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Stealth83
10-08-2004, 06:55 PM
Be advised this post contains graphic content.


Well I had my first decapitation last night… more of a partial decapitation as it sheared off his skull just above his nose. It was a single vehicle rollover on the Yellowhead , alcohol and no seatbelts were both factors.

I have seen gray/white matter before but not to this extent. The spray from the initial opening was massive (who knew 15torr was that much pressure).. The driver went out through the sunroof as it rolled it caught him on the lip of the sunroof.

The top of the head and the remainder of his brain were about 200ft away from the accident and the body.

This is my 3rd DOA this year, 6th overall. It was the most graphic of them all simply due to the sight of the hollow skull.

We did a CISD after the incident and brought in a friend who happens to be a psychologist and specialist for the canadian military for PTSD.

Joke a bit about it with co-workers as a sense of humor is a job requirement for this type of work...

The passenger of the vehicle, also not wearing a seatbelt, was ejected but closer to the accident. The truck landed upright in the median ditch and there was an ATV in the back of the truck (which also had a RV trailer). The ATV landed underneith the truck supporting the trucks rear end. The passenger was under the truck and had about 1 ft of clearance.

He was quickly immobilized and moved.

What bothers me most about these types of incidents is when there are two passengers and one is DOA the other always asks how his friend/wife/etc is doing. What do you guys usually tell them when they ask? I simply kept telling him I was unsure of his friends condition....


I am not sure of the point of this post, more just to get it off my chest. Thanks for listening.

mcaldwell
10-08-2004, 07:15 PM
No problem Stealth. The big part of CISD Management is talking about it right?

I can't say much about the injury, as I have only worked 4 relatively simple DOA's in the last ten years (3 MI's, 1 Trauma), but I can tell you that while on scene, we don't tell the other victims if there were any fatalities. I usually just say, "I'm not sure, someone else is helping him". The exception is when an uninjured friend or family member is present.

When dealing with a seriously injured patient, there is always something to be said for hope. In my opinion, it would only serve to make the patient management more difficult if the victim was shutting down mentally.

btroutm
10-08-2004, 09:27 PM
I agree with mcaldwell. Telling a patient that their friend or family member is dead will dramatically increase their stress and it may cause them to stop fighting. In a situation like that, I would say something along the lines of "they're doing everything they can for him." Don't lie, but don't tell the whole truth either.

SafetyPro
10-08-2004, 09:31 PM
Sounds like a heck of a scene to work, Stealth. I understand needing to talk about it and get it off your chest, and that's what we're here for. I've only been on one fatal TC myself (single motorcycle, during my EMT training ride-along with LACoFD) and it took awhile to cope with that.

I have worked a few mutliple-injury TCs though, and generally, when the patient asks how their buddy is, I usually say something along the lines of what mcaldwell said that they're getting the help they need and that my focus is "you" right now.

Jay911
10-08-2004, 10:13 PM
That takes me back to two crashes I've been on. Once, I was at a scene where a guy was having an argument with other people in the minivan, and tried to get out by opening the sliding door and departing (while the van was still moving). His head hit a fencepost and he was pulled wholly out of the van by the force of the blow. I was first on scene in my POV, and had a distraught wife as well as a number of bystanders to deal with.. and then it became evident that I knew the guy, in a way. He was one of those folks that are well-known around town, and can be seen all the time doing something or other. And now I was looking at his body lying face-down in the ditch with nothing above the neck.

The only piece I saw was a small triangle of skull bone about the size of a playing card.

The other incident I remember isn't a decapitation, but it was a grievous head injury nonetheless. A pair of kids in an SUV crossed the center line for some reason and were struck by a semi full of frozen food head-on at 60+mph. The semi basically went up and over the passenger side all the way back to the landing gear of the trailer. The driver was in agonal respirations when we got there and subsequently died, but the passenger was very clearly dead upon impact. Again I was first on scene; I took our rescue/medical rig to meet a fellow medic who was just a few cars behind the SUV when it was hit. So I did the circle check on the scene and was basically the first person besides the semi driver to see the passenger's condition. I won't describe it here, because I can't even bring myself to come up with words for how it looked. And this happened over a year ago..

The thing that gets me the most about these kind of calls is kind of surreal. This is a person, perhaps even a person you're familiar with.. and it's been so horribly damaged that your mind refuses to believe that it can be what you know it is. You tell yourself that people don't have the tops of their heads sheared off, or tire prints from their chin to their crown. This is a living, breathing creature, whom you may have seen live and breathe before. It's not possible to associate the past with the 'now'.

