Transported an accident victim to the Hospital. Did I do it right?

[phamilyman]

Congratulations XD2. What you did is really great. I sent your questions to a non BHPian trauma specialist friend (who specialises in emergency care and air/road transporting critical patients). Here's his responses:

Q1 Should I have disagreed to transport the victim - and waited for an ambulance instead - in which scenarios should you do this - and in which ones you should not ? My question is from a medical standpoint. I would not want to cause more hurt in a eagerness to help.

Ans : Depends on the availability of emergency services​. Locals are more aware of this. Also depends on how close your are to the nearest hospital or city. Whether to wait for ambulance or shift the patient depends entirely on you and your awareness of the area. If outsider or passing through, I advise to wait for the local authorities or ambulance. If you are a local resident and aware of the situation and if you feel the ambulance will come within 15-30mins and has already been intimated then wait for it as nobody will make way for you in traffic and ambulance people are more aware of the nearest hospitals and their facilities. If on the other hand ambulance is going to take time and you know a nearby hospital shift/transport the patient. I advise the person to take initiative only if you know what YOU are doing, don't do something because SOMETHING NEEDS TO BE DONE AND you are CLUELESS OR FORCED BY OTHERS.

Q2 If the victim does need to be moved with no immediate evacuation in sight - what should be the things we need to observe ?
In the city outskirts, I don't think even the ambulance guys care so much. I saw them move the victim from the Jeep to the ambulance - i did not see any precautions or any steps. The gathered guys picked him up and moved him to the ambulance.

Ans: Frankly the helpers in Ambulances are no better than coolies and I am yet to come across a helper who knows how to shift a patient properly. Shifting a accident victim requires skill, a supervisor and practice. Shifting a patient is separate topic in itself in medicine.

In the end we can hardy blame the helpers because after all they are barely trained folks earning their bread. (underlined portion my add)

Q3 What precautions do you take before you lay the patient - any quick steps to clean/disinfect ?

Ans : The priorities should be to minimize the blood loss and maintain the normal position of body and taking the patient to the hospital ASAP. Don't use force if you find an abnormal postion. Support the limbs and spine. Infection or disinfection is the last thing to be thought of in accident as blood loss or other grievous injuries will kill a patient long before infection sets in.

Caveat - a thread is hardly a place to tell how a person can help a vic​tim or what he can do right. This requires classroom instruction in the form of a Trauma Workshop for laymen with demos on how to shift​ or lift a accident victim, how to support the victim, etc. and this workshop takes a whole day!

[reihem]

Originally Posted by XD2

Now, my questions :

• Should I have disagreed to transport the victim - and waited for an ambulance instead - in which scenarios should you do this - and in which ones you should not ? My question is from a medical standpoint. I would not want to cause more hurt in a eagerness to help.

• If the victim does need to be moved with no immediate evacuation in sight - what should be the things we need to observe ?
In the city outskirts, I don't think even the ambulance guys care so much. I saw them move the victim from the Jeep to the ambulance - i did not see any precautions or any steps. The gathered guys picked him up and moved him to the ambulance.

• What precautions do you take before you lay the patient - any quick steps to clean/disinfect ?

This one sound a little silly, but:

• What needs to be done to clean your car after your transport an injured person. For me, it was simpler as I have an open tub - but other friends of mine did pose this question for their own vehicles - so is important I answer them. I have come to know that it is a deterrent to many a person who would have helped otherwise.

Answering from a medical standpoint via my wife who is an MBBS, MD, DM.

1. In a road accident of this nature securing the spine is of paramount importance. Moving a victim who has compromised his spine can lead to paralysis. Having said that, we lay people are in no position to determine the integrity of a victims spine and as such we can't take a call on whether to move them or not. In an ideal situation a trained paramedic should take that call and secure the victims neck with a collar and spine with a back board.

In your case I doubt you had access to a half way decent ambulance let alone a trained paramedic. Given all this it clear what you did is best.

2. If there is no one in sight and you HAVE to take action yourself - 1. bleeding points should be covered with as sterile a dressing (cloth) as available and moderate pressure should be applied. 2. the neck should be secured to avoid worsening a spinal injury 3. victim should be transported to a hospital with as little movement as possible. 4. airways should be clear of debris and fluids.

