What Happened?

There are many things a paramedic(or EMT) has to do on the scene of a trauma (or sometimes even the scene of a bad medical).

Among them is to answer the question “What happened?”

Sometimes the patient can tell you.

“I went over the handlebars on my bike and hit my head. It hurts, but I remember everything.”

“My wife hit me in the head with a two by four from behind. I fell down, but got back up and took it away from her.”

“I didn’t have my seat belt on. I saw the car coming and tried to stop. I busted my head on the windshield. That’s why there’s a big hole there — in the windshield.”

If the patient is unconscious, the question “What happened?” is easy to answer if you have a calm, intelligent witness.

“They got into an argument, and then the other guy shot him in the head with his 9 millimeter.”

“He was on the roof, he lost his balance and fell head first, striking his head on the cement.”

“He was walking across the street and a Jeep Cherokee going about 30 miles an hour hit him from behind. He went up in the air, and came down landing on his head. He doesn’t even know his name, but I know it. That man there is Robert Brown. He’s my next door neighbor. We have the same birthday.”

But sometimes the scene is chaotic. Sometimes people will tell you what happened, but only because that is what they think happened or what someone else told them had happened.

I have done many calls and arrived at the hospital to tell one story only to find out later a completely different story actually happened. He didn’t fall off the roof, he fell off the ladder. He wasn’t thrown from the car, he was a pedestrian. The driver of the car — a stolen car — took off. Sometimes in after reflection, you can see what actually happened, but your brain in the chaos goes with what someone has told you.

Maybe I was more nimble years ago, but my mind is hazy sometimes. It is hard for me to quickly sort through all the details — the conflicting information — sights, words, senses — thrown at you from multiple sources. The ability to do this well is truly a valuable and underappreciated skill. I find it is one of my weak spots.

I had one call where we found a man in arrest in his garage and his buddy said “the fuel injector exploded in his face.” I didn’t know what that meant. The victim was in arrest and while I tried to orchestrate the resuscitation, I still couldn’t figure out what a fuel injector exploding in his face meant. I could see no marks on his face. Was it a trauma? Was it an inhalation? Or did the incident just startle the man causing him to code as he had an extremely weak heart to begin with. At the hospital, when they asked me what a fuel injector going off in the man’s face meant, I had to say “I don’t know.” I was sort of busy on the scene and didn’t have time for the guy’s extremely agitated friend to draw me a diagram.

Just how important is it to get the story right. Sometimes it is, sometimes it doesn’t really matter. Injuries are injuries. What I can’t focus on will be found out under the bright lights of the trauma room.

When I was in paramedic school, my teacher told us about a patch he gave to the hospital that he was complimented on by a top doctor. The patch was basically this: “I’m five minutes out with a guy who is FUBARed.”

FUBAR, for those who don’t know, means “Fucked Up Behind All Recognition.”

It told the trauma doctor that the big one was coming in and he needed everyone on his trauma team in the room and ready to work. He didn’t need to know in particular bout the flail chest, the open tib-fib fractures, the deep torso bruising, the brain injury. He knew he was going to be busy.

Sometimes I have asked my partner to radio in for me. I’ve told him “just get me the trauma room for a full trauma.” If he is new, he may not want to patch, so I will have to. I’ll say “45-year-old male pedestrian struck in traumatic arrest, five minutes out.”

Short and sweet.

Sometimes when I patch in for a critical patient, the hospital starts asking questions about the patient’s condition. “What’s their GCS?” “What was the blood pressure?” “Which leg is mangled?” If the patient is critical and I am in the back by myself, I am sort of busy. “Hey I’m suctioning blood out of their airway so they can breathe” or “Hey I’m doing CPR by myself. See you when I get there.” Click.

The radio notification patch aside, when you do get in the trauma room, they want to hear and deserve the full story or as much of it as you can give them.

But sometimes (it seems like often lately) I don’t have it for them.

I’ve had a couple calls where I really had no idea what happened.

“What happened? I don’t know what happened? Something awful happened. They’re f-ed up, but here they are. I don’t know anything about them, other than they didn’t deserve this. I put a collar on them, got them on a board, got them in the ambulance and got on the way. I gave them oxygen, keep their airway open, took vitals, cut off all their clothes, and put a large bore, but insignificant IV in all while getting them here as quick as I could. I can’t even begin to tell you all their injuries, look for yourself. I suppose I could have the full story for you, but then I wouldn’t be here yet. I’ll be awhile coming.”

