Hidden Costs

 

We had to extricate a driver from a crash early this morning. Two people, both intoxicated (possibly also meth included) crashed into a tree on a rural road. The passenger was transported by ambulance but it took us over an hour to cut the driver out. As often happens, his feet were trapped under the dashboard. Typically, we can push the dashboard up with hydraulic tools but, in this case, he was pushed into a tree in exactly the wrong spot. We had to winch the car away from the tree and still cut it to bits to get him out. The driver had broken his right femur, tibia, and fibula, and had a concussion and serious chest injuries. The passenger was almost as bad.

Now, for the hidden costs: three fire departments took part with hydraulic tools (Jaws of Life). Two of the responders were from the county seat and are paid, but the other seven were volunteers. Two fully staffed ambulances were on scene from our county; I believe that only people who are not residents of the county get billed for services but ALS ambulance operations are not cheap. There were five LEOs helping (deputies and one trooper), and one medical helicopter. The helicopter is the only piece of the response which will probably be completely paid for. Keep in mind that all of the deputies tied up were unavailable for any other duties, just as was true for the four pieces of fire apparatus, all because someone wanted to drive home after imbibing. We talk about the cost of this stuff all the time but rarely consider the second-order costs.

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  1. MichaelKennedy Inactive
    MichaelKennedy
    @MichaelKennedy

    Arahant (View Comment):

    Or the third order costs from those first-responders having to see this kind of stuff, having to go through the tension and frustration as it’s not as easy to get them out as first thought. And then the inebriant may very well die, and it won’t have seemed worth that much effort. And over time, seeing enough of these will burn out some of those first responders.

    My son, who is now a firefighter, was a fire explorer scout when he was 17.  He went along in a response to a car wreck on a new street that had just opened near Mission Viejo CA.  A drunk had used it as a race course and lost control. He was not injured but the accident had started a brush fire.  My son was fighting the brush fire when he slid down a slope that was muddy and encountered a dead woman who had been ejected from the car.  The drunken driver had forgotten he had a passenger.  Pretty intense experience for a kid.  He is now an engineer with Calfire.

    • #31
  2. MichaelKennedy Inactive
    MichaelKennedy
    @MichaelKennedy

    Tex929rr (View Comment):

    GrannyDude (View Comment):

    Tex, do you guys have critical incident peer support/a chaplain?

    Among those second order costs is what responding to these things—even when they are (YAY!) successful—requires of our first responders.

     

    We do, thank you. So far I haven’t had to make use of one. As long as I feel that we did our best I’m usually OK. I had one 15 year old boy who was in cardiac arrest that bothered me months after the call, but I got over it. I reminded one of the young medics last night that he didn’t crash the car. The hardest ones are little kids when parents didn’t belt them in. Those are tough.

    I ran a trauma center in Orange County CA for years. Lots of stories.  I wrote a book about some of them some years ago.

    https://www.amazon.com/War-Stories-50-Years-Medicine-ebook/dp/B00ZQLNHXU/

    I had a 3 year old whose drunken father had him on his lap driving. Crushed between the wheel and the father.

    • #32
  3. Arahant Member
    Arahant
    @Arahant

    MichaelKennedy (View Comment):
    The drunken driver had forgotten he had a passenger.

    MichaelKennedy (View Comment):
    I had a 3 year old whose drunken father had him on his lap driving. Crushed between the wheel and the father.

    Yeah. My father was a policeman. I grew up hearing about these sorts of things. There’s a lot of stupid and ugly out there in the world.

    • #33
  4. GrannyDude Member
    GrannyDude
    @GrannyDude

    Doctor Robert (View Comment):

    Arahant (View Comment):

    Doctor Robert (View Comment):
    A very capable ER Doc I know retired at 55 for the same reason. He told me that in 26 years of work he had seen about a thousand deaths and a similar number of maimings, that enough horror was enough.

    More than most active-duty military officers ever see during a career, even if in the combat arms. PTSD would not be a surprise after a life like that.

    Arahant, that’s an excellent point. The horror is compounded by the fact that in most cases, my buddy was working hard to keep the patient alive and intact, so the 1000 deaths constitute 1000 body-blow failures for him. I have long been grateful that he was not working when my late first wife came out of the ambulance DOA.