3. If its a non fabric part you are cleaning sodium hypochlorite is the GO to solution for disinfection. Cosmetic cleaning I am sure others have much better suggestions.

[sgiitk]

The US scene is different due to lawyers / ambulance chasers. Many eminent doctors (non-US) have gone on record, that if they come across an accident in the US they will not rush to assist the victims.

[Geo_Ipe]

I shall make an attempt to answer the questions from a professional point of view.

Originally Posted by XD2

Now, my questions :

• Should I have disagreed to transport the victim - and waited for an ambulance instead - in which scenarios should you do this - and in which ones you should not ? My question is from a medical standpoint. I would not want to cause more hurt in a eagerness to help.

If you were sure that the Ambulance was called for and on its way, maybe you could have waited. But your scenario was otherwise. The locals were pretty sure that no ambulance would arrive. In that case, 'some transport' would be better than 'no transport'. What you did was noble.

Originally Posted by XD2

• If the victim does need to be moved with no immediate evacuation in sight - what should be the things we need to observe ?
In the city outskirts, I don't think even the ambulance guys care so much. I saw them move the victim from the Jeep to the ambulance - i did not see any precautions or any steps. The gathered guys picked him up and moved him to the ambulance.

To move a trauma victim properly, one needs quite a lot of professional training and equipment. As others have already mentioned, that kind of personnel might not be available at all places in our country.

I'm making an effort to list out things the common man can do while transporting a trauma victim:

- Is he/she bleeding? If yes, try to stop it. Tie a piece of cloth and apply pressure if you can. Do not bother searching for sterile stuff. Any piece of cloth will do at the site of accident.

-As little movements as possible. We don't know what all injuries/fractures the victim has. Make sure his/her neck is stable and not hanging down - can aggravate a cervical spine injury resulting in death or irreversible damage.

-Once you've placed the patient in the vehicle, make sure his/her airway is patent, especially if the victim is unconscious. Make sure his/her neck is extended, and not hanging forward, hindering his/her breathing.

Originally Posted by XD2

• What precautions do you take before you lay the patient - any quick steps to clean/disinfect ?

Do not worry about disinfecting the surface. Infections can be tackled with antibiotics later. Saving the life is our prioroty.

Originally Posted by XD2

This one sound a little silly, but:

• What needs to be done to clean your car after your transport an injured person. For me, it was simpler as I have an open tub - but other friends of mine did pose this question for their own vehicles - so is important I answer them. I have come to know that it is a deterrent to many a person who would have helped otherwise.

If I am to get blood stains on my car seat transporting an accident victim, I would get new seat covers on!
Blood stains can be extremely difficult to remove.

[embee]

Sincere thanks to XD2 for what you did for saving a life of a human being. Hats off to you!

Also I have found an article/notification from Government of India, Ministry of Shipping, Road Transport & Highways with the subject "need to build confidence in public for helping road accident victims"

Govt of India - 05_SC_Directive_Rescue_Accident_Victim.pdf

You can have a glance at the article/notification. Maybe it will answer some of your questions.

[XD2]

Folks, thank you all for the direction and suggestions.

In all the appreciation that has trickled in, I think it is important for me to clarify again that I honestly am not the one who deserves the appreciation for acting in this scenario. There is one unnamed local who deserves all the credit.

Quite contradictory to what it appears from my narrative, the one reason I kicked off this discussion was because when approached to help, I was "hesitant". It took me a whole minute to agree to help, and the questions I have posted represent the doubts I was faced with.

From what I now summarize:

1. In the event of an accident - first things first - call an ambulance (102, 108). For areas where a reasonable response time is possible - that is the ideal approach. In the event that no assistance will be available in reasonable time - provide necessary assistance.

Chances are that the ambulance in most non-metro corridors is just simple transport. But it does have a siren that can aid in faster transport.

Involve local bystanders to accompany you to the hospital. That will help in case of any legal complications. In my experience so far, I have been lucky in having hospital staff understanding that we were there to help - and we were not pressed for any detail.

2. Information from locals is helpful - use that to assimilate the nearest hospital - turn around from the emergency services and such.

3. Know how to aid : Good details on how to aid a transport are included in this thread (& other places). A good read of this and the linked articles provides a good insight. A short course on first aid might be helpful, but in the Indian scenario, that is difficult to achieve.

4. Disinfect the car after the patient has been transported. The stains might stay, but you can always switch your seat covers.