I had a fall patient in traumatic arrest once with bilateral leg fractures that I never saw. I had to scoop a just eaten sub out of his mouth which was like pulling sausage out of a meat grinder. It just kept coming. I wanted to say stop turning the crank. Enough is enough. How much food is down there? I didn’t get past the ABC’s on that call.

I did another call once to find two kids lying in the street, hit by a car while they were playing in the street. That’s what they told me when I got on scene where a 100 screaming people shouted at us to do something. Turned out they weren’t playing in the street (they were coming out of a store when a car went up on the sidewalk and booted them 100 feet or more into the street) and they weren’t kids — they were adults. But I couldn’t tell any of that because all broken and fetalled up, they looked like little boys.

All I could do was get them to the hospital.

“What happened?” “How fast was the car going?” “Where were they hit?” “What injuries do they have?” “What are their names?” “Do they have any allergies?”

I don’t know, but they are FUBARed.

Work your magic. I’ve got nothing left.

5 Comments

  • Hanabi says:

    Just wondering if you’ve seen the news report on this link. This was recently brought to my attention by my local EMS region website. I don’t know enough about the EMS services in the states to be aware of how you do PCR documenting cardiac arrests; advanced procedures etc. I also feel that the fact thrown in, (as you will see) about out of 20 cardiac arrests, they’ve only saved one person, gets skewed by the story, because it makes the viewer believe that every patient was found in the same circumstances. Anyway. 😀 I’d love to hear your opinion, if you have the time. Hope my link works!Hanabi

  • Rogue Medic says:

    Sometimes we have all of the information that they want.Sometimes we are only able to scratch the surface, maybe not even the right surface.We need to get them (doctors, nurses, trauma team, . . . ) to understand that we are only giving one version of events.Do we defer care to obtain information that may turn out to be critical? Sometimes.Should we? Sometimes.How do we know which ones are which? We usually do not.Too bad that the doctors and nurses often look at these times we obtain the wrong information and lose confidence in our abilities.Losing confidence in EMS may be a very bad decision. Should we similarly lose confidence in them for this bad decision?

  • Billy Sparks says:

    I once had a call that all the family would tell me is the patient was sick and the last time he got this way they took him to the hospital. The patient wanted to go but couldn’t communicate with his (just grunts and sounds). To top it off my system’s deputy medical director took my encode….that was fun.

  • PC says:

    Thanks for the comments.hanabi – I watched the video. I don’t like to comment on a call unless I am there and know all the facts. I also don’t trust I-team investigations.It seems inexplicable to me that if the patient was in V-tack or V-Fib the crew would not shock them. Some of the questions I would like to know are if the crew told the hospital the patient was in pulseless vt the whole time, what did the hospital say to them? Did you shock them? and if no, why not? What was their answer?Did the machine malfunction? Were the batteries too low? Was there a problem with the cable? Did they not have pads?How many people were in the ambulance? They only mention 2. I’m guessing she coded getting into the back and then they just raced her in with one person doing CPR and bagging while the other drove. Or were there other people there helping? The patient didn’t get epi or atropine. Why not? Maybe they couldn’t get an IV or get her tubed.Also, I believe you can recover the entire call from a life Pack 12. I’d like to see that strip. Idid recently hear about a local code where when they reviewed the entire monitor information there was a 12 minute gap without CPR. As far as documentation. I try to make mine accurate, but often when you are writing the report in the immediate aftermath, while being rushed to clear, you can forget something. Sometimes I will read the report later and realize it was inaccurate or I failed to document something I should have.I just have to believe the I-team is not telling all the story. I simply can’t believe the crew had the opportunity to shock her, knew she was in a shockable rythm and just didn’t do it. I also agree that 1 out of 20 makes them look incompetent when 1 out of 20 is about the average of a good system if we are talking all cardiac arrests.roguemedic- excellent comments as always. Thank you.Billy, thank you also. I hate when that happens.

  • Rogue Medic says:

    PC,I just watched the video. It would be nice to know more about what happened.I am aware of similar cases where the medic froze and did not provide the treatment(s) that should have been automatic.You raise some very good questions about the things we do not know, that could affect the outcome. The idea that the fire department will have an internal investigation and nothing is done, if that was the result, is wrong.

Leave a Reply

Your email address will not be published. Required fields are marked *