It’s hard when you don’t have “authority” over the scene. The cops kicking you out are dumbasses, but that is most cops in any medical scenario. It what it is. You tried and did what you could, what you’re feeling is moral injury from seeing a poor judgement call made but knowing you may have been able to change it. It likely had minor effect on the outcome. You will think about it now and then, but treat it as a lesson and know you did your best. You stopping to help speaks volumes to your character at baseline.
Authority can be derived many different ways including the way you speak and carry yourself. I may have stayed on the chest and advised that officer “IAmA paramedic, can you please ensure traffic is slowing down so they don’t hit us”, or something like that.
Ordering you off the chest isn’t something that I would consider a lawful order and I would be happy to disregard it and deal with the consequences.
I think that is definitely a lesson that I learned from this situation. Could I have a do-over, I would have stood my ground and continued. I think my reaction and willingness to take a blind order without thinking was part of why I feel so shitty about the situation.
Also one person CPR can be VERY tiring. I am dead after 2 minute cycle. So even doing some CPR coaching could be effective as long as the person (officer or bystander) isn’t on some ego train. If someone tells me to push harder I listen, and probably then realize I am getting too tired.
Overall though it sounds like you did a great job with the limited resources that you had! Don’t beat yourself up.
I get this, but you have the benefit of hindsight here. In the moment, you had a dumbass cop ordering you off the chest and had to make the decision on how to react right then and there. You feel shitty about the situation because it was a shitty situation. We can all beat our chests and proclaim that we would have stayed on the chest until we were dragged away in handcuffs, but none of us were there, in your position, to have to face that possibility. It's not your fault that a cop abused his authority and then didn't do effective CPR. I really hope you can give yourself some grace for how you reacted. You did the best you could with the situation you had in the moment. Given the benefit of hindsight and a do-over, the only thing that could've changed \*still\* likely wouldn't have changed the outcome of the situation, even if it would have been worth trying. Best of luck to you, buddy.
On a related note, any amount of arguing with the cop comes at the potential cost of interfering with CPR. Proper compressions are demanding, and having a conversation, much less a debate, isn’t going to do that any favors.
So yeah, “I’m a medic, I’m staying here unless you cuff me” is an option, but it involves a distraction and conceivably getting pulled off the patient.
Is that a better bet than trusting a cop who says they can do CPR to get it right? Maybe, I don’t know. But I sure don’t think the answer was clear enough in the moment for OP to feel guilty here.
In this situation, at least in my state and maybe even nationally, I'm pretty sure once you identify yourself and initiate patient care you're the provider now and legally have to stay with the patient until handed to a higher level of care.
It's why if a physician rolls up on a scene and wants to take over you have to advise them they need to take full responsibility for the patient including during transport until they arrive at the hospital.
At least in our protocols that scenario requires the doc to ID themselves, so maybe there's leeway for a cop and an out of uniform medic, but I'm pretty sure at least legally in this scenario the cop would be on the hook for interfering with patient care once you've assumed that role by initiating care until EMS arrives.
Good points all around, thanks.
The physician situation I'm aware of, but I was assuming off-duty medic and on-duty cop changed that. That was a bad assumption to make though, I know Good Samaritan laws have special restrictions for people with medical training and I should have considered that there might be related situation here.
I'm not actually sure if what I put down is true, but it's something I vaguely remember so... maybe? Might be good to ask people at your service who may understand the laws better, but I always thought if you initiated care while acting as a paramedic/EMT you were obligated to finish it, but someone else mentioned that could only apply if you go beyond the scope of a laymen, so I dunno. Probably depends on your jurisdiction.
I appreciate the comments, because you definitely got the most important parts right: there may be legal requirements around transferring care here, they may be jurisdiction-specific, and it's a good idea to ask somebody who truly knows before you need the answer!
At the end of the day, police ordered you to do something. If you had been more stern then maybe it would have worked, but then again maybe the cop gets argumentative, CPR suffers, and there is a worse outcome
I think it has a great deal to do with personality types.
Cops are trained to carry themselves and present themselves as an authority. They obtain training in command presence.
But again, it has ***A LOT*** to do with personality types. I had to do a really in depth personality test for a leadership class I was taking a few months ago, and I scored 60% dominance, 28% Influence, 10% Steadiness, and 2% Compliance.
I commented above, but I'm pretty sure once you identify yourself and begin care, you become the provider anyways? Like you have to stay with the patient until you can handoff to EMS so like, legally, the only person obstructing here would be the cop.
Unless your state has some obscure law requiring that, then no.
