becuase we had no way of predicting it. It doesn't stop me from doing my job, what it has done is made me aware of my surroundings, and to reassess constantly.

The urge to help is very strong, particularly amongst us (non-burnt out) paramedics. But sometimes we really have to fight it.

Here's a relatively recent story involving two medics from BC who went into a scene without first thinking about it.

And this is a memo from Toronto EMS regarding a new form of suicide that has migrated over to North America from Japan (I'm fairly certain it's been discussed here, but i feel it's deserves to be mentioned again).

Edited: Mon Jan 25, 2010 at 11:35 PM by sheerin

foxtrotdelta
Junior Forum Member

Posts: 122
Joined: Oct 2009

Tue Jan 26, 2010 9:18 AM

I'm gonna crack open pandora's box here, as I like to do... good for her that she broke the windows and went in. Everything about this job is unsafe and risk here and there is necessary for the sake of our patients. If you're thoughtful, cautious and well trained, many "risks" can be mitigated.

Things tend to swing back and forth on issues of safety and personal distance. Back in the day it was all about getting your hands dirty. Today its starting to swing much to the other direction of being over cautious. Eventually it may shift back to higher risk for bigger reward. If we wanted a 100% safe job, we'd sit in a cubicle somewhere and click away till we had carpal tunnel.

But for safety sake, let's strip the lights and sirens off the rigs (its been suggested before!) and drive 20 miles under the speed limit. We should also put on a helmet and full protective gear before we get into the ambulance. Another good idea is six-point harnesses in case we get in an accident. We cannot approach any scene until PD and FD are there and have completely searched and secured the premises. They have to pat down the person in cardiac arrest as well just in case they are armed or have sharps in their pockets. A minimum of 6 people should be used lifting any patient and only after the appropriate back harness has been secured and rechecked. If the patient is known to have Hepatitis or HIV, we shall not engage in any IV insertion or invasive procedures. We don't want any of that stuff now, do we? Actually, I want a letter signed by a MD prior to patient contact which verifies they do not have TB, H1N1, Hep C or HIV and the tests must be within the last 3 months.

I'm a big fan of cross-training, not to the point where every individual has every certification possible from all the emergency services but to where they obtain at least Awareness/Ops Level training in HAZMAT, Confined Space, Extrication, Rescue, etc. I'm a fan of mitigating hazards through smart approaches. I'm also a fan of taking a risk here and there if I think it will pay off for my patients. The fact is, responders are going to get hurt, no matter what. Unless we walk around in foam protective suits (and even then someone is going to get heat exhaustion and go down.) So you train to the point that you can reduce the hazard to yourself and you approach it in a logical way.

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Tue Jan 26, 2010 10:53 AM

Quote
Originally posted by: foxtrotdelta
I'm gonna crack open pandora's box here, as I like to do... good for her that she broke the windows and went in. Everything about this job is unsafe and risk here and there is necessary for the sake of our patients. If you're thoughtful, cautious and well trained, many "risks" can be mitigated.

Things tend to swing back and forth on issues of safety and personal distance. Back in the day it was all about getting your hands dirty. Today its starting to swing much to the other direction of being over cautious. Eventually it may shift back to higher risk for bigger reward. If we wanted a 100% safe job, we'd sit in a cubicle somewhere and click away till we had carpal tunnel.

But for safety sake, let's strip the lights and sirens off the rigs (its been suggested before!) and drive 20 miles under the speed limit. We should also put on a helmet and full protective gear before we get into the ambulance. Another good idea is six-point harnesses in case we get in an accident. We cannot approach any scene until PD and FD are there and have completely searched and secured the premises. They have to pat down the person in cardiac arrest as well just in case they are armed or have sharps in their pockets. A minimum of 6 people should be used lifting any patient and only after the appropriate back harness has been secured and rechecked. If the patient is known to have Hepatitis or HIV, we shall not engage in any IV insertion or invasive procedures. We don't want any of that stuff now, do we? Actually, I want a letter signed by a MD prior to patient contact which verifies they do not have TB, H1N1, Hep C or HIV and the tests must be within the last 3 months.

I'm a big fan of cross-training, not to the point where every individual has every certification possible from all the emergency services but to where they obtain at least Awareness/Ops Level training in HAZMAT, Confined Space, Extrication, Rescue, etc. I'm a fan of mitigating hazards through smart approaches. I'm also a fan of taking a risk here and there if I think it will pay off for my patients. The fact is, responders are going to get hurt, no matter what. Unless we walk around in foam protective suits (and even then someone is going to get heat exhaustion and go down.) So you train to the point that you can reduce the hazard to yourself and you approach it in a logical way.

