First on the scene, what to do?

A question for the professional first responders out there. What would you want me (us) to do (or not do) if we are first on the scene of a major highway accident, or see smoke and flames coming from a neighbor’s house, or even, perhaps, witness an assault or shooting? Other than immediately calling 9-1-1. (Probably a whole other conversation about how to make a 911 call. From my time listening to scanners, FR’s can spend a lot time looking in the wrong places based on lousy information given to 911 call takers.)

Response time in cities can be and usually is in minutes. But in rural and even suburban areas wait times for ambulances can be a lot longer. I live in a small town in SE PA with its own fire and ambulance service but once had to wait 30 minutes for an ambulance after a traumatic, self-inflicted injury (my FBI finger print card has only 9 of 10 spaces filled in).

So, if I roll up on a multi-car/truck pileup on a rain slicked section of I-95 what should I do? I carry a decent FAK in the car including trauma bandages and Celox. I have a fire extinguisher, a blanket and blue tarp. I carry a couple of strobe lights. So I’ve got gear. But what can and should I do that won’t compromise the patient’s condition, won’t complicate the EMT’s job and hopefully won’t get me sued?

The related question is what kind of training can a civilian get that makes one an asset rather than a liability in that kind of situation?

Now, in more than 40 years and a half million miles of driving I have never (knock on the wood trimmed center console) actually had this happen. But this forum is about being prepared, right?

I am not a professional first responder by any means, I'll be interested to hear what they may have to say. On the two traffic accidents I witnessed and was first on scene, I suggest: Go slow. First on scene can be first clipped by a fast Audi second on scene. Be safe. Stop well away from the accident, well away from the traffic flow. Blinkers on, put on a hi-res vest, put on eye shield, gloves, and leather gloves as you get out of your car. Walk back up the road well off the actual road, taking care of any traffic. Report in (call 911) - stay on the line until they say to hang up, even if you could be assisting. Be prepared - that means training in basic first aid and keeping a FAK with you in your car. Stay within your limits. Tell victims you have basic first aid training, you've called 911, help is on the way, can you help them. If they say no, don't help. Don't attempt the roadside thoracotomy no matter how bad it looks. The best you can do is apply pressure to bleeding, hold wounds stable, and calm victims, until the pros arrive. It could be gross - a woman I supported her neck for 45 minutes until she was evaluated and collared had a fair amount of scalp pulled away. Expect to stay for the duration - the firefighters didn't want me to let go her neck until they were ready, and it took a long time. Then there are accident / witness reports, and then maybe handshakes and a thank you for your help. Another woman on a moped had a grisly compound fracture of her leg and was in shock (I didn't travel with so much as a blanket then, never again). Don't move anyone unless there's physical danger to them. Tell everyone to stay in their cars until help arrives. Look for fire and other threats, but don't be afraid of it. If you have a fire extinguisher, its okay to take it with you as you assess the scene.

Know your limitations. Most of us aren't used to accident scenes, I get a bit of the shakes re-living these ones now. You won't remember to do everything, you have to be careful - you have to err on the side of caution, stay within your training, and do no harm. Help will be there as quick as they can.

I have been a first responder. In general I agree with the comments I've read so far, especially " Know your limitations. You won't remember to do everything, you have to be careful - you have to err on the side of caution, stay within your training, and do no harm. Help will be there as quick as they can."

Do what you are trained to do. Be supportive but do no harm as some people will try to make a lawsuit out of it. Also be careful about exposure to someone else's blood. It's a very high risk problem these days.

Some scenes are not stable, as in violent crime. The police have had to clear scenes before we were able to go in and help. One of my partners looked into a window and down the barrel of a 45. One patient, "slightly out of control" missed my forearm and literally bit off 3 inches of stretcher matress.

Be careful of your personal physical risk. I flagged a fireman to chase down a bystander puffing on a pipe as we had gasoline all over the place.

Keep in mind that training is training. Training does not make up for lack of experience. I have seen green medics absolutely flake out after a bad situation, especially when someone didn't make it.

Every situation always presents its unique set of problems and the training program doesn't plant a plan in your head for everything that happens. Training teaches you the basics and the ability to think and build confidence that you can handle a situation...hopefully, correctly to the best of your ability.

And I want to personally thank everyone who has ever tried to help in an emergency. Bless you! I remember a number of times when people hindered our efforts to do our job.