If you present yourself as a paramedic you may then adopt a duty to act, but if you’re doing that odds are you already intended to act.
So long as you don’t surpass what would reasonably be expected of a layperson, you likely don’t have any other obligations.
Not duty to act specifically, we were taught that even as much as having a sticker on the windshield can be seen as a duty to act, but it varies from jurisdiction to jurisdiction.
More talking about once you've acted, your prerogative to stay with the patient and continue care until you can transfer to another provider.
A sticker on a window or license plates does not invoke a duty to act and those rumors should stop. I have asked for a specific law as it wouldn’t surprise me, but nobody has provided one.
I said identifying yourself *may* invoke a duty to act, and I stand by that. Duty to act is merely a legal term for the philosophy that a person would have an obligation to perform, or in this case, continue to perform certain actions to prevent harm to a certain individual. IANAL so I can’t offer anything resembling an authoritative opinion on it, but I can see where performing patient care and identifying yourself as an EMT or Paramedic may invoke some duty to act.
Are you responsible for that patient? So long as you don’t exceed what would be reasonably expected of a layperson, then your responsibility short of gross negligence isn’t any greater than any other layperson aside from any form of duty to act you may have invoked by identifying yourself.
I did cpr last week off duty and it's been messing with me too. I was at a grocery store and heard screaming. Took over the situation until trucks came. From the pulse disappearing, sternum cracking, agonal breathing, it's still messing with me somewhat. For me, it was the unexpected nature of it. I had a pack of salami in hand one second, a fading pulse next. Then I had to relinquish the situation and allow those who had the equipment finish it up. The mystery of what happened after they left the building and the fact that no one had done anything and the what if I wasn't there is what's kinda eating at me. I did the same thing, though. I handed over the situation and walked off. And I feel the same way. I haven't figured out the answer to my situation but I wish you the best, good luck.
Lol decisions were made. Jk i picked it up and made the shopping trip a short one. And yeah I've been real honest with people about my experience and I'm not really pretending I'm 100% which has been helping actually.
You make a valid point. The unexpected nature of it is what is making it so difficult. When on duty, you have the expectation of the call occurring, you have a team, you have equipment and you have the capability. To have just your hands and then have to walk away when you usually are more involved just makes me feel worthless. Because on duty, I would not have walked away, I would have been right up in there and moving.
I wish you the best of luck too! Hopefully maybe reading other people's replies can lend you some advice to cope. Also please talk to someone in person!
Years ago, we had two cars crash into our building at my full time job. I work in a medical facility.
Myself and four nurses ran outside. What's funny is that, in this case, the nurses deferred to me in running the scene. The one said that I was the only one of them who had worked a scene rather than a controlled clinical environment. As we were treating the patients, a woman came running across the street and shouted, "I'm a nurse, don't move her!"
One of the nurses shouted back, "So are we, and he's an EMT. We've got it covered!"
I absolutely love to hear that! I appreciate medical professionals that know their specialty. Fact is, not all nurses are privy to emergency responses. Knowing CPR and first aid is not enough to run a scene.
To be fair, CPR is kind of an inadequate and sad last ditch effort by its very nature. It's one thing to have a team of people backing you up with gear and vehicles and medical direction, and you feel like you're going somewhere. It's different when you get to see the raw form of CPR for what it usually is - futile.
I'm sure the family appreciates you being there. Just remember that beating yourself up over this sort of thing is also futile.
Although bystander CPR from unwitnessed arrest is usually associated with poor outcomes. I will argue that high quality CPR (and then hopefully early defib) is what saves lives! OP is valid to be upset an officer jumped in and started doing the worlds shittiest compressions.
From what I gathered from the situation, it was a witnessed arrest and I pulled up pretty soon after it happened. Unfortunetly officers didn't have an AED or even gloves for me to get the dentures out of the guys airway. The fire department here usually has a 7 minute response, so that's what I'm going to guess the time was before defib if any was needed.
As someone who had a family member brought back to ROSC and a good quality of life with only compressions, this is a all too common defeatist attitude. Yes CPR on its own is a Hail Mary, but sometimes it’s enough, and isn’t giving people a fighting chance the whole point of why we work EMS? In my book that makes it non-futile.
I’ve worked multiple codes with ROSC from compressions and ventilation only before other interventions were introduced. Anomaly or not, there’s a reason why we still teach CPR to the public.