As I stated in my last post, I fully recognize how dangerous this job can be, and I acknowledged that we (and myself included) go into dangerous situations all the time. But when I go into a dangerous situation, I try to go in prepared. I'm not going to run into a burning building, nor am I going jump into a raging river to grab someone. And I'm definitely not going to go into a confined space where, for no obvious reason, 4 people are unconscious, at least not without the proper equipment and training.

I don't make enough money to die doing stupid things.

Your life is far more important than the life of a patient. They're already dead, you're not. If you want to be able to help them, you have to stay alive.

Okay here's a scenario, you get called to an intersection in a busy urban area for an unknown. You get there and are met be a foreman who works for the cities electrical utility. He states that 4 of his men went down into a man hole to do some work on some underground cables, approximately 10 metres below the surface and 25 metres away from the man hole opening. They went approximately 15 minutes ago with all their equipment, including a CC-TV system and two way radios for communication. After 5 minutes the foremen and other people notcied that the camera was at an odd angle and looking at nothing, and the crew was not responding to the radio. So he sends in two more guys to see what's going on and to swap out the radios. They've been gone 10 minutes and there has been no communication.
Do you go in?

Zorfox
Junior Forum Member

Posts: 174
Joined: Jun 2009

Tue Jan 26, 2010 11:36 AM

Going in the man hole would be crazy. This happens to be a very obvious hazardous situation. My original point was that even medics that have been around will do things we may look back at and wonder why we ever did it. Or suffer from that real killer called tunnel vision. I have the same thoughts as foxtrot. Sometimes the job can be dangerous and despite any training we may have, we make an informed decision to render aid. Yes occasionally at personal risk for whatever reason. I think the key is being able to realistically weigh the risk versus reward and act appropriately.

The MVC clutzy described actually reminds me of many I used to see when Nitrous Oxide was big. Kids used to inhale the gas while cruising around. When the compartment fills up they pass out crash and if the windows don't break die.

-------------------------

Don't follow the pack. Go your own way and leave a trail !

foxtrotdelta
Junior Forum Member

Posts: 122
Joined: Oct 2009

Tue Jan 26, 2010 11:49 AM

Quote
Do you go in?

Of course.. but first I'm going to take off all my clothes and smoke a pack of cigarettes.

...No you don't go in... like I said, you have to be logical and appropriately trained. Doesn't matter if one guy or twenty guys are in there, unless you have confined space training AND the appropriate SCBA (preferably an umbilical at that point) and other necessary equipment (tools, search rope, PARTNER, etc.)

You mitigate hazards to yourself and delays in response by cross-training to at least the AWARENESS level in all major disciplines. You recognize the hazard, calculate the risk vs benefit and you proceed as your brain dictates.

If you don't have the training or you don't have the tools, you don't do the job.

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Tue Jan 26, 2010 11:58 AM

Quote
Originally posted by: foxtrotdelta
Quote
Do you go in?

Of course.. but first I'm going to take off all my clothes and smoke a pack of cigarettes.

...No you don't go in... like I said, you have to be logical and appropriately trained. Doesn't matter if one guy or twenty guys are in there, unless you have confined space training AND the appropriate SCBA (preferably an umbilical at that point) and other necessary equipment (tools, search rope, PARTNER, etc.)

You mitigate hazards to yourself and delays in response by cross-training to at least the AWARENESS level in all major disciplines. You recognize the hazard, calculate the risk vs benefit and you proceed as your brain dictates.

If you don't have the training or you don't have the tools, you don't do the job.

And that's my point exactly. The car in the above example is no different than another confined space. You don't know what's in the air. You don't know if it's safe to go in or not. So you don't go in unless you have the proper equipment and the proper training.

foxtrotdelta
Junior Forum Member

Posts: 122
Joined: Oct 2009

Tue Jan 26, 2010 2:17 PM

Negative, its not a confined space at all. Its a motor vehicle and one that is readily accessible. As someone who is trained in Confined Space Rescue among other things, I can verify this.

The air contents are unknown but can be readily corrected by breaking the windows... if the atmosphere was below the IDLH for oxygen, you just fixed the problem. If there is an unknown gas and its lighter than air, you just vented it. If there's an unknown gas thats heavier than air and you break the window then open the door, you just vented it. That's a far cry from being somewhere you can become disoriented and trapped in or a place which cannot be ventilated without special equipment. Given the situation, I would vent the car, wait a few moments and then rapidly remove the patients. That gives enough time to remove the immediate threat to myself.

Part of my training involved gaining entry to a vehicle and extrication of patients. I'm issued gloves and so are most EMS personnel. That's training and equipment.