    The doctor who was medical control, and who told the EMTs to discontinue the code on my first beloved husband was  a family friend. He didn’t know who his patient was until the EMTs came to the hospital a little later. He was devastated. A year later, he was on deck when my dad arrived with what turned out to be a fatal heart attack. The great thing about living in small community is that you know everyone. The bad thing about living in a small community is that you know everyone. 

    • #34
  5. GrannyDude Member
    GrannyDude
    @GrannyDude

    The people who are drawn to this kind of work are generally self-selected and, in the case of police officers at least, screened for their ability to process “bad stuff.” (“Critical incident stress” is cumbersome, and “trauma” doesn’t seem quite right either…). 

    In Maine, increasingly, police officers are given training in how to take care of their bodies after an event, whether or not they believe it has affected them.

    When training new members of one of the states’ Peer Support/Critical Incident teams, I go through the neurophysiology of critical incident stress, and ask: “How do we know that a first responder’s brain and body changed when he or she was confronted with this critical incident?” (Think: horrible car accident, guy with a gun, guy with a “gun”, screaming woman, fire, explosion, etc.) 

    The answer is: Because the first responder did his job.

    My shorthand for the cascade of neurotransmitters and hormones is “hero chemistry.” You’re bathing in it, dear Tex. It’s great stuff, and I am awed and grateful by what good men and women are willing and able to do with it, but it is hard on your body.

    So use your chaplain. Use your CISM team.  

    Along with “drink plenty of water” and “use your tactical breathing” and whatnot, I generally remind my guys to avoid violent movies or television shows for at least 72 hours after a call like the one you’ve described. “This is a good time for those chick flicks,” I said once, back when we first started doing this. 

    One of the older guys shook his head. “My wife doesn’t let me watch those,” he said sadly.

      

     

     

    • #35
  6. MichaelKennedy Inactive
    MichaelKennedy
    @MichaelKennedy

    GrannyDude (View Comment):

    Doctor Robert (View Comment):

    Arahant (View Comment):

    Doctor Robert (View Comment):
    A very capable ER Doc I know retired at 55 for the same reason. He told me that in 26 years of work he had seen about a thousand deaths and a similar number of maimings, that enough horror was enough.

    More than most active-duty military officers ever see during a career, even if in the combat arms. PTSD would not be a surprise after a life like that.

    Arahant, that’s an excellent point. The horror is compounded by the fact that in most cases, my buddy was working hard to keep the patient alive and intact, so the 1000 deaths constitute 1000 body-blow failures for him. I have long been grateful that he was not working when my late first wife came out of the ambulance DOA.

    The doctor who was medical control, and who told the EMTs to discontinue the code on my first beloved husband was a family friend. He didn’t know who his patient was until the EMTs came to the hospital a little later. He was devastated. A year later, he was on deck when my dad arrived with what turned out to be a fatal heart attack. The great thing about living in small community is that you know everyone. The bad thing about living in a small community is that you know everyone.

    I was once caring for a woman who had been involved in a single vehicle accident.  She was very pregnant and, when we had lost her, we tried to save the baby.  The anthesthesiologist who was involved in the case commented that she was quite dark in complexion and must not be “from around here.”  He also objected to the efforts to revive this obviously unsalvageable case.  Then the obstetrician who was trying to help us save the baby found the woman’s drivers’ license.

    She was an Indian ethnic physician and the anesthesiologist’s sister.  He was also a dark complected Indian and had not recognized his sister.

    I also practiced 40 years in a relatively small community.

    • #36
  7. Josh Scandlen Inactive
    Josh Scandlen
    @JoshScandlen

    Bryan G. Stephens (View Comment):

    The penalties for Intoxicated driving are just not high enough

    what would be high enough penalty?

    • #37
  8. Josh Scandlen Inactive
    Josh Scandlen
    @JoshScandlen

    Arahant (View Comment):

    Josh Scandlen (View Comment):

    You said we talk ab the costs of all this stuff but not the secondary costs.

    what stuff are you referring to? I’m confused

    Primary costs: Those injured or killed while driving under the influence of an intoxicant or those injured or killed by them. Their medical costs, funeral costs, lost lives are frequently discussed.