The only question that I would still like clarity on is what could be marked as "reasonable time". But that would be highly subjective and conditional to the local scenarios. I would think that in Gurgaon urban - if an ambulance is close and on its way when you call - you should wait for it. In a semi-urban setting it might be worth it to take the call to transport the patient using the first available mean of transport.

Originally Posted by Rehaan

...
Have you been back to the hospital or spoken to the family? Knowing the victim's current status might take some weight off your shoulders.
...

I did not go back to the hospital post this. In the one visit that I had made, I could not gather the courage to walk up to the patient's family. Somehow it then felt like I was just there to gather a vote of thanks.

I got the feedback from the ambulance driver then and I know it a long way for the patient and his family from there. My thought is that our role ends there.

[rev_rohit]

Congratulations XD2! what you did was very much right as timely transportation is more important in India than proper transportation.

Transportation of a traumatised victim is a very ignored subject in India.
Spine stabilisation is almost never done.
Basic life support training also is non existent.

I would like to add a few points which may be of use to many of us.
First of all if available let the experts do it, call for an ambulance, and call police also, all the calls made to police headquarters are recorded. Remember to ask for the person's name and belt number as it might be required in case the victim dies on the way to the hospital.
For medical point of view following points might be of some help.

1.Secure yourself, put warning triangles etc. and if possible move the victim away from unsafe scene of the accident.

2. If transporting, the patient has to be transported as a log of wood, with head, neck and spine securely tied to a hard spine board. (any hard board will do the trick) spine should be moved carefully.
If board is not available head and neck can be stabilised by in-line manual traction.(google it to know more)

3. limb bleeding can be controlled with tight bandages above (proximal to) the bleeding point, other smaller bleeding points can be compressed to stop bleeding.

4.Nothing should be given to eat or drink as patient might require an emergency surgery which may require empty stomach for anaesthesia.

5. Fractured limbs can be supported with a stick or even a folded newspaper and tied above as well as below the fracture.

And we all should know how to perform Cardio Pulmonary Resuscitation (CPR) as it has also saved many lives.

[basuroy]

I would like to add one thing , I have not read all posts so I am not sure it if has been mentioned but - DO NOT remove helmet if the victim is wearing one . DO NOT even if he requests to . This was told to me by a doctor .

Another thing an untrained friend said and hence I am not sure about and have neither verified - do not offer water to drink and if you do , in minuscule quantity . Any one care to verify or explain why ? my friend told me it can lead to vomitting but didn't elaborate .

[Fuldagap]

Many years back I was lying on the roadside with my Bullet on my left leg and the femur bone fractured. Many people were surrounding me, but none willing to help. Luckily an ambulance was passing by and I was conscious enough to talk enough and was able to manage stuff. Pain was so supremely unbearable that even if a leaf touched the skin of the leg I would shout involuntarily. The ambulance was a Tata Ace though. Incredibly uncomfortable and the driver driving it at high speed. The road was a national highway but repair work was going on so there were many pot holes and as soon as the Ace hit any of the rough spots on the road I'd feel immense pain. Continuously I was shouting at the driver to drive slow down. The hospital was 10 kms from the spot. The longest 10 kms ever.

But there was a feeling, a very positive one that as soon as the ambulance would stop I'd be at the hospital and be in good hands and this tragedy is going to lessen if not stop. I don't have any medical knowledge but from my personal experience I can definitely say that the feeling and knowledge of the fact that very soon I was going to reach the hospital kept me going.
Therefore, when you helped that person, he might or might not have felt more pain in your Thar bed and it may or may not be the best way to transport such a patient but I feel the positive feeling of being helped and being soon transported to a hospital surpasses any other feeling or pain. Kudos to you for saving a life. You'll be blessed forever.

[VW2010]

egal issues pose a separate angle - but when I am not at fault, I would put my faith in the officer investigating and hope he gets it. I'd hope to stick with this belief until I encounter the first incident where proven otherwise.

Even better have a DVR installed in your car so you have enough evidence that you were merely helping. I think the investment on the DVR can come as a great helping hand to continue doing what you did.

I am a fan of the DVR's for both recording whats happening outside and inside.

