I felt under equipped and didn’t like it

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  • hoosierdoc

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    Driving home last night I passed a pedestrian struck by a car in Destin. It had just happened. I thought it was someone who was drunk and fell down initially. Bystanders in hysterics though. Lady had a bad head injury. I did not have a medical kit in my car. A few minutes later another doc showed up with a decent advanced kit. He had airway supplies and some other stuff we might have needed.
    turns out he was also an ED doc but for the military, also down on vacation.

    there wasn’t a lot to be done in the field, she needed a neurosurgeon. It got me thinking though that I need a decent kit with me. It felt terrible to know what to do and how to do it but have nothing to accomplish those tasks. When EMS got there we helped get her loaded up but they said if I intubated her then i’d Have to accompany her to the hospital since I assumed medical control. And i’d Have to prove i’m Licensed. I had my kids in the car at the side of the road and the hospital was 30 minutes away. Ugh. They loaded her up and sped away, attempting airway en route.

    I didn’t even have gloves. I did have airway stuff in my car (expired) but didn’t think of it until after.

    Makes me think how bad i’d Feel if I needed a gun and didn’t have one on me. Be prepared. I wasn’t.
     

    rhino

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    Driving home last night I passed a pedestrian struck by a car in Destin. It had just happened. I thought it was someone who was drunk and fell down initially. Bystanders in hysterics though. Lady had a bad head injury. I did not have a medical kit in my car. A few minutes later another doc showed up with a decent advanced kit. He had airway supplies and some other stuff we might have needed.
    turns out he was also an ED doc but for the military, also down on vacation.

    there wasn’t a lot to be done in the field, she needed a neurosurgeon. It got me thinking though that I need a decent kit with me. It felt terrible to know what to do and how to do it but have nothing to accomplish those tasks. When EMS got there we helped get her loaded up but they said if I intubated her then i’d Have to accompany her to the hospital since I assumed medical control. And i’d Have to prove i’m Licensed. I had my kids in the car at the side of the road and the hospital was 30 minutes away. Ugh. They loaded her up and sped away, attempting airway en route.

    I didn’t even have gloves. I did have airway stuff in my car (expired) but didn’t think of it until after.

    Makes me think how bad i’d Feel if I needed a gun and didn’t have one on me. Be prepared. I wasn’t.

    That's a good lesson to learn.

    I'm sure you have considered this, but have you made a decision about what level of care you're willing to provide in such situations outside of work (assuming you have necessary tools)? That of course includes to whom you're willing to extend different levels of care. I can see a strong case to be made for being willing to intubate a family member or friend in an emergency and accepting the responsibility of traveling with them to the hospital, but at the same time choosing that such a commitment is too far for a stranger if there are first responders available who could conceivably do the same thing.

    That should also help you decide what gear you want to have available and what gear you do not.

    You should at least have the bare minimum of what a some of us non-medical professionals carry on our person: Israeli Battle Dressing (IBD) or equivalent, tourniquet, some Gorilla tape, maybe a nasopharyngeal airway, maybe a 14ga needle catheter, and of course your sharp knife that you should always have with you anyway. You can do a lot with that small amount of gear.
     

    hoosierdoc

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    Rhino i’d Do whatever I could. Literally did mouth to mouth on a guy on side of the ski slope during spartan race a few years ago. He ended up dying.

    i had hoped they’d intubate her at the scene in case they had problems but they wanted to scoot which is best for trauma really. Difficult airways (facial trauma, blood, vomit, c-spine not clear) should be done by most experienced provider. Unfortunately that came with administrative hurdles I couldn’t accommodate.

    i don’t think anything would have helped her though. I need to watch my dash cam and see what it caught for audio. The lady who hit her was on her phone standing by my open driver window.
     

    Leadeye

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    That's got to be a tough choice for a doctor, I didn't know that there was such a thing as "medical control". I think I would keep things handy that didn't get you over what ever the "medical control" threshold is. You can't be expected to be a walking ambulance.
     

    hoosierdoc

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    And really i’m Out of my element there. Paramedics are better trained for field medicine. I can do airway and some advanced procedures in a pinch but that’s usually not necessary. I am not trained on how to pull people from wrecks, not good at IVs without ultrasound, etc. I can hold an airway open and c-spine in place though...
     

    KellyinAvon

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    And really iÂ’m Out of my element there. Paramedics are better trained for field medicine. I can do airway and some advanced procedures in a pinch but thatÂ’s usually not necessary. I am not trained on how to pull people from wrecks, not good at IVs without ultrasound, etc. I can hold an airway open and c-spine in place though...

    A lot of people are glad you're out there doing what you do, Doc. :yesway:
     

    Sylvain

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    Thanks for sharing your story Doc!

    You did more than most peope would ... you stopped to help.

    It's hard to be prepared for anything and having the medical knowledge and no gear is better than having a ton of gear with no knowledge.

    I carry backpack size first aid kit in the car in case I come across car accidents.
    I also keep gloves in the glove box (duh!), nitrile gloves, leather gloves to to change a tire or if I need to break a window etc.

    I have a keychain (ResQme) with a seatbelt cutter and window punch, should I need to get someone (or myself) out of a car.
    But that not much stuff and it's easy to feel under equipped when faced with something serious.

    If someone is trapped in a really badly wrecked car you would need jaws of life and team of firefighters to get the victim out.Not just a keychain tool.

    Not to mention having to deal with multiple victims when you're all by yourself, even if you're trained and have all the gear you could ever wish you had.

    I wouldn't say that you were not prepared Doc.
    You obviously have way more medical knowledge, and experience, than most people, that's being prepared.

    Sometimes there's not much you can do on the side of the road anyway, even with all the gear and medical knowledge in the world.
     

    Sylvain

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    That's got to be a tough choice for a doctor, I didn't know that there was such a thing as "medical control". I think I would keep things handy that didn't get you over what ever the "medical control" threshold is. You can't be expected to be a walking ambulance.

    Rhino is! ;)

    But that should be expected since he's prone to self inflicted knife wounds.
     

    1911ly

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    My wife and I drove up an a car truck crash. The truck rolled. It had happened just seconds before we got there. The worse wound was a guy with a nasty gash on his arm. Bleeding badly. My wife went in to nurse mode. She held the wound close until the paramedics arrived. We did not have a med kit in the car at the time. We added one shortly after. She ended up covered in blood with no gloves. It was a risk she took.

    It was awesome of you to go in to full Doc mode2 and she was lucky to have you and the other guy around. God bless you for all you do!
     

    MCgrease08

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    Just drove by a woman with her car broke down, I was going to stop and help until I remembered I don't know anything about cars or women.

    Cars have ports where you can plug diagnostic tools into...

    Women have a port you can stick things into also. Unfortunately it offers no diagnostic help and generally only helps to trigger all manner of dashboard warnings and check engine lights.
     

    natdscott

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    Dunno. I keep a pretty full kit in my car..at alllll times... for my abilities, but I'm about 4 years short of an MD.

    I also keep jumper cables, a fire extinguisher, and welding gauntlets, and a space blanket. During winter, I add a blanket and a 3-foot d-handle shovel.

    But of the two people I've known who had a vehicle directly interact with their brain, zero survived, and nobody, including neurosurgeons, could have done a fu$%ing thing for either of them.

    I'm sorry that happened for her, and for you and your family. I'm glad you'll be revising your kit. But I strongly suspect you already did just about anything productive that could have been done on scene. Don't beat yourself up.
     
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