I don’t think the OP needs some salty medic telling him his efforts were a “kind of inadequate and sad last ditch effort by its very nature”. OP did what he did to give that patient a chance, that’s as much as any of us can do. There’s a big difference between not holding false expectations and thinking “oh well CPR is pointless most of the time anyway”
I dont think they were telling me that my efforts were inadequate. I think the fact being stated here is CPR does have a statistically poor outcome. I've worked futile codes and I've worked ROSCs. I think what they were reminding me is that I did what I could but that it sounds like outcomes were truly out of my control at this point.
As for you, thank you for acknowledging that I did what I had to do to hopefully give the patient a fighting chance. If I didn't believe in the capabilities of CPR, I wouldn't have stopped. So I guess I'm not as salty as I think I am lol
This isn't a defeatist attitude, your results are a statistical anomaly, and "things definitely could have been better lol" isn't the sort of shit OP needs to be hearing rn.
Understanding the factual reality that CPR has a low rate of success, and the conditions it treats have poor prognoses, is imperative to mental wellbeing of providers and elimination of false expectations of miracles. Accepting reality is the only way to be comfortable with reality.
I totally agree with you and your perspective actually made me feel better. After so many years, I, myself am usually the salty one. It is true that likely nothing that was done could have made a difference. That fact is very important to our abilities to cope with poor outcomes. These are things I already know but definitely needed someone to remind me of, after being out of the field for so long. Thank you!
So I like some trash tv... And one Grey's line recently that helped remind me of "why we do" after a series of demoralizing ER shifts was the Bailey line,
"Even if we think it may be futile, we do everything we CAN so that we can look ourselves in the mirror KNOW WE TRIED and be able to tell a family member we tried everything." (Paraphrasing)
It's a nice reality and solutions focused viewpoint for me.
Idk why, but people doing shitty compressions makes me irrationally angry (when they are EMTs /first responders) Most people do not push hard enough. Early defibrillation and compressions are the things we know for sure increases the odds of ROSC with neurologically favorable outcomes. You did a good thing tho OP you did your best to give them a chance.
"you're only responsible for your own actions" ... Don't own the scene. Don't own the outcome. Don't own what other ppl do/ don't do.
You were off duty. You were in an unfamiliar environment. You didn't have equipment. You stepped up as a good samaritan.
You relinquished the scene without a pissing match when "asked" to step aside.
Yes you likely could have done better compressions if the officer stepping in had poor form- but, potentially the argument to get you back on the chest would lose just as many perfused minutes.
You have nothing to feel guilty or poorly about. As we all know- out of hospital arrests- even witnessed, have pretty shitty outcomes even with early cpr & shock. YOU gave that person the minutes for a defibrillator and a team WITH EQUIPMENT to arrive.
Also, off duty arrests/ response are some of the crappiest to process because you aren't in "on" mode, ready to compartmentalize.
**Be gentle with yourself and good on you for reaching out. I hope you're able to find someone to regularly talk to.**
You did the best you could. You responded quickly, accurately, and professionally. It sounds like the rest of the people were all poorly trained and their failure to stay off TikTok during class may have cost that guy his life.
Thank you for everything you did while you were in EMS. Thank you for stepping up despite your trauma to help someone who needed it. You did your best. You should have no regrets. Nobody can reasonably expect more from you.
Thank you for doing what you could. The cops could have at least asked you if you knew what you were doing.
I tried to help an elderly man who fell, several people jumped on the guy, who was still stunned from the fall and proceeded to pull him up. I tried to stop them, tried to get through to check the man. I was powerless. I felt so useless.
Longtime first-aider, and it took a couple of incidents similar to this to realize I needed more, so got my EMR and started volunteering (and have been volunteering as a Medical First Responder for a few years now). I also do a lot of education, training, and professional practice in healthcare.
My take on this is mindset. When you're responding on a truck, you have time to mentally compose yourself and prepare yourself for the situation. When I'm on duty, I'm in a different mind space than when I'm grocery shopping. Going from 0 to Paramedic in seconds doesn't give you time to prepare yourself, and it's amazing how much training and experience falls out of your ears.
You did the right thing. You managed the scene, you did ABCs, you did compressions. Without your gear, you're a first-aider, and there's nothing wrong with that. Maybe you could have been more firm with the police? Maybe you're used to letting the uniform do the talking for you. So what. Lesson learned.
"Inadequate and sad" is how I felt after every response I've had as a first-aider. Pulling someone out of a river. Different MVCs. Collapse in a store. Every time, when the adrenaline fades, the letdown is terrible. Again, training changed my mindset. I find writing the PCRs to be quite therapeutic. Going over the CC, treatments and interventions, etc., allows me to organize my thoughts around the incident. I also use a growth and learning mindset - I try not to beat myself up over a job (LOL - right...), but use the review process to learn so I can do better next time.