[wildsdi5530]

Very good initiative on your part, but as some have pointed out, very unsafe. In South India, 108 service is very good. They may demand a bribe, but are available at the most remote regions. And there is a trained para medic/ doctor in every ambulance. There are basic short term 1 year courses in para medical work which you can do for a better understanding. They should make this compulsory in school/ college. But that said, even after 12 years of training to be a trauma surgeon and 6 years experience after that, I would be scared to handle a victim of high energy trauma without trained assistants. A stable patient with internal injuries can collapse and die in 10 mins because of clot dislodgement. You can move the victim if there is risk of fire/ drowning, or other immediate threat to life. But without life support equipment and training, and resuscitation drugs and fluids, you can kill someone.
But in some parts of India, there is no govt run ambulance services, police, fire rescue, etc. or the response time is too long. Here I guess people have to take initiative. But I would really encourage everyone to take a year off and do a short term course, it may save a life someday.
But congratulations again, and you were very lucky. The victim and his family have you to thank for saving his life.

[Anand3553]

Well done XD2, you did well to save a life, a news that is so rare nowadays. All we hear is life being taken around us, people like you and the Good Samaritan remind us that there still are 'human' beings left in this world.

It is indeed a fact that in the developing country like India where the infrastructure and facilities are not up to the mark, citizen will have to play a part in cases of road accidents. It reminds me of a shameful incident I witnessed a few years ago when I was doing my college. There was an accident that had occurred and people gathered around the victim, I believe the victim had a broken leg and hand and was moaning in pain and people were looking for a car to transport the victim to the hospital. Three people carrying the victim simply jumped in front of an oncoming car in an attempt to stop it. The poor driver did not see them and almost hit them but somehow he managed to steer clear. Now comes the terrible part, there is a family in the car including a child, the car is a different state registration, the people just ask everyone to get out which they do and put the victim inside the car and ask him to go, the poor guy was running low on petrol and he had to turn in to a petrol pump which was a few meters from the accident spot. Suddenly everyone rushes to him and starts abusing him and some even go to the length of pulling his collar (All of this happens in front of his family including a child crying out loud).


They pulled the victim out of the car and jumped in front of another car and transported the victim to the hospital. By this time, the victim had passed out. After the whole episode, the driver of the first car was visibly shaken, he almost broke down and was sitting on the road leaning to his car and shaking in fear, a few people including myself talked to him and his words roughly translate to "I almost ran out of petrol, I just wanted to make sure that I do not run out of petrol before reaching the hospital" and he just sat there for almost an hour after which he was able to drive the car and leave.

I do believe that he showed tremendous presence of mind but the reward he got was so negative that he will never ever in his life stop to help a victim of a road accident ever again. I am not quite sure what lesson should be learned from this. Just wanted to share in the forum.

Thanks
Anand

[ambivalent_98]

Kudos to you buddy. It takes real courage to help an accident victim and get him to the hospital.
Its one thing to say that we must help but its completely something else to actually go ahead and do it. You have indeed proven to be a god-send angel to that poor chap. Thats a lot of courage you have shown.

Having said that and I think the most reluctance to help is mostly due to the fact that cops tend to make life miserable with their queries post the accident. So people want no piece of being involved by helping or even volunteering their names in case they were eye witnesses. They just stand by idly feeling bad and not doing anything.
Secondly many hospitals refuse to take in accident cases point blank , especially the well equipped private ones. Of late I read many forwards that the Supreme court has made it mandatory for hospitals to give first aid and stabilize the victim but then again I don't know if this is really true.
All said and done, and I confess that there have been a couple of times when I have been witness to minor incidents where I should have stopped and offered help but I chose instead to go my way. I will try better next time for sure as your incident has indeed shown that there exist still few courageous folk who are angels in disguise.

[hondaford]

Hopefully in the near future, someone will come out with an app that shows the location of ambulances around the vicinity. Somewhat like the grabtaxi app.

The samaritans at the accident site will then be able to make a better decision on whether to wait for the ambulance or make alternative arrangements to move the injured to hospital.

[Turbo_Torq]

That is a very benevolent and humanitarian act you have done XD2. I can anly appreciate and thank you for the efforts and courage you put forth in saving a soul.

In addition to all the precautionary measures to be considered while transporting/helping an accident victim that peeps here have outlined, I'd suggest to have the entire experience documented via a dash-cam or a handheld/phone or both. This way, it could serve as evidence if things were ever to tide against oneself amongst other scenarios.