Tuesday, March 26, 2013

Employees Botch First Aid, Snap at Helpful Rider

From Zack:

I am writing to share a troubling experience I just had with a Metro station manager and a medical emergency.  Around 3:20 I was coming down the escalator at Rosslyn and saw an elderly man face down next to the bottom of the escalator.  Two people were standing by him, and he was slowly getting up.

I saw someone start to run up the other side of the escalator.  When I got down, I confirmed he was already going for help from Metro employees, and I went to give a hand to the old man as the people watching him seemed overwhelmed.  He managed to get up, but was stumbling.  Quickly, he leaned on a trash can and spilled his bag he was carrying.  I noticed he was bleeding profusely, although it was unclear from where.  He couldn't explain what had happened or where he was, and his pupils were dilated.

My first aid license expired more than ten years ago, but it was profoundly obvious that he was either had a fairly severe concussion and perhaps worse.  I only go into this much detail because I never had the opportunity to convey any of what I had observed to the station manager. Two employees came, asked him questions which he was incapable of answering, and, I wish I was joking when I said this, but the next thing said after "where did you fall?" was, "Let's go upstairs and do some paperwork."  They then started carrying him to the elevator. I was shocked by this statement, and I said to the man, "I'm almost positive he has a bad concussion, you need to call an ambulance immediately."

What did I get for trying to convey the severity of the situation?  The station manager immediately snapped back "I *KNOW* what I need to do."

Like I said, my first aid certification is expired, but I do remember this: the first step is assessment.  You calm everyone down and try to figure out as much about what happened as you can, so you can relay.  Common sense, instinct, and what remained of my training told me that if you suspected a serious head injury you should not move the person.  This was later confirmed by two medical professionals (a nurse, and nurse practitioner). By so quickly moving the patient, the station manager both lost a chance to do a proper assessment, and quite possibly put the man at further medical risk.

I have a handful of questions based off this incident:

1) Do all station managers have first aid training?
2) If not, why is it not a requirement for every single station manager to have it? 
3) If so, why was their first concern asking the man to fill out paper work instead of first aid?  Why did they not spend even a minute trying to assess the nature of the injury?  Why did they move someone with a high chance of a severe head injury?

Finally, I don't need to be thanked for stopping for a couple of minutes to help the man.  But the fact that they rushed to move him to "do paperwork" belies the station manager's claim that he knew what he needed to do.  To snap at someone who is simply trying to help is unacceptable.  It'd be great if the station manager offered an apology, but I'm not holding my breath. 

Other items:
As reported here again and again, emergency intercoms don't work (NBC4)

Comments (42)

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I'm a nurse. If he fell, he really shouldn't have been moved from where he landed, especially if he was disoriented and bleeding from a head wound. Paramedics should have been allowed to arrive to assess him and place a C-spine collar on him until he arrived at a hospital to ascertain that he had no fractures.

Non-medical personnel in my hospital aren't first aid/BLS trained in my hospital for many reasons, acceptance of liability being the number one explanation when we ask. They should be trained, however, to remain with the victim and call for help, instead of moving them for something as trivial as paperwork.

You did the right thing. It's shocking to nobody that WMATA was wrong again.
I'm a nurse. If he fell, he really shouldn't have been moved from where he landed, especially if he was disoriented and bleeding from a head wound. Paramedics should have been allowed to arrive to assess him and place a C-spine collar on him until he arrived at a hospital to ascertain that he had no fractures.
Mariterri's avatar

Mariterri · 626 weeks ago

It's ironic though that by making him go up the escalator to fill out paper work, the station manager increased the likelihood of a lawsuit particularly if he did have a concussion. I just don't get the logic.
First, Aid us by signing our standard release of liability. Second, we'll see about getting you some actual help.
Stan Desselscum's avatar

Stan Desselscum · 626 weeks ago

Metro = lowlife scum! That's probably what happened. Or maybe they "helped" the guy sign something as he bled all over the floor.

"Yes, your honor. Here is the paper he signed to affirm that his injuries were not serious, were completely a result of his own actions, and needed no medical attention. What? Oh, just ignore those BLOOD STAINS all over the document, I mean, it's just some red ink we spilled on there while working on our latest budget."
Ever n Anon's avatar

Ever n Anon · 626 weeks ago

oh I'd LOVE to be the one they snapped at. My first aid credentials are quite current and I'd blow the whisle to so many legal minds they'd not know what hit em. VeggieTart hit it on the nail: they have a culture of incompetence. What frightens me is they seem proud of it.
5 replies · active 624 weeks ago
I'm with you. I'm a nurse not currently practicing, but I know that when a patient falls and hits their head, you DO NOT move them. Unless they are vomiting or choking, you leave them there, as best you can. I'd love to have been the one that person snapped at, because he'd have heard some stuff that would make his nose hairs curl. Like it has been said earlier, this is just part of the culture of incompetence at Metro.
I'm the submitter. My mother is a Nurse Practitioner, my roommate and her boyfriend are both RN's. Everyone said I was right in wanting to sit him down and wait for paramedics and not move him. It kills me that I relied on the station managers who were either untrained or not following their training instead of taking control of the situation and waiting for paramedics! Let it be a lesson to everyone - trust yourself and don't be afraid to speak up!
Zach, don't beat yourself up. So many times after the event I wish I would have been more assertive. But, your instinct is also to let the "authorities" do their job.
I agree with Dez that you did what you could/felt was right, don't berate yourself and I hope he's okay. Honestly, given the bystander effect, you did more than most people would have.

