TRAUMA DEATH
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Sudden trauma death does not allow the victim to go through the five stages of dying. However, the survivors usually do go through some or all of those stages The stage having the most impact is denial. They have had little or no preparation for the death because it happened so suddenly. With cancer, for example, there can be mental and physical preparation, love, understanding, and acceptance. With a sudden death by heart failure, an automobile accident, or some other trauma there is no time to exchange such important human emotions. Another serious side effect may be guilt (leading to bargaining) because the last encounter with the victim may have been unnecessarily unpleasant. Things might have been said and done prior to the death that were expected to be remedied at a later time. The later time is no more!
Rescue Squads and ambulance crews deal directly with trauma deaths. They know they are going to encounter some things that will make them nauseous. As a protective mechanism they may "turn off " their emotions while they are confronting the victim. They may perform as a machine when the situation crosses the line of tolerance.
There was an incident some years ago to illustrate this. A local, off-duty police officer was passing a hitchhiker on a rainy afternoon. He didn't stop. The hitchhiker made an obscene jester with his hand. The cop stopped, backed up, and a fight ensued. The hitchhiker tried to push the cop in front of a passing car, but the cop spun him around so he was accidentally hit by the car. The hitchhiker was caught under the car and dragged for about 100 feet with his head banging on the highway before the vehicle stopped. Needless to say, the body was a mess and the victim was barely alive when the New Paltz Rescue Squad arrived.
One of the members of the squad began working on the victim's face so CPR could be administered. Removal of debris and facial parts from the mouth were necessary. This was done with cool dispatch. But, after several days passed the same rescue squad member became upset over the incident. Incidentally, the victim died after several days in the hospital.
What is it like to emergency personnel if a major disaster strikes a community? If you are a member of a rescue squad and you have to deal with a great loss of life and extreme carnage, what protective mechanisms come into play. Are there any long-lasting effects of such an ordeal?
In San Diego a major PSA commercial airliner, Flight 182, crashed after colliding with a small Cessna. In several seconds the plane went from an altitude of over 3,000 feet to plunging into the earth in the residential part of the city.
The sequence, as reported in Time Magazine from the new's wires, went like this:
0900:38 Lindbergh tower: PSA 182, Lindbergh tower, ahh, traffic 12 o'clock one mile a Cessna.
0900:42 Captain: Is that the one we're looking at?
0900:43 1st Officer: Yeah, but I don't see him now.
0900:44 Captain to tower: Okay, we had it there a minute ago.
0901:11 1st Officer: Are we clear of that Cessna?
0901:13 2nd Officer: Supposed to be.
0901:38 1st Officer: There's one underneath!
0901:47 There is the sound of an impact.
0901:53 1st Officer: We are hit man, we are hit!
0901:55 Captain to tower: Tower we're going down, this is PSA.
0901:57 Tower: Okay, we'll call the equipment for you.
0902:03 Captain: Brace yourself!
0902:04 Unidentified: Ma, I love yah.
0902:05 Sound ends on voice recorder.
0902:07 Impact occurs
There were 149 lives lost in this disaster. The rescue personnel had to witness every form of human carnage imaginable. It was almost impossible to move at the scene without stepping on human tissue. The stench of death was everywhere and that part of San Diego resembled a morgue. Movies of the event show many of the personnel in a semi-dazed, comotosed condition. Some walked aimlessly back and forth among the victims seemingly unable to perform some of the simplest tasks they had been trained for. Months later many were still trying to get over the effects of the trauma. Symptoms included anxiety, nightmares, headaches, ulcers, and amnesia. Many sought professional help after the accident to try and overcome some of the aftereffects.
Those that faired best in the treatment were the ones where the therapist allowed them to understand their reactions were normal for such a disaster. There was nothing wrong with them no matter how macho they thought they had been. Humans do have limitations.
The entire nation went through the death stages collectively when the Space Shuttle exploded after launch. When people first heard the news they could not believe it. The news media repeated the film footage time after time. Then came the anger. Thiokols seals sucked. NASA should never have launched when it was so cold. The president knew the nation had to get through bargaining and depression to get to acceptance. So, the Shuttle launches were not canceled. They were postponed until safety issues were resolved.
