Single Car Roll Over Accident - NOT Training
On the afternoon of October 21st, 2018, I was traveling east bound on 316 betwen Winder and Athens with my wife returning home from a weekend trip to Tennessee. After being in the car for several hours, we were within about 20 minutes of our house. Out of the passenger side window, I saw a doe and a fawn in the grass next to the busy highway, and I began honking to try to scare them away from the road. As soon as my attention went back to the road, I saw a car that was traveling east-bound appearing to change lanes from the slow lane to the fast lane- but much sharper than usual. The car entered the median and the driver tried to turn sharply back towards the road, over-correcting in the process. This caused the car to disappear in a tumbling cloud of dust in the median. The car rolled for an estimated three or four complete rotations, eventually settling on all four tires in the middle of the median. Having watched the accident, I was already slowing down and pulling into the median as well.
You always hope that during these kind of times you'll have the clarity of mind to say something worthy of a movie one-liner, but I didn't. I belive my exact words to my wife were "Oh shit- that guy's dead. Call 911 and DO NOT GET OUT OF THE TRUCK. If you do have to get out of the truck, crawl over and get out on the driver side." Not very poetic, but that's what came out... I always have multiple medical kits in my vehicle, so I retrieved the closest kit and started sprinting toward the accident. After a quick prayer that I would be clear in thought and decisive in action, I was close enough to the vehicle to begin calling out to the person(s) inside. I couldn't see into the vehicle really at all because all of the side airbags had deployed and were blocking my view. When I ran around the back of the vehicle I could see the driver's head and didn't see anyone else in the vehicle. Fully expecting the driver to be dead or (at least) unconscious, I called out to him telling him to be still and that I was going to help him. To my surprise I heard a clear "Yes, sir" in response. In my mental preparation, I had already sub-consciously told myself to expect a body, so when I had a response I immediately thought "Oh good, this is going to be alright." A premateur thought, as any of the more experienced guys reading this already know...
At this point I was at the driver side door, which was folding in tightly as the car was pretty crushed from rolling. I put my right foot on the back door, and with two hands and a few attempts I was able to get the door open only to be faced with an airbag and a seatbelt that were both obstructing my view and access in the car. I asked the driver if he was injured and he replied with "I think so, I'm bleeding a lot." "Where are you bleeding from?" "My head." (Now my blood pressure went through the roof.) I told him to be very still because I had to cut the airbag and he responded that he understood. While doing so I asked him if there was anyone else in the vehicle, to which he replied there was not. I asked him to verify that and he said clearly "No, there wasn't anyone with me. I'm sorry- I think I fell asleep."
The airbag and seatbelt both had blood on them, which was immediately transferrred to my hands. By this point another person had arrived on scene and asked if he could help. I told him to help me get the airbag out of the way and to get the seatbelt off while I opened up my kit to start getting gauze. He did, and the driver was able to get out of the car on his own and stand up. When he did, I could see the extent of the lasceration above his right eye at the hairline of his head. It was spurting bright red blood, and a lot of it. I had the driver sit down right where he was and I applied (in extremely ugly fasion) an Israeli bandage that I had prepped. As the bandage was applied I could still see the blood pulsing out with every heart beat, but in decreasing amounts. I'm no doctor- but if someone is bleeding and they start to bleed less with the application of a pressure bandage, I have to believe that's a good thing. I asked him to maintain pressure on it with his hands while I continued working through my M-A-R-C-H protocols and talking to him. There was a conversation to ascertain his mental clarity, and at this point multiple other drivers had gathered around us. He was having no trouble communicating, so I believed his airways and respiration were good to go. With this in mind, I asked him to lie down and then asked him if we was injured anywhere else. The right side of his pelvis had some pain but otherwise no other major injuries. I was utterly amazed that this guy wasn't severely more banged up. By this point, bleeding was controlled and EMS was starting to arrive on scene.
During the course of our conversation, he was able to tell me his name and other details. Some details came immediately (where are you from) and others took a while for him to work through (what time of day do you think it is), but he was able to successfully answer. Throughout the entire encounter, he was polite, thankful, and relatively calm given the event he had just experienced. After providing a statement to law enforcement and EMS, the officer told me I could go as the injured driver was loaded into the ambulance. I gathered the rest of my kit (which had been strewn all over the place), walked back to my truck, and visually took an assessment of where his blood was on me. When I arrived back at my vehicle, my wife was on the verge of tears until I told her- "he's going to be fine." At first, given the amount of his blood that I had on me, I could tell she didn't believe me. I assured her that he was conscious and fully alert, and that he would be okay and she was overcome with relief. I grabbed a bottle of water and started washing as much of his blood off of my arms as possible as my own relief started setting in. I started telling my wife some of the details, and some of the things I immediately wished I would have done differently. I'm going to add them into this article for my own reference as well as to provide some insight to others who train with me.
I've now worked approximately 10-12 of these type of accidents, being one of the (if not the) first people on scene at a major wreck. Some of the people were alive and came out of it, others were dead as soon as I got to them, and some others were alive when I arrived and expired soon after. As is to be expected- with each one of these accidents, the process seems slightly more manageable in my own mind. After each of them, there are things that I tell myself I would do differently if I could rewind time. I'll list a few of those out now and provide some additional thoughts.