The choice to approach and vent the vehicle is a personal one for most Medics. I wouldn't say someone is wrong for not doing so but if someone were to make the personal choice to do so, I don't believe it is recklessly dangerous or inappropriate.

clutzycowgirlEMT
Senior Forum Member

Posts: 972
Joined: Apr 2005

Tue Jan 26, 2010 2:43 PM

Sorry guys, didn't mean to post this and forget it...must be that ADD kicking in again!!

I have to admit that I'm back to scratching my head~I thought there was going to be an easy answer and they were cooking meth in the trunk of the car but talked with responding officer today when I got on shift and he said no.

Sheerin~ I fully understand your concerns and believe me when I say the thought did cross my mind to wait, but I have a small mind capacity and it flitted out so fast I didn't catch it...lol. I had no intention of spending any more time in the car than absolutely necessary to assess a pulse on the passenger in the front. I also realize that my decision in doing that may have been wrong at the time and may have cost me my life~but thankfully it didn't and my shoulder Angel was on duty. We have so many situations that cause us to break windows on a vehicle and this will not be the last time that it happens...it is just the first time that we've broken into a vehicle and all the occupants are apparently already dead with no obvious signs of trauma. Yes maybe I should have processed the law enforcements statement a little deeper but I can look back and critique and pull apart every call I've ever been on and probably realize I've been in some very dangerous situations without ever knowing it. That is a risk that comes along with my occupation and where I and others work. I could also have "gone down" the other night walking in to a friends house who's sewer vent was frozen shut and they were both overcome by gases...things we do such as that in our daily lives are also as life threatening as what we do on the job and we cannot be paralyzed by that fear although we need to remain respectful of it.
Your comparisons to running into a burning building or going down a manhole where ppl have not responded are totally not even close to this situation, and although I understand your points, there is still a huge difference. The situation may have been totally different had I been on scene alone, but I wasn't.

Rob~the only significance of the LE response time is I wonder if we had gotten there as soon as he did if there may have been more of a chance for my pt in the rear of the vehicle. As well as the fact that, working on a reservation, I tend to CYA a lot. The name change? Well...it seems I and two co-workers have little black clouds that follow us around on the rez when we go to work! Guess it's all about having the honor of working the shifts when everyone gets paid....

Ed~Admittedly, the only thing I really noticed for a day or so afterwards was allergy type symptoms and a dull headache which I attributed to the possibility of a sinus infection.
Oh..the window punch...omg...I am still so embarassed over that whole situation it may take a bit longer to post it!

Lets just say I'm glad the patient locked in the rig was not in a life threatening situation while we tried to break into the rig......

We have had fourteen teen suicide attempts in the last two weeks where I work with only two being successful and I am now leaning towards this being a deliberate attempt at ending their lives in such a way that their families still reap the 'benefit' of the tribe issued life insurance policies...after looking at the toxic gas postings I am also going to speak with LE again to see if there was anything odd about the contents of the car, besides the case of beer....(which wasn't 'odd' to see)

I wonder if there will ever come a day when I can get off shift and know that I did everything totally right and not pick apart my calls into such tiny pieces....but then again...I don't think that would benefit me either.....

-------------------------
EMT&SAR "so others may live"
Clutzy~~the original Village Clown
All I ask is the chance to prove that money can't make me happy.

Edited: Tue Jan 26, 2010 at 2:48 PM by clutzycowgirlEMT

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Tue Jan 26, 2010 3:17 PM

Quote
Originally posted by: foxtrotdelta
Negative, its not a confined space at all. Its a motor vehicle and one that is readily accessible. As someone who is trained in Confined Space Rescue among other things, I can verify this.

The air contents are unknown but can be readily corrected by breaking the windows... if the atmosphere was below the IDLH for oxygen, you just fixed the problem. If there is an unknown gas and its lighter than air, you just vented it. If there's an unknown gas thats heavier than air and you break the window then open the door, you just vented it. That's a far cry from being somewhere you can become disoriented and trapped in or a place which cannot be ventilated without special equipment. Given the situation, I would vent the car, wait a few moments and then rapidly remove the patients. That gives enough time to remove the immediate threat to myself.

Part of my training involved gaining entry to a vehicle and extrication of patients. I'm issued gloves and so are most EMS personnel. That's training and equipment.

The choice to approach and vent the vehicle is a personal one for most Medics. I wouldn't say someone is wrong for not doing so but if someone were to make the personal choice to do so, I don't believe it is recklessly dangerous or inappropriate.

You're still at considerable risk if you vent the car and you're not wearing proper PPE, not to mention unnecessary.

Quote
Sheerin~ I fully understand your concerns and believe me when I say the thought did cross my mind to wait, but I have a small mind capacity and it flitted out so fast I didn't catch it...lol. I had no intention of spending any more time in the car than absolutely necessary to assess a pulse on the passenger in the front.