The members of the New Paltz Rescue Squad (NPRS) are loaded with experience and credentials. Most are Emergency Medical Technicians (EMT's) or Paramedics. The EMT course requires about 120 hours of training beyond the primary first aid course. The Paramedic training requires over 1000 hours of additional training. Most of the members that have talked to the Death Education class have seen many deaths or people dying. Two members came to the class in 1993. They were Paramedic Lanny Migliorado and EMT Debbie Hernandez. Here are the answers to their interview:
Q. There have been many cases where the victim was robbed of money and/or jewelry at the scene of an accident. How do you feel about this problem?
Lanny: I don't think that's a problem in New Paltz. When we get to a scene we are doing more cutting, taking things out, or ripping things off and I think that's what happens most of the time. A lot of that happens on the way to the hospital. I've never had someone come up to me and blame me for that.
Debbie: The only time I've cut a wallet off is to identify someone. And, anything we have we try to give back. We try to clean everything up on the way to the hospital. We do not steal.
Q. Whenever you drive in the van do you hope you do not have to deal with a serious accident?
Debbie: Yes, everyday. We prepare ourselves on the way to the scene. The driver tries to get us there quickly and safely. The squad leader, which Lanny is, usually tells the tech what to get and what to get ready so we can be prepared as soon as we get there.
Lanny: The biggest thing is to mentally prepare yourself for the actual scene.
Q. Did you ever have to walk away from an accident because it was too gross?
BOTH: No, not so far.
Q. Can you describe an accident that was unpleasant?
Debbie: There was a gentleman that was working on the campus (State University) that fell into a transformer. The whole ride to the hospital was pretty nasty. He had fallen into the transformer by his head. The exit wound was through his finger. The electricity came out through his hand, and throughout the whole ride to the hospital we were trying to save him. He smelled like burning animal flesh and his hair was all falling off in my lap. When I came home that day my grandmother kept asking me what he looked like. I kept saying he looked like anybody else. I had never met him before. He was darker - I guess he had a darker tan.
Lanny: The worst one I've ever seen was the plane crash out here, by the High School. There was a lot of disfigurement and dismemberment. We had to remove the bodies and that was something else. It hits you and you don't realize it. There were arms and legs that were actually dismembered. We had to pick up this arm and pick up this leg. You shut off. You are on autopilot. When you are there is doesn't hit you, but when you go home and think about what you actually did, that's when it starts to hit you harder. You get quiet and get away from people. People might ask you a lot of stuff and you just want to put it behind you. You try to talk about it with a lot of people that you know, a lot of people on the Squad. You can't go up to someone on the street and talk about it because they don't understand what you are going through. Your friends generally try to be supportive , but they may not want to hear about it.
Q. How do you feel about talking about it now?
Lanny: It brings back memories. It's been a couple of years now and I don't want to think about it everyday.
Q. What is the breakdown of the types of calls you go on.
Lanny: In this area we don't do a lot of trauma deaths. We cover the Thruway and get a lot of auto accidents there but not here. You may get 5 or 6 deaths a year from a car. You do more medical deaths rather than trauma deaths. We have about 12 to 15 deaths per year although the number varies.
Debbie: Some years it's up and some years it's down. Last year, when I joined, There was a lot. All of a sudden people were dropping off like flies. We had like 5 or 6, and they were all in about 3 months. We didn't have a death for months and all of a sudden they were clumped together from September to December.
Q. What about suicides?
Lanny: You get them. It's usually low in this area. It will go up, I am sure.
Debbie: It's more attempts than actual.
Q. What would you do if you got a call to take care of a friend?
Lanny: I have had to do only a couple of friends. And, its' hard. You do your job but in the end it's a lot harder. A friend of a friend that I work with was killed and it was tough.
Debbie: The father of a friend of mine was dying of cancer. He was getting closer and closer to dying. By then he didn't know who anyone was. When the family called the Rescue Squad they also called our house because we live down the street from them. I wasn't on the Squad at that time and remember saying, "What's taking them so long. They want an ambulance - let's go. It's bad enough as it is, let's move along." It got very tough at the end. They got scared and new he needed immediate help at that time.
Lanny: You don't want any of your patients to die. That's the way we feel. It was tough because we knew the family. We not only had to deal with the patient but also we had to deal with the family.
Q. In studying the PSA air crash in San Diego we discovered rescue personnel have major psychological problems when dealing with major disasters involving a large amount of human death. Do you have any idea if we had one of the commercial airliners flying over New Paltz crash what you would do?