But, man, they're lucky this wasn't me. No, I'm not a medical professional, but I have lots of (generally expired, I'm current on CPR only) training. Doesn't matter, I haven't forgotten what to do and I'm certainly no wallflower. They would have had to physically restrain me to move him (though I wouldn't necessarily put that past WMATA staff, and then I'd probably be in jail for failing to comply or something).

I don't necessarily think that every WMATA staff member needs formal first aid training, but could they at least be trained not to move a sick/injured person and call for help unless there's an imminent threat to the injured's safety? That's kind of the FIRST first-aid lesson.
Kathryn_DC's avatar

Kathryn_DC · 624 weeks ago

Zach, thank you for trying. It is a sad fact that often the person who knows the right first aid procedures has to strongly advocate for the patient. There have been many times that I have had to bark at well-meaning people who are about to do something that will create damage. (It's called 'taking charge of the scene') Another technique is to get those bystanders involved in a more correct way, such as getting them to hold pressure or something.
hrh king friday 13's avatar

hrh king friday 13 · 626 weeks ago

Paper work. PAPER WORK. Wtf is wrong with these people.
I would have called 911 and requested an ambulance. Screw the paperwork and the Metro workers who don't know how to handle a medical emergency!
Stan Dessel's avatar

Stan Dessel · 626 weeks ago

Welcome to FirstAid+

You're welcome!
not to mention that the metro employees put themselves at risk--it doesn't sound like they were wearing gloves or other protection from someone who was bleeding profusely. And if they get HIV, hepatitis, whatever you just KNOW it's going to be expensive for WMATA, and therefore to us.
1 reply · active 626 weeks ago
Hm...if they were concerned about that, perchance they should have stepped back and called for help? Personally, I carry a tiny emergency kit that includes a pair of gloves (plus a mini-mag flashlight, a couple band-aids, a latex strip that can be used as a tourniquet, and a few sealed packs of gauze...I've only ever needed to use the flashlight and band-aids, but the beauty of that kit is that I can either use it to help someone else or, if I'm the person in need and have some of my senses about me, tell others to grab it and use it), but there's always the option of telling the person not to move and calling for professional assistance.
I almost feel like we've discussed this first aid training issue before, and WMATA workers have weighed in. Don't have time this morning to comb through the discussions- does anyone else remember where this discussion happened?
6 replies · active 624 weeks ago
I'm pretty sure all of the stations have AED's. Someone in the station should be trained in AED and CPR to be able to use one. I would assume that station managers would be trained, and also have some basic first aid training, but this is Metro and the union probably prevents them from that being part of their job.
http://unsuckdcmetro.blogspot.com/search?q=%22fir...

It looks like there are a couple stories.
Here's what n2deep had to say about it:

To be perfectly honest with you , i am a metro employee who will never touch an injured person on a train. i will try to establish communication with them and call for an ambulance when asked for or deemed necessary. we have been told in the past that we are not covered under the "good samaritan" policy. like police and fire personnel. we can be sued and Metro will not back us. i am not about to be sued for trying to do the right thing. sorry ain't happenin'! also the train operators are instructed by OCC to see if the passenger can be moved under their own power to the platform. OCC only wants their trains moving, bottom line. and as for first aid training.... i was instructed in CPR 20+ years ago. nothing since and haven't heard about any future training.
There are three things here. First, calling for help is a perfectly valid response. That is NOT what these employees did. They, second, moved an injured person when they shouldn't have. Tell them to be still and call for help if you can't or won't do anything else. Third, I think the proclamation that WMATA employees would not be covered under good samaritan laws is BS. Even if they're given basic first aid training, they are NOT trained medical professionals. To me, this REEKS of Metro trying to avoid responsibility (maybe the employee is not liable but the agency is). Overall, though, FINE, don't touch them. Tell them to stay put and get a professional on the scene. If Metro's policy is really "move them if you can," they're opening themselves up to far more liability with that than even suggesting that employees intervene where they feel they can.
KathrynDC's avatar

KathrynDC · 624 weeks ago

omg yes, total BS about the Good Samaritan laws. It is really serious if Metro is telling their employees that they are not covered. They were written expressly to cover non-professionals in the first place. I really hope it is one ill-informed manager telling staff that, not Metro as a whole.

