Perhaps I need a debriefing?

[Wackie]

I did my first ride out yesterday. The very first call was for a lady who died in her sleep. She had signs of rigor so we gave our condolences and left. No big deal.

My next call was freaking crazy. A mass casualty incident. Three patients flown, two transported who were also critical. We needed more hands on scene, we later discussed. Our medic crew got split up to help with an extrication. Our box got raped and we waited on scene with a really bad open compound ankle fracture for thirty minutes longer than we should have while waiting for our cot to come back.

Anyway, I was given a pat on the back for not losing my head or anything. I chalk it up to ignorance because I don't think it hit me until today just how bad that scene was.

I knew one of the patients flown arrested at the ER within an hour of his arrival. I saw him on scene when he was struggling to breathe.

We transported our patient to a hospital I do some volunteer work for. Today, I asked the nurse how the patient's doing. He might not ever be able to walk on it again. She then told me all three which were flown died. So, that's three out of five total.

As I did mindless volunteer work, I started thinking about it. Previously, I had hashed out in my head what I could have done better and things like that. But, I realized today that I hadn't had a clue as to how bad that scene was.

I remember seeing the urgency in everyone's eyes but for some reason I didn't feel that as much. Perhaps it's just because I'm a student on my first call so my judgement isn't honed yet. Or perhaps I was simply focused on my patient.

But then perhaps when I saw all of the patients on the ground when sizing up the scene, they were compensating at the time and at a glance they didn't look as bad as they were. So maybe it's a lesson in realizing how much patients can compensate. I never did see the two who had to be extracted from the vehicles.

We brought our patient into the medic and went to work on him, so I wasn't out on the scene much. He was critical, but not to the point of running lights and sirens to the ER.

It just bugs me that I didn't seem to know how bad that scene was. Any input is appreciated.

[DwayneEMTP]

Wackie, sounds like you are doing well.

If you do a search on CISD (not a dig on searching, just some really good stuff in there) you are likely to find you will be happy you missed it....

Not for me to say how best to deal, I'll leave that for the experienced folks, they know best.....

Good luck...

Dwayne

[medic001918]

CISD is a personal thing. Everyone "debriefs" in their own way. Weather it's by talking to a friend or family member, going to the gym, playing a sport, etc. The list could go on and on. Whatever you do to help you deal with the stresses of what you've done. And that applies not only to things on the job, but stresses in general.

As far as not recognizing how sick the patients were, that's a separate thing. How far into your class are you? If you're nearing completion, you might want to think a little more about what you've learned in class and how it applies to these calls. It sounds like it was a pretty nasty scene that may or may not have been lacking the organization it needed in order to ensure it's success. I wasn't there, so I can't say. With experience comes the confidence in recognition of what is happening on a scene. Many scenes can be chaotic with countless things going on at once. Hopefully there's someone doing a good job of orchestrating resources to help maximize patient care and minimize scene times. After you've got some calls under your belt, you'll be able to look at a patient or a scene and know when it's time to get moving. One thing that I would reflect on (and I'm not bashing you in any way) is that you saw the "urgency in everyone's eyes but for some reason I didn't feel that as much." This statement is troubling. On a scene of that magnitude (MCI), with the number of providers there displaying a sense of urgency, did you think their concerns were unjustified? Or did you feel you had your part of the scene (your patient) under control? It's just something to think about when working with some experienced providers. There's usually; but not always; a reason for their feelings to a patients presentation.

Also, just another point of learning is that you had a "critical" trauma patient that wasn't to the "point of running lights and sirens to the ER." I'm curious about the area you were riding in. How far away was the ER? Remember that in most major trauma cases (sounds like he may have been a candidate based on mechanism, injuries to himself and others involves) you are racing against a clock. If your patient is critical, choose the fastest means of transportation for him. If you're close enough to a trauma center, this may not be with lights and sirens. Your SOP's will also provide some guidance into that aspect of the decision. Just some things to think about. All in all it sounds like you did do rather well. You have much to learn still, just like all of us. We're just in different places in our learning curves. Good luck and post back with any more questions.

Shane

NREMT-P

[Dustdevil]

Go back and revisit it all with the crew you were riding with. Hopefully, you did plenty of "debriefing" over the run when you got back to the station that day. But you still obviously have questions and things you want to say. Do it with them. And do it with your instructor too. You don' need a "debriefing." I don't think you are having emotional problems. I think you just need to get it all in perspective operationally and medically so you understand everything that happened, and that you did a good job. $hit happens, and that MVA is no different than every other critical MVA you will run on.

