Off-duty EMT at scene of accident (need medical info for novel)

In my latest novel, I’ve got a character who’s an EMT. She and another character, who’s a mage with a (secret) talent for healing, show up at the scene of a single-vehicle motorcycle accident along a wooded road. Nobody else around, and the EMT is off duty without her gear.

I’ve been reading up and discovered that EMTs/first responders don’t have any legal requirement to render aid under these circumstances. Most of the people talking about it indicated that they would likely just call 911 and wait for the pros with proper gear to get there.

Ideally, I’d like the EMT to do at least something so she appears competent, but I don’t have this kind of knowledge. So, my questions are:

  1. What kind of mortal injuries would a kid who ran off the road on his sportbike and crashed into a tree likely have? He’s wearing a helmet. I want him to be injured badly enough that even if the ambulance arrives in minutes, he’d be dead if he doesn’t get help immediately.

  2. What could trained a EMT/paramedic do without any gear, after calling 911?

  3. What would be a good imminently-fatal injury for the victim to have that my mage character could heal and thus stabilize him enough that he lives until the ambulance arrives and he can get better care? I don’t want her to heal him completely, just deal with whatever’s going to kill him before he gets help. I’m thinking of some kind of catastrophic internal bleeding–would that work? I want something with outward signs the EMT can identify but can’t do anything about (so she’ll know something’s fishy when her friend suddenly concentrates hard and the problem fixes itself).

Thanks!

ABC - Airway, Breathing, Circulation

First, make sure the scene is safe, then examine the victim. Establish if they are breathing, and if not, work to make that happen by clearing the airway first, then rescue breathing if needed. And finally chest compressions if no heartbeat. For most civilians they don’t train you on rescue breathing anymore but an EMT would still perform them (I believe). After all that you would staunch major bleeding and treat for shock.

Possible spinal injuries would require the rescuer to take precautions about moving the patient and opening the airway.

The most obvious potentially fatal injury to me would be a compound fracture (broken bone through the skin) damaging an artery putting the victim in immediate danger of bleeding out (exsanguination). Your EMT would treat that by putting pressure on the artery to seal it off or possibly a tourniquet above the wound. The mage could repair the artery so the victim is out of immediate danger and the EMT would know something was fishy when she’s told there is no damage to the artery when every EMT knows what an arterial spurt looks like.

I’ll step aside now until a real EMT comes along. Good luch with your book!

What about some kind of internal bleed in the chest cavity or the gut? Would there be outward signs of that? My mage character has been trained to view auras and can see interior damage more clearly than the EMT would, but the EMT would need to be able to see the outward signs. While I like the fracture/artery thing, I’d prefer to have something that the EMT is literally not capable of dealing with because she doesn’t have the gear/expertise, so there’s no doubt in her mind that the mage did something to save the victim.

Thanks!

My wife who is an emt suggests a flail chest which is where there two breaks on the same rib bone causing a floating middle portion of the rib which prevents the lung from fully inflating. The bone could puncture the lung which maybe what your mage fixes. The treatment the emt could give is to put compression on the rib by wrapping it with something, my wife suggests her pants. Signs and symptoms include chest pain and shortness of breath, a closer exam will show part of the chest going moving in the opposite direction of the rest of the chest.

missed edit window Also instead of a punctured lung the mage could partially heal the broken rib (so that there is only one break) after the emt wrapped the injury. This would be far less of a life threatening situation. When they get to the hospital the patient is unwrapped and the symptoms the emt saw pointing to flail chest are gone. You could possibly have her ,or a doctor, question if she really saw what she thought she saw.

A torso wound with internal bleeding can result in abdominal swelling and severe abdominal pain. The victim will react sharply to any attempts to touch the area. Severely broken ribs can be seen externally.

Crushed airway might work (maybe the motorcyclist had a tree branch impact the front of his/her neck?). It can be quickly fatal. The mage maybe un-crushes it, establishing an open airway?