    Secondary costs: Costs associated with the rescue that are not directly attributable in a budget, nor recoverable from insurance. As Tex listed above, this can be volunteer time as well as cost for full-time, professional first responders. It also includes opportunity costs where if so many people were not tied up at this site caused by negligent use of intoxicants, police and others could have been elsewhere.

    Tertiary costs: Emotional fatigue and wear and tear on the responders as demonstrated by Doctor Robert above in talking about his friend the ER doctor. It’s hard to keep doing this work after seeing this type of thing too often.

    The costs from Drunk Driving. Okay. I wasn’t sure which costs you were referring to

    • #38
  9. Arahant Member
    Arahant
    @Arahant

    GrannyDude (View Comment):
    One of the older guys shook his head. “My wife doesn’t let me watch those,” he said sadly.

    I laughed.

    • #39
  10. Tex929rr Coolidge
    Tex929rr
    @Tex929rr

    Josh Scandlen (View Comment):

    Bryan G. Stephens (View Comment):

    The penalties for Intoxicated driving are just not high enough

    what would be high enough penalty?

    Honestly, IMHO, nothing seems to stop the vast majority of drunk drivers from doing it again.  I frequently read of fatal crashes where a driver has multiple convictions but is drunk behind the wheel again, licensed or not.  Jail time works but only as long as the actor is incarcerated.  

    • #40
  11. MichaelKennedy Inactive
    MichaelKennedy
    @MichaelKennedy

    Tex929rr (View Comment):

    Josh Scandlen (View Comment):

    Bryan G. Stephens (View Comment):

    The penalties for Intoxicated driving are just not high enough

    what would be high enough penalty?

    Honestly, IMHO, nothing seems to stop the vast majority of drunk drivers from doing it again. I frequently read of fatal crashes where a driver has multiple convictions but is drunk behind the wheel again, licensed or not. Jail time works but only as long as the actor is incarcerated.

    Lots of that category are illegal immigrants.

    • #41
  12. Phil Turmel Inactive
    Phil Turmel
    @PhilTurmel

    Tex929rr (View Comment):

    Josh Scandlen (View Comment):

    Bryan G. Stephens (View Comment):

    The penalties for Intoxicated driving are just not high enough

    what would be high enough penalty?

    Honestly, IMHO, nothing seems to stop the vast majority of drunk drivers from doing it again. I frequently read of fatal crashes where a driver has multiple convictions but is drunk behind the wheel again, licensed or not. Jail time works but only as long as the actor is incarcerated.

    I think we should bring back flogging for repeat offenders.

    • #42
  13. Tex929rr Coolidge
    Tex929rr
    @Tex929rr

    So, a family member of the driver complained that the reason for the crash was unknown.  Except that the deputy sergeant told me that the first deputies on scene said the driver was still drinking from a cup with alcohol in it – as well as glass and blood.  Waiting to hear from the trooper who supervised the blood draw at the hospital.  I suspect the family is very scared of a lawsuit by the passenger’s family.  

    To emphasize how rural/small town this is is all, I was the deputy sergeant’s Algebra 1 teacher.  

    • #43
  14. Tex929rr Coolidge
    Tex929rr
    @Tex929rr

    For anyone who saw this conversation, the driver was indicted for intoxication manslaughter.  Took over two years but it finally caught up to him. 

    • #44
  15. Chuck Coolidge
    Chuck
    @Chuckles

    MichaelKennedy (View Comment):

    Tex929rr (View Comment):

    Josh Scandlen (View Comment):

    Bryan G. Stephens (View Comment):

    The penalties for Intoxicated driving are just not high enough

    what would be high enough penalty?

    Honestly, IMHO, nothing seems to stop the vast majority of drunk drivers from doing it again. I frequently read of fatal crashes where a driver has multiple convictions but is drunk behind the wheel again, licensed or not. Jail time works but only as long as the actor is incarcerated.

    Lots of that category are illegal immigrants.

    When I took the local papers, what I regularly read was about no DL, couldn’t speak English, no proof of insurance.  Will the sheriff get reelected? You betcha!

    • #45
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