As everyone else has said , know your limits and don’t try to go beyond them.

Also sometimes the best course of action is nothing at all, and by that I mean that sometimes just someone who can talk to the victim, hold their hand if that’s what they need will do worlds of good for the moral, let them know that they are not alone and help is on the way.



“Be careful of your personal physical risk. I flagged a fireman to chase down a bystander puffing on a pipe as we had gasoline all over the place“

A couple of years ago we had something like this happen to us on a roll over, except it was the local LEO that popes a flair and tossed in near a puddle of gas next to the truck we were trying to cut the guy out of .

A couple of years ago we had something like this happen to us on a roll over, except it was the local LEO that popes a flair and tossed in near a puddle of gas next to the truck we were trying to cut the guy out of .


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Doesn't it just boggle your mind, when professionals make such profound mistakes??!!

I remember being told by CHP if you are going to help to always park 'downstream' of the wreck so that your car doesn't become a second accident. They park upstream because they have lights and use the car to protect the accident scene. Someone might want to confirm this but i also remember that if you are out at about 2-3am and come across someone on the right shoulder, park and don't use the emergency blinkers. Evidently, this is because the drunks out at that time will aim for anything with light on to 'follow home'.

depending on the situation, first responders do try to put there cars/trucks in such a way, so they will act like crash barriers, when tehy respond to a car crash. Handbrake on and steering wheel full to the left or right, so if it does get hit, it will roll to the side of the road, instead of making the pile larger. Equipment is replacible, people aren't.

For normal people, always make sure you are safe. We don't need another victim. Keep you action, down to what you know and have been trained to do.

Parking depends on the situation. For example, I used to be an EMT. If we were first on, we'd park upstream, to act as a traffic barrier. The trick was parking so that we could get out once we had our patient. If we weren't first on, we'd park downstream so we could leave without passing the scene.

Limitations! Know them.

Don't get tunnel vision; make sure you tell 911 an accurate description.

DO NOT BECOME A VICTIM! If it's in the middle of I-95 at 7pm on rain-slicked roads, you're just setting yourself up to be killed by traffic.

If you want to help, be ready to leave when told. Some folks are great to help, others are complete a$$holes that endanger folks. Get in the way, you may be arrested. Most EMS/Fire folks have no qualms getting PD involved.

If you don't know how to triage, learn. It's all well and good to try and do CPR on someone, but if you've got 3 folks in the next car and they bleed out and die, you've killed 3 (and still probably not saved the first). You NEED to manage time and resources when you're the only one there.

Honestly, as EMS, random folks being first on are kind of scary. Too much "wannabe" attitude (even saw a guy with a Crown Vic and amber light bar, trying to be like a cop, even with dark blue clothes). A police dept. I used to work with actually confiscated a guy's FAK, vest, and helmet. Why? It had the Star of Life on it, which is a trademark. He wasn't an EMT, medic, or associated with EMS in anyway. We ended up taking half his stuff and throwing it on our ambulance - his equipment was top-notch, but he was a hazard to others.

Lastly, again, don't become a victim. Gloves at the least, eye protection and a mask if there's squirting fluids. Traffic hazards, environmental hazards (are you going to freeze on the side of I-95 in january once you give your coat to someone in shock?), legal ramifications (though Good Sam. laws usually are pretty good), etc. Don't feel like you NEED to help. Only do it if it can be done safely and help others.

I really cannot add more then what has been already posted. Training and on-going practice are key to any skill mastery and would suggest ARC First Aid training (basic, community, advanced or whatever is available in your area) as a start. CERT training and if it moves you join the local Volunteer Fire Department and obtaining First Responder training would be great addition.

Pete

Some sound advice already posted here. There are some points I would like to emphasize:

First, DON’T put yourself in a situation where you could become another victim and make the situation more complicated. This should be common sense but you would be surprised how many people allow “tunnel vision” or “the candle moth syndrome” to affect their decision making process and put themselves and others into life threatening situations because they want to help. I have seen just as many trained rescuers without experience do this as laypersons. The best advice I can give anyone is STAY OUT OF TRAFFIC! Time after time I see bystanders trying to direct traffic or standing in moving traffic lanes as cars wiz by at highway speeds. Don’t forget that even HUGE fire apparatus lite up like Time Square parked on roadways get hit regularly. You safety is your priority… not the victims already involved in the incident.