Also, if Metro isn't paying for CPR training for all staff, it can be obtained at no cost through the fire department.
KathrynDC's avatar

KathrynDC · 626 weeks ago

Speaking as an EMT, this makes my blood boil. Not only did they step in on an accident victim, they clearly had LESS training than the person who was trying to help in the first place.

This is the point at which people with valid first aid training have to advocate on behalf of the victim. If I had been there, there is no way that guy would have left my care, because it's a violation of my license to turn him over to idiots.
The station manager was wrong to move the man, but if they felt they had to move him, why didn't they use the elevator instead of that monster escalator?
2 replies · active 626 weeks ago
OP mentions that they at least headed towards the elevator with the guy...

i'd like to think in that situation i'd whip out my phone and call 911; wonder if APD would transfer the call to transit police?
You probably would not get sufficient cell phone reception.
Can this be shot to the news stations for more coverage? Incompetent at your job is one thing but when it when someones well being is on the line its another. That idiot station manager has to be called out.
Hey people metro employees are getting themselves into more liability issues.

Hey Unsuck- can you find out how much Metro pays people to set up skits on employees? It seems it is a daily occurrence as I am hearing from other employees. If you didn't know.... a lot of these scenes are planned and set up in a particular employee.

Find out how much Metro spenda on these skits that arwe played out on employees.
3 replies · active 626 weeks ago
We should stage an Unsuck skit. Hidden-camera style.
Hey next time a skit is played out, I want autographs from the theater group who is responsible for this type of waste of tax dollars.

Hey Unsuck can you find out through FOI who metro or the jurisdictions hire and how they go about hiring these actors to play out skits and how much they pay an hour? I bet most of the employees don't know this is going on.
Unsuck Flash Mob!!! Can I wear the MacRuff suit?
even if station managers had first aid training, they wouldnt use it because they dont give a sh*t about you, your injury, or your complaints.
1 reply · active 626 weeks ago
If you knew what I know, you will always call on your own the state or county police in the jurisdiction where you are at the time of the incident. Then wait there for them to arrive, this may take a while.
I hope the man got proper emergency medical care and is recovering. The station manager lacks basic human decency and common sense. It's sickening, but no longer surprising, to read about Metro employees like this.
I saw a similar injury at Rosslyn on Friday in the morning. It was an Air Force Lt. Colonel his head was totally bandaged with the ACFD already there. The station manager was tending to his bandages. A fall there, depending on the height, could easily be life threatening and the escalator is the only way in or out (except for the elevator, the shaft of which ultimately goes outside the station to the street level- constantly tripping my claustrophobia if I use it).

I think the ultimate problem at Rosslyn is the lay out. The staff is too far away the main action of the station and if something happens they have to go down a 200+ foot escalator to get to one platform, even more escalators to get to another. A vigilant station manager is too far away to be of any help to customers.
First of all, I am surprised they came to him-once at the Ballston station I had a freak incident where the wind gust coming down the escalator to the street sucked all my air out of me, so I was standing there clinging to a rail on the wall, doubled over gasping for air and grabbing my chest...all manner of people passed me by, metro and non metro.
Second, they really do get nasty in an emergency-it's like they weren't taught the first rule was to at least APPEAR calm even if they aren't. I was in a bus accident last year, and one of the teens on the bus who wasn't hurt asked the bus driver a question; the bus driver not only yelled at him, but also cursed at him! Granted the kid asked a dumb question, but people would have probably remained more calm if the bus driver had at least acted like he had his head screwed on straight. Right after he went on the teenager, some of us started panicking, one lady started crying, some folks actually got off the bus and left...I just think if he had kept his attitude at a minimum during the emergency things would have gone more smoothly.
It's like they weren't taught to take a leadership stance in an emergency, but rather to just panic like a chicken with its head cut off like the passengers. Imagine if other officials, such as police or firemen, reacted that way...
OT - Unsucks's famous metro bus driver photo was on Popville yesterday:
http://www.popville.com/2013/03/dear-popville-met...
The NBC story (linked to at the end of the above post) on Metro's nonfunctioning emergency call buttons misses two things. First, at 1:05 in the video, Stessel makes a misleading comparison by saying that having two emergency button malfunctions on average per week should be considered in the context of 730,000 daily trips. The number of riders per day is not relevant here because not all riders are trying to use the emergency buttons every day! What IS relevant is how many riders try to use the emergency buttons each day versus how many riders try to use the buttons only to have them fail. That percentage will likely be much higher than the percentage using all riders as the denominator as Stessel suggests. Second, the NBC reporters should have investigated how frequently these intercoms fail on trains in other cities and compare that failure rate with the buttons on WMATA's trains. If the failure rate is much lower on other cities' trains, it would suggest that WMATA is not fixing their intercoms, or not bothering to detect nonfunctioning ones, or has a poor detection system...

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