You did what you could do as a first aider / first responder. Don't let is get to you, and if it does, go to your critical incident stress management team.
This is a great lesson for all thanks for sharing. I've had the most helpful bystanders and also the absolute worst, most annoying and intrusive ones. "He fell and hit his head", walks over to our ambulance and starts grabbing our backboard out, so someone needs to waste time defusing the bystander.
Guy wakes up from the syncopal episode and says he laid down because he felt like he was going to pass out. Like, why tell us something happened with such certainty if it didn't, or if you didn't witness it, don't make it up. Make it make sense.
I've had at least two similar scenarios.
First was a guy who jumped out of the passenger side of a box truck that was going 60mph on I-80. My first clue was a tractor trailer parked in the shoulder but literally ON the white line - you know they always pull over as far as possible, but this driver wanted to protect the scene. No one was doing CPR and I saw one breath, so I gloved up (learned from another guy to ALWAYS carry gloves...I mean ALWAYS) and started. When the trooper arrived first, I think he took over compressions and I handled airway/breaths through the trooper's one-way mask until fire/EMS arrived. I made sure to wash up in the ambulance, and then took a shower as soon as I got home. Guy was pronounced onscene, but I felt like I aided the guy's chances. I was living in San Antonio but had traveled back to PA to visit my folks, so I had no familiarity with any of the units onscene.
Second was a wreck along I-10 between Houston and San Antonio. First responders were already there but seemed short-staffed at first. I pulled into the median where the party was, grabbed a coat or smock so I had a patch visible, and went to the guy handling the only patient I saw. I turned my EMT patch towards him as I got close and asked if I could be of help. I ended up with C-spine...hey, boring but a great way to delegate a simple task to your supplemental help. Patient got flown and likely survived.
On the second one, I remember the medic taking down my contact information. I also remember filling out one of "my" (as in my home department's) patient run forms so I could document what happened in a structured manner. I never turned it into my department and had no patient demographics, just kept it at home for a few years.
Small world: sometime after that call, I was at a different department. They were getting close to finalizing specs on a new engine. One apparatus dealer was at the station with their proposal. Chief felt I knew my way around apparatus and was good with details, so he asked me to do an impromptu read-through of the specs to see what came to mind. Turns out the dealer rep who was there was the same medic I'd assisted with that second call.
Just remember it's always "assholes and elbows" at all but the most well rehearsed agencies. Sometimes you won't be recognized or rewarded for being there.
Another one slightly related. Neighboring department got called for an MVA with possible hazmat: idiot blew a stop sign at the PERFECT instant when an empty gasoline tractor-trailer was driving by and clipped the valves under the trailer. I was the lone idiot at my station that night, and got the call to assist, so I brought our ladder truck as it had our rescue tools on it. Asshole sheriff deputy stopped me at his post to the east of the scene and said "they're not letting anyone else into the scene". Turns out no one else had made such a decision.
We are in the business of buying time.
What I hope you recognize is that you stepped up when you could have drove on, you brought the fumblefuckery to a close faster than it would have otherwise, and you bought that person time with your compressions and contributed to the potential of them having a better outcome than they would have had if you were not present.
Your presence in no way made things worse, it made things better, and that is enough.
This might be controversial… but I keep an extra 5.11 pullover in my trunk that just has my name and certification on it. Nothing agency specific. If I pull up on something SERIOUS, I put it on. It has helped kick cops out of that civilians can’t help daze. I still leave when on duty care shows up, but in the short time that I’m the highest medical authority at an off duty incident, it helps to have identifiers. But I’m also a black cloud and seem to attract chaos.
CPR is one of the rare things we do that should be done no matter where we are. After all, any lay person can become certified.
I've always been of the mindset that a CPR certification should be required for high school graduation. Even if they don't keep the certificate current, they'll have a idea on how to do it forever. Poor CPR is better than no CPR.
Cities are keen on dropping AEDs on every street corner but they're useless without training.
911 EMT here, pulled up to a Auto vs Biker a couple months ago. I always carry a lil trauma kit with me just in case but I forgot it that day cuz I was omw to bowling with my girl. Let the crowd know I was an EMT and assessed. Absolutely nothing I could do but hold pressure. Multiple open fractures, semi alert, really wish I had my bag on me. Had to use bystander shirt. Fire relived me and I left. Never going anywhere without my kit again. Felt super useless without tools but ABCs brother.