Second, as anyone who has taken CPR knows, early activation of the 911 system is the key step in any emergency to assure the proper response gets dispatched and on the way quickly. No matter what tools or training you have, even if you are an on duty fire fighter/EMS worker/PD officer notifying the call center that there is an emergency is your first priority. Before you call 911, take a deep breath and calm down. A frantic 911 with (frequently wrong) spotty information can cause more confusion. By calming down and observing what is going on you can give the 911 operator a clear view of what is going on allowing them to make the right dispatch decisions. If you keep driving while you call 911, report where the accident happened not where you are 5 minutes later when the operator ask you (seriously, this happens ALL the time).

Lastly, sometimes your best action is to do nothing but make the 911 call. As someone else noted, know your limitation. What level of training do you have, what tools do you have with you, are you trained to use those tools you have? I know that is not in the ethos of the member’s of this forum, but sometimes you are going to be ill equipped and ill prepared to do anything but make a situation worse. The hard part is to know when to do something and when to just make the call. Taking that deep breath and staying calm can help you make that decision based off of facts not emotions.

Speaking of parking, there was a local incident in the news just a couple days ago that was really sad but also makes me so angry at the waste.

This was radio news, so the details are a bit sketchy, but there was some traffic accident in the fast lane or carpool lane of a divided highway with a grass median. Fire/EMS was already on scene and had parked their equipment to shield the accident scene from traffic (I have no idea if there were flares out yet) but someone (inattentive? DUI?) comes barelling along, sees the flashing lights late, swerves onto the grass median to avoid hitting the emergency vehicle, and runs over a victim being treated by a medic on the grass median, away from the roadway. The medic survived but the victim was killed. What a waste.

Anyway, it just emphasizes the point that just because the original accident has happened, doesn't mean that you can't be involved in another one in the same spot. So be very cautious if you're going to be around the accident scene!

I think that all the other responses represent an excellent overview. One of the most helpful thing civilians do for us is to help us FIND THE SCENE!

At the last house fire we did, it was up at the end of a long, long lane, and some smart person sent someone up to the end of the lane to direct us and tell us how far down it was and another person at the long driveway leading to the house. Because it was so far down the lane, we were able to have an engine reverse-lay 5" supply line from the scene out, which saved quite a few minutes, because the were able to dump all 1500' of their 5" line and then we just pulled down another 500' to meet the end of their drop, knowing that we were already hooked up to the attack engine at the other end of the 5" line, and also that we'd immediately need a lot of water right away just to fill 2000' of hose. All this because two people simply helped us find the scene and give us a tiny bit of information more than we had.

As far as response times, we're likely neighbors (I'm in Bucks County) and 30 minutes is on the long side for a response, but not at all unexpected given that so many EMS companies have gone bankrupt in the last 2 years. We just lost the ambulance crew for Dublin PA, and up here in the North end, the EMS squad is always on the verge of economic collapse.

Excellent point. I work for an employer where the local FD knows the buildings by number, but finding an arresting employee in the warren of hallways would be tough. As part of our CPR training we are trained to begin CPR but also to send someone out to the front of the building to notfy the receptionist (who calls security), and flag down the engine company and make sure they can come back and find the patient quickly.

As much as this is good advice, it's not always possible to know your limits until you find them. Last year, I worked a fatal wreck with a member who, until that moment, had only worked on wrecks that did not involve a death.

We waited a long time for the coroner to come and tell us that the dead guy was in fact dead, and in that time, we kind of stood around looking at the car and studying how it wrecked, and after a while, we became oblivious to the body in the car. When the coroner showed up, he assessed the body, stood up from the car and said, "Cut him out" and then we set to work. We were doing fine, going really slowly, not taking any risks. Then came the time to actually start pulling he body out, and while I had noticed early in the extrication process that the guys legs had been cut off just above the knees, the woman working with me on the job did not, and she did not react well at all. Although she helped me pull the guy out, she never ran a call with us again after that. But she seemed OK, and didn't hit a limit until it was quite late.

To the point of the gore and yuck factor. It's a human being, even when it's a dead body. We are all built from the same parts and fluids, we all break in the same ways, and if you look at a compound fracture or an amputation as an urgent repair needed on a fantastic machine, it's a lot easier. I always see the messy jobs as a major problem to be solved - stop the leaks, keep things from getting worse, keep the machine going until experts can work on it.