Lanny: I think about it a lot. I don't know if I would want to be there. The personnel suffer from post-traumatic stress. The AMS is starting to realize that this is starting to happen. They have crisis teams that will go to an area after this has happened. It's normal practice now to have these teams come in. You need these teams and anyone that tells you they don't after experiencing a major disaster is crazy. The experience is overwhelming.
Debbie: There's a crisis team in Kingston. The clients are picked from a lot EMS and Emergency Room workers and the whole group gets together and talks about what they have dealt with. As rescue people you can't (and it's hard to) go home to your mother and tell her what you have dealt with today. And then there is the matter of confidentiality that prevents you from talking to people outside the medical community. That puts a strain on us.
Q. Knowing all of this, why would you join the Rescue Squad?
Lanny: I don't know why I did sometimes. Actually you don't see a lot of this stuff and it is a good feeling to help people. You have to outweigh the good and the bad. It's something I enjoy doing day by day.
Q. Do you get calls that are really not serious?
Lanny: Every call is an emergency call. There are more calls that are not serious, thank God.
Debbie: An example of this happened on March 13 when we had that terrible snow storm. The only 2 legitimate calls we had that day was there was a bus roll over on the Thruway, and a patient with a heart condition at about 11:30 that night. I got struck on 2 other frivolous calls one for a GOMER, an older person that goes to the Emergency Room at least once per week. I picked up the GOMER and took him to the hospital because he called once at 8 o'clock that morning and called back at 11:30 to say that it hurt a little more. I was on with two officers at the time. The one officer looked at him and said, "Do you realize we are in the middle of a blizzard and we could have a serious car accident any minute?" And, he said, "I have all day." When he was loaded in the ambulance he wanted the stretcher a little higher and then a little lower. Then he asked me if we knew where we were going. I looked him in the face and said, "I've been to every hospital in this area and I know where I am going. Take it easy." The other was for a college girl with a sore throat who, because her mommy was not around to baby her, decided her throat had gotten too unbearable and wanted us to take her to the hospital. We had to take her to the hospital. We get a lot of calls like that now because finals cause anxiety attacks. The people with these attacks probably realized two days before their finals they haven't looked at anything (books, studying, etc.), and no one is around to calm them down. I had a guy that had eaten wings and beer the night before and hadn't eaten anything the rest of the day who said, "Oh, I have a tummy ache."
(Note: GOMER stands for "Get Out of My Emergency Room.)
Lanny: There is an older person who calls and calls and calls and calls. He may call ten or fifteen times for things that are stupid. He was unable to make himself a bowl of cereal. I don't mind coming down to do that, but you are taking an ambulance out of service to go down and peel someone's bananas. That makes you mad. We have to go to all calls. You can't deny these people. If they want to go to the hospital we cannot refuse them. Also, we cannot force someone to go if they don't want to.
Q. Have you ever had anyone that resisted help?
Lanny: Yes, a lot of people such as drunks on the street, and people whose friends will call. To a point, some will get physical. If they do not want to be touched than you are not going to touch them obviously. A lot of people have DNR's (Do Not Resuscitate). Many people do not fill them out or do not keep them updated. They have to be updated every 90 days. If you get called to a house and the patient is in cardiac arrest, if you are not shown a DNR you must do CPR on those people. I've had family members try to pull me off the patient. Once they call us, if they don't have a DNR we have to treat them. We are legally bound to do it. Sometimes it's necessary to take the family aside and talk to them in a calm manner.
Debbie: We had one patient that had a DNR but it had expired about three months prior. No one cared to do anything about it so this poor old woman had to go all the way to the hospital with CPR in progress. She wanted to die.
Q. Have you had experience with suicides?
Lanny: I never actually seen a successful one. I've seen a lot of attempts. Mostly what we do with the attempts is to talk to them. They need verbal support. A lot of times their friends will back away from these people. Mostly I've seen attempted suicide by using pills. I've known people that have gone on calls for gunshots, both successful and unsuccessful.
Q. Have you had members of the Rescue Squad that you didn't want to continue as a member because they were incompetent?
Lanny: Everyone is going to make mistakes. There are people you like more than others. Everyone has been trained and knows what to do. If someone were to really mess up it would be brought up between the officers and discussed. There has been nothing involved with patient care. Most of the problems arise because of members not following orders.
Q. Have you ever seen someone die?
Lanny: Yes. Car accidents are where you usually see this. Sometimes you'll be called to houses where someone is having difficulty breathing or something like that, and they will die right in front of you.
Q. Has anything startling happen when someone died. Do they say anything unusual?
Lanny: I've never had one do this.