Neither did the medics from BC who i referred to in a previous post

Quote
I also realize that my decision in doing that may have been wrong at the time and may have cost me my life~but thankfully it didn't and my shoulder Angel was on duty.

I too am grateful you were unharmed.

Quote
We have so many situations that cause us to break windows on a vehicle and this will not be the last time that it happens...it is just the first time that we've broken into a vehicle and all the occupants are apparently already dead with no obvious signs of trauma. Yes maybe I should have processed the law enforcements statement a little deeper but I can look back and critique and pull apart every call I've ever been on and probably realize I've been in some very dangerous situations without ever knowing it. That is a risk that comes along with my occupation and where I and others work.

We work in an inherently dangerous job, but have the ability to learn from past mistakes. Good medics, take full advantage of that ability. Those who don't, stand a very good chance of dying.

Quote
I could also have "gone down" the other night walking in to a friends house who's sewer vent was frozen shut and they were both overcome by gases...things we do such as that in our daily lives are also as life threatening as what we do on the job and we cannot be paralyzed by that fear although we need to remain respectful of it.

No one is suggesting that we be paralyzed by the fear of death. I am just saying that you don't always have to go running into a situation without first thinking about it. Realistically, if you had waited a few minutes to properly assess the situation and vent the car, would it have made a difference?

Quote
Your comparisons to running into a burning building or going down a manhole where ppl have not responded are totally not even close to this situation, and although I understand your points, there is still a huge difference. The situation may have been totally different had I been on scene alone, but I wasn't.

So if you and your partner had been overcome by whatever it was that took out the 4 passengers, who would have saved your butt?

foxtrotdelta
Junior Forum Member

Posts: 122
Joined: Oct 2009

Tue Jan 26, 2010 4:51 PM

I've been at this for a while, I'm a HAZMAT Technician, I'm a Firefighter, I know the risks and I'm not dead yet.

The most dangerous aspect of the job and the one where MOST fatalities occur is in response. So in reality, you're far more likely to die driving to the call than breaking the window and being overwhelmed by some huge toxic gas cloud with ppm so high it instantly incapacitates you. By that logic, we should take the lights and sirens out of the ambulances because they are far more likely to lead to a fatal accident.

The link you posted about the BC Medics who recklessly entered a CONFINED SPACE, in my mind, does not sit on the same level with someone punching windows who is outside in open air.

Again, you said the motor vehicle was a confined space and honestly, its not. Not by OSHA standards, not by NFPA standards. Its enclosed.. it has the capacity to hold gases but it does not carry the same hazards as a true confined space.

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Tue Jan 26, 2010 5:26 PM

Quote
Originally posted by: foxtrotdelta
I've been at this for a while, I'm a HAZMAT Technician, I'm a Firefighter, I know the risks and I'm not dead yet.

The most dangerous aspect of the job and the one where MOST fatalities occur is in response. So in reality, you're far more likely to die driving to the call than breaking the window and being overwhelmed by some huge toxic gas cloud with ppm so high it instantly incapacitates you. By that logic, we should take the lights and sirens out of the ambulances because they are far more likely to lead to a fatal accident.

The link you posted about the BC Medics who recklessly entered a CONFINED SPACE, in my mind, does not sit on the same level with someone punching windows who is outside in open air.

Again, you said the motor vehicle was a confined space and honestly, its not. Not by OSHA standards, not by NFPA standards. Its enclosed.. it has the capacity to hold gases but it does not carry the same hazards as a true confined space.

While they may not be the same level, it's the same continuum.

I'm not specifically speaking about firefighters or HAZMAT technicians. I'm speaking about medics who don't have that cross training. While you may have the tools and training necessary to vent this car, I don't. I'm a run of the mill Primary Care Paramedic. I don't have specific CBRN training, I don't confined space training, I don't have HAZMAT training. I was speaking for myself when I said I would be reluctant to crack the windows on that car. If you read back, you'll even see where I said I prefer that HAZMAT/CBRN took care of it, specifically becuase they're trained to do it.

While the car it's self is not a true confined spaces as designated by OSHA and other agencies, it does, in this case, contain an unknown toxic environment that is in a relatively closed space. It's still stupid to put yourself in there without the proper PPE.
In the example I cited, the BC paramedics, they, as you said went recklessly into a true confined space. Now I ask you, if they were stupid enough to do that, do you think they would have gone into that car without giving it a second thought? Now to reverse that, if you were to enter that car without thinking about it, would you stop and think before you entered a true confined space?