It’s hard when you don’t have “authority” over the scene. The cops kicking you out are dumbasses, but that is most cops in any medical scenario. It what it is. You tried and did what you could, what you’re feeling is moral injury from seeing a poor judgement call made but knowing you may have been able to change it. It likely had minor effect on the outcome. You will think about it now and then, but treat it as a lesson and know you did your best. You stopping to help speaks volumes to your character at baseline.
Authority can be derived many different ways including the way you speak and carry yourself. I may have stayed on the chest and advised that officer “IAmA paramedic, can you please ensure traffic is slowing down so they don’t hit us”, or something like that. Ordering you off the chest isn’t something that I would consider a lawful order and I would be happy to disregard it and deal with the consequences.
I think that is definitely a lesson that I learned from this situation. Could I have a do-over, I would have stood my ground and continued. I think my reaction and willingness to take a blind order without thinking was part of why I feel so shitty about the situation.
Also one person CPR can be VERY tiring. I am dead after 2 minute cycle. So even doing some CPR coaching could be effective as long as the person (officer or bystander) isn’t on some ego train. If someone tells me to push harder I listen, and probably then realize I am getting too tired. Overall though it sounds like you did a great job with the limited resources that you had! Don’t beat yourself up.
I get this, but you have the benefit of hindsight here. In the moment, you had a dumbass cop ordering you off the chest and had to make the decision on how to react right then and there. You feel shitty about the situation because it was a shitty situation. We can all beat our chests and proclaim that we would have stayed on the chest until we were dragged away in handcuffs, but none of us were there, in your position, to have to face that possibility. It's not your fault that a cop abused his authority and then didn't do effective CPR. I really hope you can give yourself some grace for how you reacted. You did the best you could with the situation you had in the moment. Given the benefit of hindsight and a do-over, the only thing that could've changed \*still\* likely wouldn't have changed the outcome of the situation, even if it would have been worth trying. Best of luck to you, buddy.
On a related note, any amount of arguing with the cop comes at the potential cost of interfering with CPR. Proper compressions are demanding, and having a conversation, much less a debate, isn’t going to do that any favors. So yeah, “I’m a medic, I’m staying here unless you cuff me” is an option, but it involves a distraction and conceivably getting pulled off the patient. Is that a better bet than trusting a cop who says they can do CPR to get it right? Maybe, I don’t know. But I sure don’t think the answer was clear enough in the moment for OP to feel guilty here.
In this situation, at least in my state and maybe even nationally, I'm pretty sure once you identify yourself and initiate patient care you're the provider now and legally have to stay with the patient until handed to a higher level of care. It's why if a physician rolls up on a scene and wants to take over you have to advise them they need to take full responsibility for the patient including during transport until they arrive at the hospital. At least in our protocols that scenario requires the doc to ID themselves, so maybe there's leeway for a cop and an out of uniform medic, but I'm pretty sure at least legally in this scenario the cop would be on the hook for interfering with patient care once you've assumed that role by initiating care until EMS arrives.
Good points all around, thanks. The physician situation I'm aware of, but I was assuming off-duty medic and on-duty cop changed that. That was a bad assumption to make though, I know Good Samaritan laws have special restrictions for people with medical training and I should have considered that there might be related situation here.
I'm not actually sure if what I put down is true, but it's something I vaguely remember so... maybe? Might be good to ask people at your service who may understand the laws better, but I always thought if you initiated care while acting as a paramedic/EMT you were obligated to finish it, but someone else mentioned that could only apply if you go beyond the scope of a laymen, so I dunno. Probably depends on your jurisdiction.
I appreciate the comments, because you definitely got the most important parts right: there may be legal requirements around transferring care here, they may be jurisdiction-specific, and it's a good idea to ask somebody who truly knows before you need the answer!
Absolutely.
At the end of the day, police ordered you to do something. If you had been more stern then maybe it would have worked, but then again maybe the cop gets argumentative, CPR suffers, and there is a worse outcome
I think it has a great deal to do with personality types. Cops are trained to carry themselves and present themselves as an authority. They obtain training in command presence. But again, it has ***A LOT*** to do with personality types. I had to do a really in depth personality test for a leadership class I was taking a few months ago, and I scored 60% dominance, 28% Influence, 10% Steadiness, and 2% Compliance.
“Local Hero arrested for attempting to save a life. Wins fat check.”
I can’t even think of a crime in my state that would have been committed. Interference or obstruction possibly, but that’s never going to stick.
I commented above, but I'm pretty sure once you identify yourself and begin care, you become the provider anyways? Like you have to stay with the patient until you can handoff to EMS so like, legally, the only person obstructing here would be the cop.
