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What happens after a car accident? Hospital vs. on-site paramedic?


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#1 stokes

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Posted 23 October 2014 - 02:47 PM

Hi Everyone!

 

I'm working on a scene following an accident, and would love some insight into what might really happen in a similar situation.  My character runs into a tree after losing control of her car, but her speed before the collision was dramatically cut (she yanks up on the parking brake) so while her car is pretty banged up, so is okay outside of a few minor cuts and bruises.  My question is how the accident would be handled after the police and such were called to the scene.  Assuming someone calls an ambulance, would she be taken to the ER despite claiming to be okay to check for head injuries/concussions, or would a paramedic do an onsite assessment and let her go?  Similarly, would she be given a breathalyzer or sobriety test at the scene of the crime, or would they take her to the ER first and then assess?

 

I've only been in a very minor fender bender, so wasn't sure how something with more damage would be handled.  Would greatly appreciate anyone's personal take on how the situation would go down.

 

Huge thanks in advance!
 

Stacy


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#2 LucidDreamer

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Posted 23 October 2014 - 06:32 PM

Unfortunately, I've had first hand experience...

 

My husband and I were hit by another driver in a head-on collision last Feb.. Airbags deployed (btw, they give off white "powder" that looks a bit like smoke, and my husband at first -- rather rattled, of course -- yelled for me to get out of the car because he thought it was on fire). I lost consciousness for just a second or two -- I remember the car coming straight at us, but not the impact or the air bags deploying, or my glasses flying off my head (they ended up in the back seat).

 

Like your character, we were not badly hurt, although the car was totaled. However, because we were hit so hard, the EMS insisted that we be checked out on the scene, then put us in neck braces and placed us on back boards.  (Very uncomfortable). We were taken to the local hospital via ambulance. At first, they did ask us if we wanted to go, and I guess we could've said no, but once my husband complained of back pain and my blood pressure plummeted and I almost passed out, they insisted that we go.

 

So I guess you could refuse, if you didn't appear badly hurt, but you probably wouldn't want the character to display any type of neck, back, or head injuries, or any other obvious signs of possible serious injury. Also, the EMS is very vehement about telling you that if you refuse to go to the hospital to get checked out, you will probably "void" your insurance coverage if you develop problems later. (Which I did -- didn't know this could happen, but I got a form of pleurisy a week later from the impact of the seatbelt on my chest/lungs).

 

Didn't have any sobriety tests administered at the scene. I don't know if they just judged that from my husband's demeanor, or if some of the later hospital tests covered that. The driver of the other vehicle (who was at fault) was also taken to the hospital so I guess they waited on her as well. The police did check her car over very carefully (found some empty pill bottles, so that launched an all-out search).

 

Any more questions, I'll be glad to answer!



#3 stokes

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Posted 23 October 2014 - 07:26 PM

Thanks, Vicki!  Exactly what I was looking for, although I'm sorry your advice comes from first hand experience.  Glad you and your husband were okay!  I may ping you later if I have questions, but this gives me a nice place to start. I think I'll need to rewrite the scene so she goes to the hospital, just to make sure it lines up with expectations and feels believable. Thanks so much!!


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#4 LucidDreamer

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Posted 24 October 2014 - 09:12 AM

Give her a nice long wait in great discomfort from the backboard, neck brace, and any bruises, etc. while she lies on a "trolley" in the ER and you'll have it, LOL.

No one will remove the neck brace or backboard until a doctor says it's okay, and that can take some time. Then there's a wait for a room/bed in the ER, and more tests, etc.

We were hit around 3PM -- got home from the hospital (family member picked us up) around 1AM.

 

:smile:



#5 stokes

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Posted 24 October 2014 - 11:55 AM

Ooh, great insight.  I'll definately make it later in the day.  I had the whole thing happening in the span of a few hours.  And I'll make reference to the neck brace.  I think I'm going to fast forward to her actually being in the room, with the doc for the finally eval, and use all of this as background.  Thanks so much!  Supper helpful!