As for lights and sirens. Well that's a totally different kettle of fish. But to speak in generalities, reading many of the stories and discussions posted here and other EMS forums, looking at the videos on youtube, and reading the many LODD notices, I think in many places in the states that it might just be a bright idea to remove them.

foxtrotdelta
Junior Forum Member

Posts: 122
Joined: Oct 2009

Tue Jan 26, 2010 6:31 PM

When I operate as a Medic, I'm not operating as a Firefighter. We carry gas masks but SCBA is not immediately available. Without summoning special equipment, I only carry Level C PPE in the ambulance.

I said earlier that if someone chose not to attempt to disturb the vehicle, I wouldn't consider them negligent or fault them. I still feel however that using common sense and a window punch you could safely open a vehicle containing high levels of CO or such without causing serious harm to yourself. Weighing the risk vs reward in this particular scenario, the lives of 4 young men may deem that such a risk is acceptable. Noticing 3 of them were apneic and one had minimal signs of life should put an urgency on the matter which would dictate by the time you summoned a HAZMAT team, everyone is the vehicle would essentially be beyond resuscitation, barring extenuating circumstances. Activating HAZMAT means retreating and forsaking the victims.

Its a personal choice everyone would need to make and choosing to try and rescue them does not make you stupid.

Again, based on my knowledge and the scenario provided by clutzy, diving into the vehicle head first would be stupid. Breaking a window and letting it dissipate is not stupid, were the victims still alive, it could save them by virtue of providing fresh air alone.

The key points I was trying to make are such:

- Training to Ops or Awareness in various disciplines will help make those decisions more informed.

- Its a risky job no matter what, and I'm willing to roll the dice if it means saving a life and it doesn't put other people (including responders) in harms way.

roblanious
Veteran Villager

Posts: 4098
Joined: May 2006

Tue Jan 26, 2010 11:36 PM

Quote
Originally posted by: clutzycowgirlEMT
I also realize that my decision in doing that may have been wrong at the time and may have cost me my life

NO. You did NOT make the wrong choice. Punching out the windows and venting a theoretically toxic environment-and we don't know if was toxic or not, was the CORRECT thing to do. If it was the atmosphere that was potentially toxic, then what caused the vehicle to run off the road, because if it was toxic enough to cause the driver to run off the road, it was back up on the road where the vehicle ran off. I am sure you would notice containers or other sources of a toxic gas if the source was outside the vehicle.

You approached the vehicle as you are trained and supposed to do. You did a scene size us and sensed no signs of a hazardous atmosphere or environment. Sure, there could be a sniper near by. That is so rare that it is not something we can alter all of our responses to protect ourselves from. I am sure you looked around when you arrived anyway.

There was no clue to anything amiss until you assessed your patients. It was then that things seemed a little queer (I mean the word in its literal sense). You already accessed the vehicle and the patients. You found a patient barely alive. You rapidly extricated that patient as best you could, as you would if the vehicle were on fire or another hazardous situation was emerging. So, NO. You did everything right.

Quote
the only significance of the LE response time is I wonder if we had gotten there as soon as he did if there may have been more of a chance for my pt in the rear of the vehicle. As well as the fact that, working on a reservation, I tend to CYA a lot.

I hate to say it, but I don't think it would have mattered. Your patient was already dead but just did not know it. If the other three were dead in the same vehicle and this guy was barely alive, he would not have made it anyway.
Now did you sit back and wait for LE to arrive before arriving on an MVC call? If so, then I would question why and raise my eybrows, but unless you sat back and waited about a half our or so, and even then, I don't think it would matter.

Quote
Well...it seems I and two co-workers have little black clouds that follow us around on the rez when we go to work!
I wonder if there will ever come a day when I can get off shift and know that I did everything totally right and not pick apart my calls into such tiny pieces....but then again...I don't think that would benefit me either.....

I feel your pain. I was called the Grim Reaper back in the mid 90's when every shift it seemed I had a DOA, a cardiac arrest or a GSW or respiratory failure that would later die. Though I laughed it off, I became very bitter about taking one more DOA and even the cardiac arrests were an emotional strain. When I look back I see it affected me emotionally, though I laughed it off at the time. It will make you stronger and it will pass, as it did for me. As much as like to bust your stones once in a while (actually you bust mine), I would love to work a shift with you out there as I bet I could learn a lot from you, regardless of your EMS level.

-------------------------
Greatness is not standing above our fellows and ordering them around, it is standing with them and helping them to be all they can be.
G.Arthur Keough (1909-1989) Educator

Edited: Tue Jan 26, 2010 at 11:38 PM by roblanious

clutzycowgirlEMT
Senior Forum Member

Posts: 972
Joined: Apr 2005

Wed Jan 27, 2010 9:04 PM

As of our last run into the ER (1/2 an hour ago), everyone is still 'confunded' on COD and the autopsy reports have not come back yet. My conversation with the responding LE resulted in "I never really looked, but the car is still in the tow yard."