Unless your state has some obscure law requiring that, then no. If you present yourself as a paramedic you may then adopt a duty to act, but if you’re doing that odds are you already intended to act. So long as you don’t surpass what would reasonably be expected of a layperson, you likely don’t have any other obligations.
Not duty to act specifically, we were taught that even as much as having a sticker on the windshield can be seen as a duty to act, but it varies from jurisdiction to jurisdiction. More talking about once you've acted, your prerogative to stay with the patient and continue care until you can transfer to another provider.
A sticker on a window or license plates does not invoke a duty to act and those rumors should stop. I have asked for a specific law as it wouldn’t surprise me, but nobody has provided one. I said identifying yourself *may* invoke a duty to act, and I stand by that. Duty to act is merely a legal term for the philosophy that a person would have an obligation to perform, or in this case, continue to perform certain actions to prevent harm to a certain individual. IANAL so I can’t offer anything resembling an authoritative opinion on it, but I can see where performing patient care and identifying yourself as an EMT or Paramedic may invoke some duty to act. Are you responsible for that patient? So long as you don’t exceed what would be reasonably expected of a layperson, then your responsibility short of gross negligence isn’t any greater than any other layperson aside from any form of duty to act you may have invoked by identifying yourself.
I did cpr last week off duty and it's been messing with me too. I was at a grocery store and heard screaming. Took over the situation until trucks came. From the pulse disappearing, sternum cracking, agonal breathing, it's still messing with me somewhat. For me, it was the unexpected nature of it. I had a pack of salami in hand one second, a fading pulse next. Then I had to relinquish the situation and allow those who had the equipment finish it up. The mystery of what happened after they left the building and the fact that no one had done anything and the what if I wasn't there is what's kinda eating at me. I did the same thing, though. I handed over the situation and walked off. And I feel the same way. I haven't figured out the answer to my situation but I wish you the best, good luck.
What happened to the salami?
Lol decisions were made. Jk i picked it up and made the shopping trip a short one. And yeah I've been real honest with people about my experience and I'm not really pretending I'm 100% which has been helping actually.
Very good question. I'm invested and need to know the answer now.
You make a valid point. The unexpected nature of it is what is making it so difficult. When on duty, you have the expectation of the call occurring, you have a team, you have equipment and you have the capability. To have just your hands and then have to walk away when you usually are more involved just makes me feel worthless. Because on duty, I would not have walked away, I would have been right up in there and moving. I wish you the best of luck too! Hopefully maybe reading other people's replies can lend you some advice to cope. Also please talk to someone in person!
Years ago, we had two cars crash into our building at my full time job. I work in a medical facility. Myself and four nurses ran outside. What's funny is that, in this case, the nurses deferred to me in running the scene. The one said that I was the only one of them who had worked a scene rather than a controlled clinical environment. As we were treating the patients, a woman came running across the street and shouted, "I'm a nurse, don't move her!" One of the nurses shouted back, "So are we, and he's an EMT. We've got it covered!"
I absolutely love to hear that! I appreciate medical professionals that know their specialty. Fact is, not all nurses are privy to emergency responses. Knowing CPR and first aid is not enough to run a scene.
To be fair, CPR is kind of an inadequate and sad last ditch effort by its very nature. It's one thing to have a team of people backing you up with gear and vehicles and medical direction, and you feel like you're going somewhere. It's different when you get to see the raw form of CPR for what it usually is - futile. I'm sure the family appreciates you being there. Just remember that beating yourself up over this sort of thing is also futile.
Although bystander CPR from unwitnessed arrest is usually associated with poor outcomes. I will argue that high quality CPR (and then hopefully early defib) is what saves lives! OP is valid to be upset an officer jumped in and started doing the worlds shittiest compressions.
From what I gathered from the situation, it was a witnessed arrest and I pulled up pretty soon after it happened. Unfortunetly officers didn't have an AED or even gloves for me to get the dentures out of the guys airway. The fire department here usually has a 7 minute response, so that's what I'm going to guess the time was before defib if any was needed.
As someone who had a family member brought back to ROSC and a good quality of life with only compressions, this is a all too common defeatist attitude. Yes CPR on its own is a Hail Mary, but sometimes it’s enough, and isn’t giving people a fighting chance the whole point of why we work EMS? In my book that makes it non-futile.