Most motorcycle accidents produce head injuries, either open or closed, along with cervical spine injuries, as well as fractured extremities. Stopping any bleeding along with stabilizing the c-spine would be most important. Of course, airway is the most critical. If the Pt is not breathing, the C-spine wont matter. Bleeding can possibly be controlled using the passer-by’s t-shirt (or something similar). C-spine stabilizing can be done either by holding the pt’s head still, or using whatever is at hand to fashion a “brace” of sorts.

Be sure to mention SDMB in the acknowledgements!

(I’ve done this! The SDMB is a really great prose-fiction advisory board!)

Definitely!

Let me float a scenario for our experts here - how would it be if the motorcyclist veered the bike away from the tree just before he hit, so the end of the handlebar hits him in the lower gut? If it hit him just right, could it nick/crush an important vein or artery, something where he’d bleed out pretty fast? I really want to showcase my mage’s healing ability on something like that, if it’s at all reasonable. He’s still breathing when they find him, though not as well as he could be. I definitely don’t want it to be a head injury, and I don’t want it to be something the EMT could have any chance of even helping with in the field with no gear. She can possibly do other things (or simply say that without gear her hands are tied and she has to wait for the ambulance, frustrating my mage character a little) but the healing of the life-threatening internal injury has to be all the mage.

I like the one with the rib too–that would work just about as well. Though I’m kind of partial to imminent bleed-out, since that’s pretty dramatic. :slight_smile:

Another thought I had would be that the mage character detects the actual cause of the accident, rather than just a normal accident what it was some medical condition that happened before the crash like a blood clot to the brain that caused a stroke.

It is conceivable that an impact with a tree could produce what is known as a flail chest. That type of injury in a closed injury where a section of the rib cage is broken off (as opposed to just simply breaking a rib). This can cause internal bleeding, and can be fatal, depending on circumstances. A passer-by EMT without equipment could do little, except attempt to provide an airway, and try to stabilize the broken section of ribs. Another scenario might be a traumatic pneumothorax. This can be from broken ribs that damage the lung tissue. Not a lot can be done in the field if the injury is closed.

Whatever happens the stabilized victim has to be left with a furry tail of some kind because … magic reasons, and the mage will have to get his pants off so this can have room to grow as he is cured.

ooops.

First: Love that the Dope is indeed such a terrific place to bring speculative fiction ideas for fleshing out, etc. Always have enjoyed that aspect of this place.

Second: I encountered quite a few EMT and Paramedic folks while I was active who stated quite clearly- some almost angrily- that when they were not on duty they would never engage in a scene needing their help. That they did enough while AT work. Didn’t want to screw up a family vacation, etc etc. My inner response was always " fuck you cupcake. You have skills and experience that could make a difference here, right now, but don’t want to mess up a day out with the family? Then don’t be in the EMS business. " I’ve encountered/ witnessed a handful of emergencies and have always stopped. My god. I’d want someone ELSE to stop for me !! Good link on Good Samaritan Laws, how they work, etc.

Third: Asking for a situation where minutes count isn’t in of itself unbelievable. People DO witness trauma in real time. People DO drive by a few moments after an accident has occurred. That’s life. I caught a woman who slid from her folding chair as a grand mal seizure set in.

Here’s one that fits your scenario. I was driving north on the NYS Thruway. I was being someone clearly drunk or having a medical problem. ( This was around 2001 and so texting while driving was not a thing yet. Not really. ). I called 911 and talked to the State Trooper, explaining the situation. They sent a few cars to try to catch up to us. One from behind, the other one coming south towards the Harriman tolls area with the intent of turning around. The person- incredibly- didn’t crash into the toll area barriers, but instead blew through. No more than 2 miles past the tolls they went unconscious. Swerved hard into the Jersey barrier in the center median, deflected and headed for the shoulder, where the car rolled quite a few times. I watched as the driver was partially ejected through the driver’s window, but was held in place by her seat belt.