Man, finally a question I know something about, and after reading all of the responses, there is NOTHING I can think of to add...

Once in a while, a thought runs through my head that I can't believe I used to be in that line of work. It's been a long time ago. Amazing how I still vividly remember some things I have been through. No regrets.

Just a few thoughts, in my experience:

1- Call 911 (if possible) and give the most accurate and detailed description of where the emergency is at. For example, N/B direction of ---, east of ---. etc.

2- Pay attention where you park because the emergency vehicles will block you in for as long as they're there. Don't park near a fire hydrant if there's a fire.

3- If there are injuries, don't move victims unless you absolutely have to- you could make their injuries worse. I recently responded to an accident where the unbelted driver wound up on the passenger's belly. I told the passenger not to move and to leave the driver there. The passenger was hysterical and wanted me to do something- he called me everything in the book. Turned out the driver sustained a broken back, punctured lung and broken ribs. I can only imagine if I removed the driver... I don't have very deep pockets.

4- My pet peeve... if there are no or very minimal injuries and the cars can move, MOVE THEM OUT OF THE WAY! There is no sense in leaving the cars there to prove fault of the accident. The damage will more than likely prove that anyway.

5- I'll think of more later, I've got to refill my glass...

Great topic. Being a firefighter, I appreciate help from bystanders to a point.The biggest thing to remember is to not become part of the problem, as was mentioned before.

Thanks for all the interesting and insightful replies. To summarize:
• Call 911 and give precise information as to position and conditions
• Assess the situation against your capabilities
• If you think you can help, park your vehicle out of harm’s way (downstream, if possible)
• Maintain situational awareness, protect yourself so you don’t become another victim
• Render aid as you know how, but first do no harm.
• When the pros arrive do what they say and leave when asked

Also, just so I don’t leave anyone with the wrong impression, I am not a FR wannabe. I don’t gawk at fires or accident scenes, don’t chase ambulances or firetrucks. I carry a scanner because I want to avoid accident scenes at all cost (I drive 500-600 miles a week, the last thing I want is to get caught up in more traffic). I let the pros do what they do and stay the heck out of their way when I can. I carry small personal strobe lights so I can be seen when changing a tire on the side of the road. (I will purchase some safety vests for all the cars, that’s a darn good idea.) Carrying the other gear is just being prepared.

But I don’t think I should shirk from helping out when a need arises. I will plan to get the training recommended and I will keep all the info from your replies somewhere in my brain. Hopefully it will pop up if and when the time comes.

Thanks folks, good conversation.

Andy

Me too. Been away from it for almost eight years. Had a lot of fun, got scared a few times, had to play God more than once, deciding who lives and who dies (triage can be hard on the first responder sometimes), saved a few blinkers that I thought were a gonner. Cost me, among other things, two operations on my lower back (but kept two small children alive). Wouldn't trade it for the world, but probably wouldn't do it again...

The DOT has posted that on signs along the interstates here.

Hi Andy,

I like all of the responses so far. I recently completed a First Responder course at my local Hospital and I also live in a rural area.

After taking the course, I think it's VERY important that based on the questions you are asking, you too should track down such a course and take it, even if you are not planning to help a local volunteer FD/Ambulance team. Many people take the course as part of work safety as well.

You realize quickly during that course that even armed with all the information you are digesting you have just scratched the surface of what there is to know.

Keeping yourself safe is job #1. If there's something you think you can help with and not injure or infect yourself doing or you feel you have a moral obligation, the answer is "maybe" help and that's putting it politely. You could easily injure yourself or others making it worse. Calling it in and staying on with the communications is probably one of the best things you can do without any training.

It's funny, when I first started following this site, I was interested in First Aid and had many of the same questions as you. I was chastised pretty nicely for not understanding the difference between a bandage and a dressing. Now I know the difference and I also know why I was chastised. The pros know this stuff and unless you go about learning it yourself, you probably ought to stay clear and help only peripherally, else you will get in the way or injure yourself or someone already hurting.

Given your questions and my own assumptions about how you feel, my guess is that a class is in your near future. Call your local Ambulance and they can put you in touch with the people you need.