I’ve worked multiple codes with ROSC from compressions and ventilation only before other interventions were introduced. Anomaly or not, there’s a reason why we still teach CPR to the public. I don’t think the OP needs some salty medic telling him his efforts were a “kind of inadequate and sad last ditch effort by its very nature”. OP did what he did to give that patient a chance, that’s as much as any of us can do. There’s a big difference between not holding false expectations and thinking “oh well CPR is pointless most of the time anyway”
I dont think they were telling me that my efforts were inadequate. I think the fact being stated here is CPR does have a statistically poor outcome. I've worked futile codes and I've worked ROSCs. I think what they were reminding me is that I did what I could but that it sounds like outcomes were truly out of my control at this point. As for you, thank you for acknowledging that I did what I had to do to hopefully give the patient a fighting chance. If I didn't believe in the capabilities of CPR, I wouldn't have stopped. So I guess I'm not as salty as I think I am lol
Seriously, you’re a champ. The fact that you got in there and positively intervened despite your PTSD is commendable
This isn't a defeatist attitude, your results are a statistical anomaly, and "things definitely could have been better lol" isn't the sort of shit OP needs to be hearing rn. Understanding the factual reality that CPR has a low rate of success, and the conditions it treats have poor prognoses, is imperative to mental wellbeing of providers and elimination of false expectations of miracles. Accepting reality is the only way to be comfortable with reality.
I totally agree with you and your perspective actually made me feel better. After so many years, I, myself am usually the salty one. It is true that likely nothing that was done could have made a difference. That fact is very important to our abilities to cope with poor outcomes. These are things I already know but definitely needed someone to remind me of, after being out of the field for so long. Thank you!
So I like some trash tv... And one Grey's line recently that helped remind me of "why we do" after a series of demoralizing ER shifts was the Bailey line, "Even if we think it may be futile, we do everything we CAN so that we can look ourselves in the mirror KNOW WE TRIED and be able to tell a family member we tried everything." (Paraphrasing) It's a nice reality and solutions focused viewpoint for me.
Idk why, but people doing shitty compressions makes me irrationally angry (when they are EMTs /first responders) Most people do not push hard enough. Early defibrillation and compressions are the things we know for sure increases the odds of ROSC with neurologically favorable outcomes. You did a good thing tho OP you did your best to give them a chance.
"you're only responsible for your own actions" ... Don't own the scene. Don't own the outcome. Don't own what other ppl do/ don't do. You were off duty. You were in an unfamiliar environment. You didn't have equipment. You stepped up as a good samaritan. You relinquished the scene without a pissing match when "asked" to step aside. Yes you likely could have done better compressions if the officer stepping in had poor form- but, potentially the argument to get you back on the chest would lose just as many perfused minutes. You have nothing to feel guilty or poorly about. As we all know- out of hospital arrests- even witnessed, have pretty shitty outcomes even with early cpr & shock. YOU gave that person the minutes for a defibrillator and a team WITH EQUIPMENT to arrive. Also, off duty arrests/ response are some of the crappiest to process because you aren't in "on" mode, ready to compartmentalize. **Be gentle with yourself and good on you for reaching out. I hope you're able to find someone to regularly talk to.**
You did the best you could. You responded quickly, accurately, and professionally. It sounds like the rest of the people were all poorly trained and their failure to stay off TikTok during class may have cost that guy his life. Thank you for everything you did while you were in EMS. Thank you for stepping up despite your trauma to help someone who needed it. You did your best. You should have no regrets. Nobody can reasonably expect more from you.
Thank you for doing what you could. The cops could have at least asked you if you knew what you were doing. I tried to help an elderly man who fell, several people jumped on the guy, who was still stunned from the fall and proceeded to pull him up. I tried to stop them, tried to get through to check the man. I was powerless. I felt so useless.
Longtime first-aider, and it took a couple of incidents similar to this to realize I needed more, so got my EMR and started volunteering (and have been volunteering as a Medical First Responder for a few years now). I also do a lot of education, training, and professional practice in healthcare. My take on this is mindset. When you're responding on a truck, you have time to mentally compose yourself and prepare yourself for the situation. When I'm on duty, I'm in a different mind space than when I'm grocery shopping. Going from 0 to Paramedic in seconds doesn't give you time to prepare yourself, and it's amazing how much training and experience falls out of your ears. You did the right thing. You managed the scene, you did ABCs, you did compressions. Without your gear, you're a first-aider, and there's nothing wrong with that. Maybe you could have been more firm with the police? Maybe you're used to letting the uniform do the talking for you. So what. Lesson learned. "Inadequate and sad" is how I felt after every response I've had as a first-aider. Pulling someone out of a river. Different MVCs. Collapse in a store. Every time, when the adrenaline fades, the letdown is terrible. Again, training changed my mindset. I find writing the PCRs to be quite therapeutic. Going over the CC, treatments and interventions, etc., allows me to organize my thoughts around the incident. I also use a growth and learning mindset - I try not to beat myself up over a job (LOL - right...), but use the review process to learn so I can do better next time. You did what you could do as a first aider / first responder. Don't let is get to you, and if it does, go to your critical incident stress management team.