Pulled over, cursed, got my stuff and ran over. To find a woman dressed in the classic bartender/ waitress outfit of white shirt, black bowtie, black pants. Unconscious. With not one but TWO penetrating wounds in her skull. ( These from the torn area around the window of the car. The metal framing crushed and tore as the car rolled and pierced her skull twice. )

ABC’s. I pulled her out of the car, laid her out and found her to be breathing. Reeking of alcohol. Just…reeking. State Trooper got there a moment or two later. I asked him to call for a helicopter. In the time it took the helicopter to arrive, and as I knelt there holding her neck in place to maintain good cervical alignment, her breathing slowly became more labored and her face and eyes started to darken slightly. This from the two small penetrations into her brain.

She was alive when the helicopter lifted off. She didn’t live out the night.

So. I was RIGHT there, with training and tools. And there was fundamentally nothing I could do. Consider this kind of thing when you structure a trauma situation that could or could not be resolved using magic.

Now to your scenario.

Here’s the thing. You want some level of verisimilitude here or you wouldn’t be asking for input. Handlebars ram into lower abdomen at 73 mph? Yes, you can have tears and ruptures etc. To whatever degree of severity you want to create. But the penetrative trauma likely with even a 25-30 MPH motorcycle accident ( that’s with some good quality leathers on, zipped up and padding the front of body ) are still significant.

So. Our hero, who we might name Kelvin cause he’s one cool dude, goes over the high side. He’s got leathers on and yet as he and the bike are rolling, the handle bar/ gear shift metal bits ram into his abdomen with enough force to do major damage.

I and my mage stop by 4 minutes later. If Kelvin isn’t dead already from the odd ruptured aorta ( a fabulously rapid and brutal way to die ), he will likely have significant enough multiple internal trauma that obeying the A.B.C.'s of First Response would mean that I’d establish a sound airway first. Let’s say Kelvin is - miraculously- conscious and responsive. So, Airway is good. He’s able to speak so Breathing is fine. Circulation is next. That’s mighty vexing to accurately assess down the ravine where he was thrown. ( Because how unsexy would it be if he crashed at the edge of a Wal-Mart parking lot?? :smiley: )

When I was riding I had a jump bag. Within that were the basics of first aid blood flow control- bandages, latex strips, nitrile gloves, etc. Oxygen, mask, air bag, cervical collars, etc. My mage would have given me the right size collar, because you know…it’s a mage and knows things. In assessing circulation, I’d want to basically cut away all of the patient’s clothing but since this accident happened on January 7th just outside of Scranton, PA and the ambient temperature is 22º f, that presents its OWN risk set. So I do an in-clothing assessment. I find extreme pain response and tenderness in the rib and abdominal regions. I find blood pouring out of the left sleeve of the leather jacket from an open fracture of the left humerus. While it seems fairly certain that Kelvin’s gonna die of internal bleeding fast, that fast bleed on the left arm could do him in within 10 minutes as well.

This mage, is it all-knowing and all-powerful? If so, then why is it relevant that I’m an EMT instead of, say, a guy who delivers Dunkin’ Donuts supplies every morning? If the mage ISN’T all- knowing and all- powerful, how much info do I need to provide to said mage so it can do its magic?

I’m not trying to be difficult here, but providing a device in a story that’s magical kind of removes most if not all of the dramatic tension from a situation like an accident. I could be the lord master of Paramedics or the greenest of green newbie E.M.T.'s. It wouldn’t matter if I had magic on my side. Within 1 second the internal damage would be magically healed and the bone fragments resolved and vascular damage healed in the arm. No drama there.

What are the limits of this mage that my being an E.M.T. becomes useful, relevant or dramatically interesting?

Great comments, Cartooniverse! Helpful and gave me a chuckle. :smiley:

Here are some more details:

  • Kelvin has gone off the road into some trees. Isn’t visible from the road–mage notices because she happens to be idly scanning auras as they drive by (hey, squirrels and coyotes have auras too!) and spots his. It’s late fall in southern California, so no adverse weather conditions, just chilly and dark. Cause of accident is probably excessive speed: young guy, new sportbike, empty road…yeah.