Multiple Medical Kits:
I always have at least two medical kits in my vehicle. However, they aren't necessarily next to each other which offers both advantages and disadvantages. In this case, I grabbed the kit that was most readily available and ran toward the accident. The problem with this is that I was carrying essentially one IFAK with some supplemental items that I have added. Luckily, there was only one person involved in this accident, but if I would have encountered multiple people that needed a pressure bandage, one of them would have been waiting for me to run back to my vehicle which was about 40 yards away. For me to unwrap and apply the Israeli bandage, then run to my truck and back with the other medical kit would have likely taken somewhere near 3 to 4 minutes. If you are bleeding from the head as much as the driver was, that's likely to be a life-changing amount of time. My first lesson of this incident was that I ran into the mix of it dramatically under-equipped if there would have been multiple injured people or even multiple injuries on the single driver. I was incredibly fortunate to learn this lesson without having to watch someone bleed out during my learning. This won't happen again as there will be redundant EVERYTHING in each of my kits by the end of this week.
This is one that I can't seem to learn... I don't want someone else's blood on me. It's not a good thing for a multitude of obvious reasons. During the last accident that I helped out at, I DID remember to get my gloves on before getting to the person that was bleeding profusely. I remember thinking to myself that I was very glad I remembered to do it and that I would make sure I'd do that from now on if I was ever in that situation again. I failed. I didn't have gloves on at any point during this process, and I had a significant amount of his blood on me from my hands to my elbows. I must get better at this.
My seatbelt cutter sucks. It was literally useless. That is one tool that I have never had to use during training, and one that I learned I will need to be practicing with. Thankfully the driver was alert and able to get the seatbelt off of himself, because my attempts to cut through his belt were futile at best. I'll be addressing this issue by investing in a significantly nicer cutter and also by practicing cutting seat belts on any of the old cars we train with. Honestly- this area was where I felt most deficient in my attempts to help in this event.
Opening the Israeli Bandage:
If you don't know what an Israeli Bandage is, please check out it here from Dark Angel Medical. They are essentially a pad of gauze that has an elastic wrap around it and an "H" hook to securely fasten it. It worked fantastic, once I got it out of the damn wrapper. During the process of cutting his side-airbag out and trying to remove his seat belt, I got a decent amount of his blood on my un-gloved hands. Knowing that I had a driver with a severe bleed from his head, my blood pressure was now extremely high and my fine motor skills were negatively effected. Couple those two things together, and it makes it difficult to open a sealed plastic wrapper. Should I have bitten it to open it? Should I have started to open it prior to getting blood on my hands? I don't know the answer to either- but instead I got a secondary knife I had available and cut it open. Though this isn't the preferred method, it's not like a chest seal where it is vital that the bandage not have a knife puncture and I needed the package open more than I needed it in pristine condition. I don't know how I would do this differently in hindsight- but I wanted to include it here as it is something to be aware of. Train with dish-soap on you hands to simulate the texture of blood. Do it after cardio exercises to get that heart rate up, and I think you'll find it frustratingly tedious to get the package open. I sure did...
Application of the Bandage:
"Uncle Hugh" (Hugh Coffee of Ditch Medicine) always tells us that the way you pick up cute nurses is by properly and professionally applying a good-looking bandage. He says that they'll be so impressed with the application of the dressing that they will simply be overcome with the need to meet whichever stud so eloquently applied said bandage. If this is true, I'll likely never know as I won't be winning any awards for prettiest application of the Israeli bandage. It was ugly... It was wrapped hastily and I was more concerned with direct pressure than I was with making a nice looking bandage. However, it was effective for the few minutes that I needed it to be until EMS and the other professionals arrived to take over. In the event that we were in a more remote location and experienced a longer wait time before EMS arrived, it would have been much better for me to wrap it more precisely and appropriately so that it wouldn't require any additional pressure to be manually applied to it. During my training, the majority of the immediate action exercises require the stressful application of a tourniquet- a skill with which I feel mildly comfortable. I will now be adding in the hasty application of a pressure bandage, as I poorly applied this one. It worked, but it won't win me any awards within our training circles for the prettiest application.
Training and Repititons:
I think it's fair to say that I train medical and tactical skills a good bit more than most civilians. Yet every time these skills are tested, I realize how much more training and repetition work there is to do... I feel like I'm getting better, but I also feel like there is so far to go. Some of the guys I've trained under are so much more methodical, calm, effective, and efficient- adjectives I would completely avoid when describing me during these events. While trying to appear as calm as possible to keep the injured driver calm, I felt about as awkward as a mule on roller skates when trying to do simple tasks like open plastic packages. I will improve. I will train more application of pressure bandages, cutting of seat belts, and working with simulated blood on my hands. I will make myself put gloves on even in training, and I will work on clearing my mind and slowing my thoughts. I will do this because I owe it to myself and to those around me. So do YOU... Yes, YOU... YOU- reading this right now, you may be the first responder to an incident involving a loved one or a complete stranger. It's a bad time to start learning or practicing while someone is bleeding out in front of you. You owe it to yourself and those around you to start learning these skills NOW.
My training resume is available on this site, and it includes some trauma medical. It will include more in the future. People that I have personally trained with and can't recommend highly enough are as follows:
- Hugh Coffee of Ditch Medicine
- Dark Angel Medical (Ross Francis is fantastic)
- Jesson Bateman of Crisis Application Group
- Jay Paisely (18Z and retired Special Forces Medic)
- Chase Jenkins of Talon Defense
- Clark Sparrow of Sparrow Defense
If you're interested in training with any of these people, please let me know and I'll personally put you in contact with them. Not being trained and not having equipment with you are both worthless excuses while someone is spilling blood on the ground. Make sure you don't ever have to look back and say "I wish I would've known what to do."