If for some bizarre reason you still feel uncomfortable or begin to obsess on this incident:

• 1. DO NOT start asking around about CISD. It's bull$hit snake oil.

2. Seek professional help. And CISD idiots are not professionals. Licensed Professional Counsellors and Psychologists are professionals.

3. Get out of EMS now, before it causes you irreparable emotional damage.

• Good luck!

[Wackie]

I'm about half way through the course.

That no feeling of urgency is what is bothering me. Command wasn't set up very well. They had five on the ground and took a little while to ask for help. We heard the call and knew we'd go. We went ahead and started that way. They radioed and sent us out without lights and sirens. We were half way there when we went full lights and sirens. When we got there, they had just started to triage.

And as I think about it, when we stepped out onto the scene I was rushing. I was rushing to the patient and to assess and splint him. So, perhaps since our patient was stable and doing really well is why I didn't get that feeling anymore. Or because the medics I worked with seemed so calm? I dunno. It's what I'm trying to work out to learn from. It's getting harder for me to go back and remember everything. It kind of sucks that we're on spring break now so I won't see my instructor until next week.

The no lights and sirens to the ER was a call made by the medics I rode with as well as the patient. The medic drove the speed limit and the patient kept asking us to slow down "We're in no hurry". One of the medics asked if a certain hospital was alright with him and he refused and asked to be transported to a different hospital which was about fifteen minutes away.

That hospital is a trauma III btw. The nurse I spoke to said he needed to go to a trauma I because of the three that were flown. So, I'm kind of dealing with that too because I'm a little confused. We haven't gone over trauma yet. Just from reading ahead, I thought an open compound fracture was a critical patient. Especially one like that. You could see tendons, bones, and fatty tissue. His shoe was filled with blood. His blood pressure was a little low but a slow drip brought it up quickly.

I hate that I didn't start coming up with all of this while I was at the station.

[Dustdevil]

We just posted at the same time, so make sure you scroll back and read.

That no feeling of urgency is what is bothering me.

No feeling of urgency is a good thing. Go with it. Hold it near and dear to you. It will serve you well in your career.

There is nothing more annoying than a partner who gets all urgent about everything.

So long as you aren't lethargic, don't worry about it.

[jmac]

wackie,

don't know if you know it or not but the medic that says that a call does not effect him is not really telling the truth, or he has no adrenal glands, the call seems to have affected you, but just remember you did not cause the incident and you did what could be done in the circumstances, while it is good to critique a call don't over hash it by yourself with "what-ifs" and "if things were different".

you are going through the course at the moment and any person in EMS will tell you that school and real life are two completely different animals, you got through the incident, talk to someone with experience that was there or with one of your mentors, they will or should not let you ponder on something like this, and remember everyday in an ambulance is different, just some are more shagged up then others hence SNAFU

in my opinion not having a real sense of urgency may not be a bad thing, could be that you are focused and don't even know it, now if you stopped for coffee and a cigarette on the way to the hospital....that would be a different matter.

end of line is if it still bothers you seek council,

keep safe.

[DwayneEMTP]

Wackie, I can't help with your issue, but I would like to make an observation.

If your understanding of the accident, the sequence of events and your feeling about them are any indication, you will be fine!

You explained the accident, the parts relevant to you and your feelings, and the actions of those around you and how they might have contributed.

There are many Medics on this site that can't express their thoughts half as well. I'm impressed, for what it's worth.

If I ever get splattered in an MVA, I hope someone with your calm logic comes to scrape me up....

Dwayne

[UMSTUDENT]

Getting used to dealing with tragedy is something that takes time for some people. Others deal with it easily. Blaming yourself isn't the way to go and seeking professional help is definite must if you continued to be bothered by the incident. Seeking a professional psychologist is a must if one is available to you.

While many people here bust on CISM, it is still the standard in many jurisdictions around the country and should have been offered to you upon completion of the call.

If you need more information the following is a great resource:

http://www.icisf.org/

[Wackie]

Thanks for all of the replies.

I think I've got it down now. What I think I did was trust that the others were doing their jobs and I focused on mine and was able to block out the rest of the scene, to the extent of being able to perform my job (as well as I could lol). I just happened to get one of the better patients who also did not require the care the others did.

I need some experience under my belt to aid in making judgement calls like some of the 15 year vetrans could on scene as well as more training.

Looking back, I could have done a better assessment, and there are a few other things I know I could have done better. My next run, I'll keep that in mind and make sure I use the experience to do better.

As for now, I have something else to obsess about. I just got my new driver's licence in the mail. :shock:

Why they let me out in public, I don't know.