Rob~Wow!

Yes, we did tend to (or I did?) bust each other's chops! But thank you for the kind comments and the honest assessment. I appreciate honesty in its purest form regardless of whether it is good or bad and you and I seem to "keep things real" between the two of us whether we agree or not. Thank you....I am not a patient person, but I will have to wait out the black cloud as I'm not ready to throw in the towel yet. I am however, ready for a shift where I can clock out at 40 hrs and NOT have to pick apart a call, or rerun a scenario, or double guess myself!! Maybe even two in a row like that would be nice!!

I probably have no right to complain as I had the opportunity to throw all this away and work for a transport service (with pay increase) a month ago and even tho I was tempted...I'm not ready to give up the "detective" part of the job to be limited to inter-facility transfers either.
I'm not sure I could teach you anything if you came and rode some shifts here, lol, but I think it would do a lot for helping rural vs non rural EMS understand the "why's and how's" of how they each do something.

'Sides, I'm an I and your a P...you'd have to do the work!! LOL..wait a minute...when you coming????????

Foxtrot~Thank you as well. You make some awesome points that there should be more cross training in EMS. Although we have had HazMat training and I have had confined space training as a part of my SAR, many of us would benefit from more in depth training as well.

Sheerin~I'm going to continue to disagree, lol. The lack of braking marks down the side of the incline are not a true indicator that is going to set off red flags in my mind. I have been on several "car accidents" where the reason from no braking can be anywhere from hypoglycemia to hyperdrunkemia to just plain "didn't realize it was icy and it happened so fast." I don't always take the word of LE as we've been enroute to a scene and had these same officers radio us and tell us to step it up because the patient is seizing, unconscious, etc...when in all reality, the patient is a dang good actor. I take their words into consideration constantly, but don't base my actions or assessments on what they tell me.

Quote
No one is suggesting that we be paralyzed by the fear of death. I am just saying that you don't always have to go running into a situation without first thinking about it. Realistically, if you had waited a few minutes to properly assess the situation and vent the car, would it have made a difference?

I am waaaay past the stage of running into situations without thinking about them, trust me. I'm not sure I ever even went thru that phase actually...unless it was my days in the early 80's playing ski hill rescuer..lol! Your ideation of this call seems to read like a ricky rescue book where the ambulance comes roaring up and the techs get out and run down a hill willy nilly with no cares in the world, focused only on playing the rescuer when in fact it was nothing like that. But we could disagree on this fact for ages and it would not get me any closer to my original reason for posting...
Realistically, "a few minutes" would have passed after the window had been punched and a pulse assessed on the driver before I entered the car and assessed the front seat passenger. And no, the outcome doesn't appear to be any different.

Now, here's a scenario for you~ It's 0530 and you are paged out to an elderly male patient who lives alone and called 911 complaining of SOB and CP. By the time you arrive, there is no answer at the door but you see a light on in the kitchen. Do you go in on the premise that it is a cardiac case and he's on the floor non-responsive now? Or do you go back to the rig, call the HazMat team and wait the alloted time for them to arrive and make sure the "confined space" is safe to enter.....

Quote
And that's my point exactly. The car in the above example is no different than another confined space. You don't know what's in the air. You don't know if it's safe to go in or not. So you don't go in unless you have the proper equipment and the proper training.

Judging from your above quoted answer...you don't go in because "you don't know if it's safe to go in or not."

-------------------------
EMT&SAR "so others may live"
Clutzy~~the original Village Clown
All I ask is the chance to prove that money can't make me happy.

roblanious
Veteran Villager

Posts: 4098
Joined: May 2006

Wed Jan 27, 2010 11:30 PM

Quote
Originally posted by: clutzycowgirlEMT
I probably have no right to complain as I had the opportunity to throw all this away and work for a transport service (with pay increase) a month ago and even tho I was tempted...I'm not ready to give up the "detective" part of the job to be limited to inter-facility transfers either.

Oh, dear God, don't do that. At least not as a primary job. That is mental suicide. Occasional transports shifts are a nice break, but will destroy your will. Save that for the time when it is almost time to retire. I am not knocking transport folks, but I think that would drive you insane.

Now, here's a scenario for you~ It's 0530 and you are paged out to an elderly male patient who lives alone and called 911 complaining of SOB and CP. By the time you arrive, there is no answer at the door but you see a light on in the kitchen. Do you go in on the premise that it is a cardiac case and he's on the floor non-responsive now? Or do you go back to the rig, call the HazMat team and wait the alloted time for them to arrive and make sure the "confined space" is safe to enter.....

There have been a couple of law suits in the late 90s and around 2000 where EMS either did not immediately force entry or make more of an effort to search an area for the patient. I wish I had the cases at my fingertips. One of them was almost exactly as you stated.