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#6 LucidDreamer

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Posted 24 October 2014 - 12:41 PM

Glad I could help. Good to know these experiences are useful for something. :smile:



#7 mwsinclair

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Posted 18 November 2014 - 01:25 PM

You've got very good insight from the patient's perspective, which is probably the most appropriate for what you're working on. I'm an active EMT in New Jersey (almost 30 years) and can provide some of that perspective too, if you'd like.

For example, if a patient lost consciousness for any time, I would have strongly recommended she go to a hospital -- a certified trauma center, preferably. Airbag deployment suggests a significant "mechanism of injury," which is a key factor in how we assess whether someone really needs to go to the hospital and which one. If the windshield were "spidered" (cracks in the safety glass look like a spider web) that suggests something hit it, perhaps a forehead. So any head injury is, pardon the pun, a no-brainer for going to the hospital. Also, if a patient absolutely refuses to go to the hospital, we also require that they sign our call sheet to that effect and that the signature is witnessed -- usually by a police officer, but perhaps a fire fighter. And we also let that person know that if they change their mind and they're still in our town, we'll take them to the hospital. Of course, the initial refusal is noted to the hospital, and I have no idea whether or how that affects the insurance company's response.

Lucid's comments about back boards and neck collars are, understandably, accurate. They're not comfortable. They go together, however. Your character should not appear at the hospital in just a collar if she's been in a car accident.

I'll be happy to answer any other EMT-POV questions you might have, too, or to address other scene elements.

As for the breathalyzer question, that's the police officer's call. If he or she had reason to believe alcohol was involved (e.g., aroma on the driver's breath, presence of empties in the car, simple question of "have you been drinking"), that's enough to justify requesting the test. But they know to take into account the circumstances (weather, driver's explanation of swerving to avert an animal, etc.) In other words, unless there's reason to believe the driver was drinking, that's not a mandatory test.

#8 AQCrew

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Posted 18 November 2014 - 01:27 PM

 Assuming someone calls an ambulance, would she be taken to the ER despite claiming to be okay to check for head injuries/concussions, or would a paramedic do an onsite assessment and let her go?  Similarly, would she be given a breathalyzer or sobriety test at the scene of the crime, or would they take her to the ER first and then assess?

 

 

 

So... like Lucid -- whose experience was FAR more scary and severe -- we've had the unfortunate pleasure of having a complete crazy person run head-on into the back of our parked car -- at about 40 MPH.

 

In the middle of daylight.

 

We will tell you that it sounded like a bomb exploded -- not figuratively.  Literally.  And bomb -- and it was so loud that it drew the entire neighborhood out of their houses and into the street -- just to see what had happened.

 

A nurse was late to her shift at the hospital, and for some strange reason, she plowed right into the back of our parked car.  Yes, going about 40 MPH.

 

Just FYI: she was not hurt either.  She literally stepped out of the car, and asked, "what just happened?"  Very old style car, but fairly certain an airbag was deployed.

 

Just for reference: people don't call an ambulance -- they call 911, and the dispatcher sends out the police, fire trucks, and ambulance to the scene.  We had three cop cars, two fire trucks, and one ambulance.

 

The cops talked to the nurse at length.  They managed the traffic.  They took photos, assessed the scene, took street measurements around the crash, collected evidence, talked to witnesses... They gave the nurse a breathalyzer test; she passed.  She wasn't escorted into the ambulance until she started complaining about neck pain.  Every answer she gave to the cops' questions: "I don't know what happened." Almost like a pro.

 

It was a new vehicle, by the way.  Not even 30 days old.   The lesson: don't park a new car on a busy street.

 

FYI, the paramedics would also worried about internal bleeding, so it's going to be pretty rare not to be cajoled into the ambulance and taken to the hospital.  The paramedics are going to be the ones who are going to convince you that it's necessary, or like Vicki said, face insurance problems down the line.   And then they will give you the choice of which hospital to go to...

 

On a separate and recent occasion, we've also had the unfortunate pleasure of riding inside an ambulance.  The gurney straps were bright orange.  And it's extremely small in there. You couldn't fit more than the patient on a stretcher, one paramedic, and a person sitting down on the side bench.  The paramedics were all focused on the vitals and the paperwork.