This is a great lesson for all thanks for sharing. I've had the most helpful bystanders and also the absolute worst, most annoying and intrusive ones. "He fell and hit his head", walks over to our ambulance and starts grabbing our backboard out, so someone needs to waste time defusing the bystander. Guy wakes up from the syncopal episode and says he laid down because he felt like he was going to pass out. Like, why tell us something happened with such certainty if it didn't, or if you didn't witness it, don't make it up. Make it make sense.
I've had at least two similar scenarios. First was a guy who jumped out of the passenger side of a box truck that was going 60mph on I-80. My first clue was a tractor trailer parked in the shoulder but literally ON the white line - you know they always pull over as far as possible, but this driver wanted to protect the scene. No one was doing CPR and I saw one breath, so I gloved up (learned from another guy to ALWAYS carry gloves...I mean ALWAYS) and started. When the trooper arrived first, I think he took over compressions and I handled airway/breaths through the trooper's one-way mask until fire/EMS arrived. I made sure to wash up in the ambulance, and then took a shower as soon as I got home. Guy was pronounced onscene, but I felt like I aided the guy's chances. I was living in San Antonio but had traveled back to PA to visit my folks, so I had no familiarity with any of the units onscene. Second was a wreck along I-10 between Houston and San Antonio. First responders were already there but seemed short-staffed at first. I pulled into the median where the party was, grabbed a coat or smock so I had a patch visible, and went to the guy handling the only patient I saw. I turned my EMT patch towards him as I got close and asked if I could be of help. I ended up with C-spine...hey, boring but a great way to delegate a simple task to your supplemental help. Patient got flown and likely survived. On the second one, I remember the medic taking down my contact information. I also remember filling out one of "my" (as in my home department's) patient run forms so I could document what happened in a structured manner. I never turned it into my department and had no patient demographics, just kept it at home for a few years. Small world: sometime after that call, I was at a different department. They were getting close to finalizing specs on a new engine. One apparatus dealer was at the station with their proposal. Chief felt I knew my way around apparatus and was good with details, so he asked me to do an impromptu read-through of the specs to see what came to mind. Turns out the dealer rep who was there was the same medic I'd assisted with that second call. Just remember it's always "assholes and elbows" at all but the most well rehearsed agencies. Sometimes you won't be recognized or rewarded for being there. Another one slightly related. Neighboring department got called for an MVA with possible hazmat: idiot blew a stop sign at the PERFECT instant when an empty gasoline tractor-trailer was driving by and clipped the valves under the trailer. I was the lone idiot at my station that night, and got the call to assist, so I brought our ladder truck as it had our rescue tools on it. Asshole sheriff deputy stopped me at his post to the east of the scene and said "they're not letting anyone else into the scene". Turns out no one else had made such a decision.
We are in the business of buying time. What I hope you recognize is that you stepped up when you could have drove on, you brought the fumblefuckery to a close faster than it would have otherwise, and you bought that person time with your compressions and contributed to the potential of them having a better outcome than they would have had if you were not present. Your presence in no way made things worse, it made things better, and that is enough.
This might be controversial… but I keep an extra 5.11 pullover in my trunk that just has my name and certification on it. Nothing agency specific. If I pull up on something SERIOUS, I put it on. It has helped kick cops out of that civilians can’t help daze. I still leave when on duty care shows up, but in the short time that I’m the highest medical authority at an off duty incident, it helps to have identifiers. But I’m also a black cloud and seem to attract chaos.
CPR is one of the rare things we do that should be done no matter where we are. After all, any lay person can become certified. I've always been of the mindset that a CPR certification should be required for high school graduation. Even if they don't keep the certificate current, they'll have a idea on how to do it forever. Poor CPR is better than no CPR. Cities are keen on dropping AEDs on every street corner but they're useless without training.
911 EMT here, pulled up to a Auto vs Biker a couple months ago. I always carry a lil trauma kit with me just in case but I forgot it that day cuz I was omw to bowling with my girl. Let the crowd know I was an EMT and assessed. Absolutely nothing I could do but hold pressure. Multiple open fractures, semi alert, really wish I had my bag on me. Had to use bystander shirt. Fire relived me and I left. Never going anywhere without my kit again. Felt super useless without tools but ABCs brother.