-------------------------
Greatness is not standing above our fellows and ordering them around, it is standing with them and helping them to be all they can be.
G.Arthur Keough (1909-1989) Educator

foxtrotdelta
Junior Forum Member

Posts: 122
Joined: Oct 2009

Thu Jan 28, 2010 9:41 AM

Wow that's almost identical to a call I had about a year ago. My partner and I responded to a Life Alert activation with the report that no one answered on call back. PD and FD were both unavailable (out on other jobs.) When we arrived it was a fairly dark residence, locked up and only a light in the bedroom was on but the window was on the 2nd floor so there was no way to see in.

Knocked on the door 7 or 8 times, rang the door bell, etc. Eventually we could hear a very faint cry for help from inside. After some mild deliberation, we kicked the door in and found an approx. 90 year old man who had fallen in his bedroom, fractured his pelvis and had a severe head laceration. He had already lost significant amounts of blood so we quickly immobilized/stabilized, transported and dropped fluid en route.

Perfect scenario for this.. if we had waited for other services (would have taken at least another 20 minutes), that fellow probably would have died. Were we reckless for kicking in the door? We didn't have a halligan and axe, we didn't have a rabbit tool or a hydroram, we weren't wearing PPE. No helmet, no turn outs, no gloves.

There could have been a knife wielding murderer inside.
There could have been a gun wielding home owner.
The house could have been boobytrapped (especially in the case of drug dens and meth labs.)
The house could have been full of CO.
Where does it stop?

As with almost everything in this profession, you are judged not by your actions but by the outcome. At least in my area, the ends justifies the means. If you do something untried and unorthodox and it saves a life, they pin a medal on you. If you do something like that and there's no positive outcome or harm to someone, they call you a dangerous criminal.

I like the example of the two NJ Medics who performed an emergency c-section out of protocol by directions of an ER physician. They were initially praised as heroes by the media and local officials but when that child died in the hospital, they lost their certifications and were banned for practicing in NJ.

The great challenge of being a Paramedic is trying to be perfect while being required to stay human.

Edited: Thu Jan 28, 2010 at 9:43 AM by foxtrotdelta

missclampett
Senior Forum Member

Posts: 212
Joined: Apr 2008

Thu Jan 28, 2010 10:28 AM

I know I'm late to the party....

I dont think you did the wrong thing, CLutzy. When I see someone dead in a car gone off the road with no obvious injuries my thoughts go first to cardiac arrest, not toxic enviroment. And how would you know they are dead if you havent broken the window yet? I had a call once where the guy had a heart attack and went off the road, airbag went off and there was hardly a scratch on him. Also had a siezure patient that drove full speed into a brick wall and "looked dead" on arrival because she was postictal.

-------------------------
It's not that I want you to get hurt, I just want to be there when you do.

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Thu Jan 28, 2010 11:30 AM

People sue in the US over everything.

As for your scenario Clutzy, it's not exactly an accurate analogy to the call you posted (and neither was my discussion of the LODD in BC). But looking at your scenario, i there are factors that would need to be examined (and the same goes for all calls). Would i go rushing into the person's home? Probably not without some careful consideration. The thought process doesn't need to take long, but it can definitely make a difference. Spend the 30 seconds examining things, it's not going to make a difference to the patient, it could make a difference to you.

Going to back to my original post, all I said was I would be reluctant to enter the car. The main reason being, from what you wrote, the voice in the back of head would be saying "that ain't right". If it had been a single person in there then I wouldn't think anything of it. But the fact it was multiple people, all unconscious/dead for no apparent reason then yeah, that sets off the alarm bells.

In the end, you were there and you made your decision. There was most likely other factors at play that you didn't write about. So my response is limited by the information I have. I am, in essence, armchair quarterbacking (which I apologise for as I know it's annoying).

medicntrainin
New Forum Member

Posts: 2
Joined: Feb 2010

Wed Feb 17, 2010 2:16 PM

I agree.. I as an EMT am trained to do everything that i can do. Every EMS unit around my parts have gloves and also have masks and everything else. You never know if there is someone in that vehecle still has a pulse you could save the life by letting fresh air in.. Dont understand how someone would actually stand around and let someone die because they are to scared to do their job. Way I look at it, If your scared, get out. This job has risks and they are the risks you have to take. So I agree with you.

jayffemt
Veteran Villager

Posts: 1251
Joined: Feb 2005

Wed Feb 17, 2010 6:19 PM

Unfortunately it's not always a case of not doing our job.

A toxic atmosphere can incapacitate any responder that gets close enough, if that happens, you have changed your status to victim, and now the scene requires a replacement for you and an additional crew to treat you.

