The Scenario

Returning home from work on her daily commute, Sandra found herself abruptly slowing due to unusual traffic on a moderate-speed backstreet, reaching the site of a severe three-car accident about five minutes later. Realizing there were injuries and no EMS on site yet, she pulled over to assist.

Grabbing the first-aid kit she kept in her vehicle, she approached the scene carefully assessing to be sure there were no hazards. The vehicles were in a haphazard line on the narrow shoulder and partly in the lanes. It appeared the second auto had rear-ended the leading one, and then been sandwiched by the car following it. The lead vehicle, a compact SUV was some distance ahead. Its rear door had sprung open, obscuring her view, but Sandra could tell there were no other cars involved.

Sandra reached the rear-most vehicle first. It was unoccupied. In front of the middle car, she found four people, all responsive. A middle-aged man, apparently from the lead vehicle, was standing, rubbing his neck with a loosened necktie and talking on his cellphone. She could overhear him contacting EMS. Two were lying on the ground. One was a man bleeding from his left upper arm just above the elbow. Although he was pressing a T-shirt into the wound, blood was dripping out and there was a small pool; he looked pale. The other person, a few paces away, was a slightly younger man, about late 20s, who seemed to be bleeding from his mid, inner right thigh. A teenage girl – either a bystander or a passenger – was trying to help by putting pressure on the wound but the blood on the ground was pooling quickly, and it was apparent bleeding was both uncontrolled and excessive.

Sandra’s first-aid kit had barriers, one commercial tourniquet, a single large clotting gauze, a triangle bandage, standard gauze, ice packs and other typical supplies.

Take a moment and write down what you would do if you were Sandra. Think about how events might unfold and ways Sandra might respond.

The Response

Here is one-way Sandra might respond. Keep in mind there is rarely only one right response, so there may be other, or even better actions Sandra might take – but adequate aid provided is better than perfect aid withheld.

Having already assessed that the scene was safe for her, that EMS was on the way and all patients were responsive, Sandra went directly to the younger man being helped by the teenage girl. His bleeding looked to be the worst and life threatening. While giving the rescue medical statement, getting consent and donning barriers, she gave barriers to the girl, Sujung, and with only limited clotting gauze available asked her to help the other man by putting continuing direct pressure and not removing the shirt he was using. Taking over direct pressure, Sandra reassured the young man, Zeke, while applying clotting gauze. Bleeding was slowed but not stopping, so she applied the tourniquet above the wound, winding it tight until the bleeding stopped.

Sandra waved over the man who called EMS, Pablo, as she went to help the one with a bleeding arm, Armando. “Please sit with Zeke,” she told Pablo after he insisted he was fine, “and let me know if he passes out or if you see bleeding.” She did this to monitor Zeke, but also so she could monitor Pablo. “Your neck seems to be bothering you,” she said. “Please stay seated and avoid turning your head until you get checked out. Just to be safe. Let me know if you start to feel bad or if you have any numbness or tingling anywhere.”  

Armando nodded weakly to the rescue statement. Sujung had done as instructed, but bleeding continued through the T-shirt fabric. Looking around for an improvised tourniquet, Sandra considered Pablo’s tie, but went immediately to her triangle bandage. What was lacking was something strong enough to wind it with, so she asked Sujung for help finding something. “What about a car jack handle?” Sujung said, pointing to the open rear door of the SUV. It worked; the improvised tourniquet stopped the bleeding. Sandra tied the handle in place because it was too long to easily slide into a key ring on the bandage like she’d practiced.

With Sujung and Pablo’s (stationary) help, Sandra monitored Armando and Zeke until EMS arrived 10 minutes later and took over the scene.

Note: You can use this as the basis for verbal discussions or practice scenarios with your EFR® classes and refresher sessions. You can change some of the variables – conditions, injury types, resources available, number of patients, etc. – to stimulate discussion. Encourage students to think of different ways to handle the same problems.

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