Having said that, talking about it - whether it be in a forum like this, with your fellow firefighters, or in a CISM/CISD session - is well worth it. It's a healing process. Any member of our department has the right to request CISM be put in place on any response. We're lucky enough to have members who are trained in it and acquaintances who have professional training in the field, and are willing to sit on a CISD session. I have to say that I've used it more than once, and it's benefitted me greatly each and every time.

One last point to add - like the others, I always say something like "someone else is taking care of him/her, but we need to focus on you right now". There's no need to possibly aggravate their injuries (the non-physical ones) with bad news at that point.

ftfdverbenec770
10-09-2004, 02:03 AM
i had my first decap back in the spring, and nothing helps better than just talking about whatever you feel. if it had not of been for talking to fellow guys around the house that just happened to be on the scene with me, it would have taken a much longer time for me to get over the reaction of this.

as a few other of the guys have said all ready on this thread, you dont want to lie to the people enquiring about the well-being of the person, but the news will add stress to that person. i think a simple, we are doing what we can, can be a responce. the person asking might not be happy with that answer, but just dont tell the whole truth.

blueeighty88
10-15-2004, 05:24 AM
First decap I saw was a man in a 1990's Chevy. Came around a sharp turn at an unsafe speed and made a mad dash into the woods. No seat belt. Driver was thrown on to the passenger seat, and the window handle thing poked through the very top of his head, the car finally came to rest against another tree, herniating his brain through the hole in his head, and shearing the skin. The skull was shattered into a few hundred pieces, so there was nothing to hold the head together. It was gone above the upper jaw. Part of the spinal cord, tongue, and lower jaw along w/ all of the teeth were showing.

On another run, it was a shooting, he shot himself just before we arrived I believe. There was steam rising from his body. There was nothing left above the mid-chest. One arm was nearly amputated, everything else was obliterated.

CISM can make you deal with your emotions, that you don't show on the scene. They can tell you what you might expirence, and how to deal with it. I've had stress reactions, some times it happens right when I see a bad sight, sometime sit happens a week later. Sometimes it doesn't effect me till I think about it.

Some things will stay with you for a few months, maybe a year. But some things you will never forget. Some things are too awful to forget, and they outweigh the good things that are too wonderful to forget. But the bad ones, the grusome calls, you can't forget them, they will be with you all the time, and the only thing you can do is learn to give yourself a little CISM by enjoying life. Something may not bother you right now, it may not come back for 20 years. But you remember, that maybe it's better that this person hit a tree instead of a family. Don't feel for the person, it's not your emergency, it was theirs. Show empathy, not sympathy. I'm not one to give advice, but I knew both of these people very well. One was a fellow firefighter, one was my neighbor. You can't picture what you have in front of you as being a person. Because you can't immagine that something so awful, horrific, or grusome could happen to a human being. And you can't immagine it happening to someone you know. I've spent years with sleepless nights trying to remember what those people looked like, with out seeing what they looked like those summer evenings. I'm not giving advice, that's the last thing I want to do. I just want to put it out there that all of us attend horrific accidents, and we all react differently. The only thing we can do is talk. Thats' all I got. It's 5:30 am. You know how good it feels to type this, I never type or write, it's like taking a cinder block off my chest to tell someone about it. Doesn't that sound cheesy? :rolleyes:

PrttyEMTB
10-15-2004, 08:56 AM
My instructor told us to always say, "we are doing all we can." because in every case its primarily true. She told us that the worst call she had was a MVC the driver was injured but stable and aware, and her 6 year old daughter was in the passanger seat (I think it was a truck..) but anyways, they were taking the mother away to the hospital and she was speaking with the daughter, and the daughter was speaking back and appeared fine, you know.. "i'll see you at the hospital etc.." Well the child had the front dashboard in her lap pinned her down. As soon as they pulled the dash off of her lap she passed on scene. My instructor said she bled to death, internally and externally there was nothing that could be done.

smurfe
10-16-2004, 11:34 AM
I just tell them someone else is taking care of them. Not a lie at all cause it is either the coroner or FD extricating or the PD doing scene investigation. Has me covered every time. I do have the urge to let an intoxicated driver that caused devastation to others to see the scene but I don't if I can help it.

Smurfe:)