A HEPA mask can filter particulates, but not gasses, and some gloves can be degraded quickly by chemicals.

I agree that in a small container (a car) and with attention to wind, people downwind etc, you might take the risk of popping a window, to at least reach in for a pulse. But remember that it is a risk, and that you could damage your health or end your life to find out that the victim is already beyond help. Would your family accept that it was worth it?

-------------------------
Only 1*

roblanious
Veteran Villager

Posts: 4098
Joined: May 2006

Wed Feb 17, 2010 11:25 PM

There are risks in everything. Even getting in our car and going to work. The key is the potential risks and the alternatives. Weight the risk to my life to the life of the patient. In this case, there is very little immediate potential risk. If there is a risk in this situation, then it is as small as someone popping out of the woods and shooting at us. If we were all worried about that, we would never respond until a SWAT team cleared every scene we arrive on.

-------------------------
Greatness is not standing above our fellows and ordering them around, it is standing with them and helping them to be all they can be.
G.Arthur Keough (1909-1989) Educator

grambograham
Senior Forum Moderator

Posts: 3691
Joined: Apr 2004

Thu Feb 25, 2010 8:09 AM

Personally, I don't think I would have broken the window. No brake marks or skid marks indicate a lack of response of the driver. As they were down the road and not in front of a house, this was likely unplanned.

Being that there as minimal damage and all were unconcious, leads to a toxicological cause. Having 2 adults both unconcious indicates it is toxic enough to lead to incapacitation. Given that they hadn't stopped on the side of the road indicates that it was quick and had little to no warning. That limits the possibilities. The big one for me would be H2S.

Being certified to work in an H2S environment, I can tell you I would not EVER want to be exposed without SCBA as it will kill you before you even know it is there. It could even be porpane or natural gas. Both odourless without added chemicals and heavier than air... AKA, it will stay in the vehicle in high concentration for a long period of time. Cyanide is another chemical which works quickly, leaves little evidence initially and kills quickly. Luckily, it has an odour.

Bottom line, If they are unconcious/dead with no obvoius cause in an enclosed environment (poor air exchange), they stay that way until somebody with the proper equipment breaks the glass. I don't care what you want to do, I'm going home alive at the end of my day.

-------------------------
If you can keep your head while all else around you are losing theirs'............................... You probably haven't checked with your answering service!

jayffemt
Veteran Villager

Posts: 1251
Joined: Feb 2005

Thu Feb 25, 2010 12:02 PM

The cause doesn't have to be toxins, I've gone to a few MVAs with the lack of skid marks, etc. and it turned out to be a seizure, or an unknown medical, and in another, an MI.

The cause of the other passenger's lack of responsiveness could be from impact injuries, depending on the severity of the crash, seat belt use etc., a crash may not appear severe, but can still kill. Airbags impacting unrestrained passengers have been known to kill, especially children.

A scene like this leaves a lot to the judgement of the responders.

-------------------------
Only 1*

sheerin
Junior Forum Member

Posts: 197
Joined: Jul 2006

Thu Feb 25, 2010 12:46 PM

Quote
Originally posted by: medicntrainin
I agree.. I as an EMT am trained to do everything that i can do. Every EMS unit around my parts have gloves and also have masks and everything else. You never know if there is someone in that vehecle still has a pulse you could save the life by letting fresh air in.. Dont understand how someone would actually stand around and let someone die because they are to scared to do their job. Way I look at it, If your scared, get out. This job has risks and they are the risks you have to take. So I agree with you.

Your life is FAR more important than the patients life. I don't say that becuase i'm scared to do my job. I say that because my education and training has taught me to evaluate every situation and to make a quick assessment to determine whether or not the level of risk is acceptable for the resources I have at my disposal.

As for standing back and potentially watching someone die. Yeah that is a very tough thing to do, and sometimes it's necessary. I'll give you an example. A few months ago a crew out of my base was sent for a fall. They arrived on scene and found a teenager who had been working at his summer job on the ground beside a ladder. The kid was in contact with an electrical line. He was working putting up some siding on a house when somehow the ladder fell away from the house striking the electrical connection. The line separated from the house and landed on the leg of the teen. A coworker ran up to assist and was incapacitated by the current running through the ground. On assessment the coworker was unconscious as was the teenager. The teen had obvious third degree burns to both legs and appeared to be breathing. The coworker's boots were smoking and he was breathing as well.

The crew couldn't do anything. They had to wait till hydro arrived to disconnect the line. One of the crew members stayed close enough to visual observe while the other went back to the truck.

In the end once the power was disconnected, both patients were transported, the teen was unconscious with third degree burns to the legs, abdomen and back, he died a few hours later. The coworker had both feet amputated.

Would you have run in tried to pull the kid away from the wire?


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