#9 mwsinclair

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Posted 18 November 2014 - 01:30 PM

Also, at least in NJ, if paramedics are called to the scene, they will essentially over-ride any medical recommendations made by an EMT. The medic is a higher medical authority. The medic often will ask the EMS crew chief if their presence is required (usually, medics will be dispatched before EMS has arrived because you don't want to wait on such things).

#10 mwsinclair

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Posted 18 November 2014 - 01:37 PM

For a separate reason, we also had the unfortunate pleasure of riding inside an ambulance.  The straps were bright orange.  It's extremely small in there. You can't fit more than the patient on a stretcher, one paramedic, and a person sitting down on the side bench.


The strap color is somewhat random. Most often, we have specific colors for specific jobs. The straps attached to the cot, for example, in my squad's ambulances are maroon. The ones we use to secure patients to the board are orange or red, and we also have blue straps that we use to criss-cross the torso. Trust me, it gets difficult to discern which strap attaches to which on a cold wet night on a highway, so you make it as clear as possible. And depending on whether more equipment is required (there's a device called a KED -- Kendrick Extrication Device) they may have other color straps, too.

And ambulances come in different forms, but I will not dispute that room gets swallowed up quickly in there.

#11 AQCrew

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Posted 18 November 2014 - 01:38 PM

Also, at least in NJ, if paramedics are called to the scene, they will essentially over-ride any medical recommendations made by an EMT. The medic is a higher medical authority. The medic often will ask the EMS crew chief if their presence is required (usually, medics will be dispatched before EMS has arrived because you don't want to wait on such things).

 

So wait... what's the difference between an EMT and a paramedic?

 

For example, you call 911, and a fire truck and an ambulance shows up to your house.  The men who come into your house to assess you and your emergency are EMTs or paramedics?

 

Let's say two of those guys end up treating you and driving you to the hospital?  Are they EMTs or paramedics?



#12 mwsinclair

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Posted 18 November 2014 - 01:49 PM

The difference between an EMT and a paramedic is training (note: not experience). I have been on a squad for nearly 30 years -- an EMT for most of that time -- and I am not a paramedic, who is required to take more courses that certifies him to do other procedures that I am not allowed to do. Some states have EMT-I certification, which allows an EMT to also administer an IV; this was briefly allowed in my area of NJ in the early '90s when the first Gulf War was upon us and there were concerns about medics being sent overseas leaving the domestic field bereft of paramedics (at least, that's how I recall it).

If you call 911, you're connected to a certified EMS Dispatcher, who very quickly assesses the situation and immediately dispatches required agencies, e.g. EMS, PD, perhaps fire, perhaps Medics. If a person calls saying, "I think my mom's having a heart attack," the dispatcher will ask a bit more to determine what makes the caller say that, but she's also dispatching EMS because you at least have a sick patient. In my town, PD are also automatically dispatched to help ensure scene safety. (It's not unheard of for EMS to be attacked because some numbnuts thinks we carry drugs; we don't, though paramedics do.)

As for who's assessing, it may be both, depending on when people arrive. I might be in the midst of assessing a patient when the medics arrive and they'll say, "finish the BP and let us know what you think." Or they may immediately step in. Once they assume care of the patient, they are in charge of the patient. They can determine that their level of care is not needed for transport and release the patient to the EMTs. All of that is logged on both their paperwork and ours.

And it's common in my area for EMTs and medics to be in the back of the rig together.



#13 mwsinclair

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Posted 18 November 2014 - 02:18 PM

And if I can make it more complicated, in the town where I ride, if there's a call in the middle of the night that requires medics, a fire truck will also be dispatched because they sleep in their building. My squad is completely volunteer and we do not have sleeping quarters in our facility, so the EMTs respond from home, get the ambulance and go to the scene. We've developed a system in which one person takes our first-responder vehicle home at night and goes immediately to the scene and can release the fire department. Otherwise, we could end up with five vehicles descending on the scene (PD, FD, two EMS vehicles, plus the paramedics).

 

That said, urban EMS is often quite different from the suburban EMS I'm a part of.






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