  • Mage is a 21-year-old advanced apprentice (she knows a lot, but still has a lot to learn). She’s got a particular affinity for healing magic, but hasn’t had a lot of practice on humans, because magic isn’t generally known. She’s mostly practiced on healing animals and occasionally patching up her master, who gets hurt a lot saving the world and doing stupid things like punching walls when he gets frustrated. :). She’s smart and quick-thinking, but by no means all-powerful or all-knowing. She doesn’t even have that much knowledge of basic anatomy.

  • The EMT is intermediate level (probably not a full paramedic, but she’s been at it for a while). She doesn’t know the mage is a mage. She doesn’t even know magic exists. She’s as mundane as they come (at least until her world gets rocked by what she’s about to see).

  • Normally the mage wouldn’t even get involved, but while doing a reading on the guy, she sees some kind of nasty internal problem that needs to be dealt with NOW or the guy will die. It could be the EMT spots signs of it too, but can’t do anything about it. That’s important–it needs to be something the EMT can’t affect at the scene. The mage really doesn’t want to take a chance on revealing her powers, but she can’t just let this poor guy die.

  • EMT has your attitude: if she can help, she’ll help. She’s still young as well (about 25) and idealistic enough to want to help, which is why she got into this job in the first place. So anything she can safely do without gear, she will do.

BTW, thanks to everyone who’s offered suggestions. I love the Dope! Even if I can’t use them all, they still give me food for thought and that’s appreciated.

I took him to mean that (and correct me if I’m wrong, OP) the mage may have the ability to heal, but may not have knowledge of anatomy to go solo. He might be able to fix a compound fracture, but determining where an artery ruptured may be beyond him. A friend’s dad had an AAA (abdominal aortic aneurysm), but no one knew it, because the rupture happened where the aorta touched something in his chest (I forget what, exactly), and sealed itself.

OP, don’t forget about internal bleeding (generally indicated by blood pressure, severe abdominal pain and tenderness, bruised abnormally warm distended abdomen), or severe head trauma (helmets aren’t a 100% guarantee of head safety). Or spinal column injury. One of the indicators is priapism. A lot of times, spinal cord injury will cause an erection. In some cases, it can develop into gangrene, and can require amputation.

This is kind of huge, IMHO. You are proposing an all-powerful being. The peripherals don’t matter. ( Inexperienced, etc. ) The Mage can heal anything, yes? You will have to someone establish parameters for the powers of this creature or one of several rather dystopian realities will be expected to emerge in the book and if they don’t readers may ask “Why not??”.

  1. EMT keeps Mage’s powers hidden. Becomes Healer Of The Planet.
  2. Mage becomes a known entity. Becomes Healer Of The Planet.
  3. Mage’s powers are recognized but Mage cannot be controlled and chooses not to heal everyone who is injured or dying on the planet. Boy THAT’LL piss people off. Maybe.
  4. EMT cannot figure out HOW she healed Kelvin, nor can the hospital staff.

I know this is speculative/ fantasy fiction and one gets to make up the rules. That’s one of the most enjoyable thing about writing stories. I’m not trying to dissuade you here, just asking very pointed questions about the framework- because others will ask them as they read or as they help you flesh the bigger story out.

Asking people to take a leap of faith is completely acceptable. It worked in " Manhattan " just as it worked in the third Indiana Jones film. How big a leap, and how far, and what are the limitations, are the questions I have right now.

Let’s go back to Kelvin. He’s pretty fucked but not completely fucked. Paramedics please do check me on this but from the internal injuries the OP’er has hinted at, our dear hero Kelvin won’t make it to the Emergency Department, correct? If that’s the case, then the EMT- green as she may be- likely knows that her efforts will be in vain. ( That should never stop someone doing EMS work, by the way. )

You’re actually channeling my inner 25-year old female. Thanks !! Hope I’m a redhead :smiley: