This article first appeared at EMSWorld.com Jan. 30, 2014.
Danger on the road remains a fact of life in EMS, and one for which many agencies remain unprepared. Though most incidents aren’t fatal, every agency should plan ahead for the possibility of provider death or serious injury by getting familiar with the EMS Line of Duty Death Handbook.
Download the EMS Line of Duty Death Handbook
Jim Pollard, public affairs manager for AMR Central Mississippi, can testify to that. He says the resource was a godsend after one of his service’s paramedics, Jennifer Hesselbein, was struck on a scene and critically injured July 31, 2013.
Earlier that same week, Pollard had taken a copy of the handbook to a meeting. “I said folks, we need to go through this.” They didn’t make that happen before the crash, but they had the resource fresh in their minds as they anxiously awaited word on whether Jennifer was going to survive.
“I got the call from our communications center and ran off copies of the LODD handbook and highlighted a few specific items in it,” Pollard says.
Although it may seem that much of the handbook’s advice should come to mind naturally, he says, “It was great to have those prompts and a structure for organizing resources to manage an awful situation.”
The Incident
Jennifer and her partner Jonathan Blackwell had been dispatched to an emergency scene at about 8:45 p.m. when they came upon another incident en route. On the four-lane road with a double yellow line, there was a vehicle stopped in the left lane on their side and a woman outside it flagging them down.
She said she had hit a man, and several feet ahead of her across the yellow line was a man lying on the pavement. He was able to talk, and his immediately visible injury was a broken arm. The partners radioed for another ambulance to go on to the original call while they handled this scene.
Jennifer was bent over the patient when, “All of a sudden a vehicle coming from the opposite direction veered across the double yellow line toward Jennifer and Jonathan,” Pollard says. “Jonathan saw the vehicle bearing down on them and pulled her toward him as fast as he could.”
The vehicle hit and killed the patient instantly and hit Jennifer on the left side of her body. It continued down the road until it hit an empty vehicle and came to a stop.
Jennifer was knocked under the front bumper of the ambulance and was unconscious. Jonathan pulled her out, tended to her and immediately called for help.
“Jennifer was severely injured head to toe on her left side,” Pollard says. She gave permission for Pollard to describe her condition.
Jennifer’s Injuries
She suffered facial injuries that included her left eye, which she has since lost, and injuries to her scapula, ribs, pelvis, knee, left tib/fib and ankle. It was only recently discovered that she had also suffered a broken right wrist. Her pelvis and additional other fractures are now held together with metal. “We’re grateful beyond words that her brain is intact,” Pollard says.
Several crews and a supervisor responded that night, and Jennifer was transported to the University of Mississippi Medical Center—which happens to be the only level 1 trauma center in the state, and was just four miles down the road. The driver of the crashed vehicle was also transported, and was released and arrested that night on DUI charges, Pollard says. He was denied bond and is in jail awaiting trial.
“Everybody was just on pins and needles… the initial report was that we could lose her,” Pollard says. “There was a great deal of concern that night.”
At one point there were about 25 colleagues, plus members of other agencies, gathered outside the ED to express their support. Jennifer was known for being spirited about her work, Pollard says. The staff got some level of comfort from the emergency physician on duty that night, who happened to be a former paramedic who had worked at their agency.
Jennifer was in the surgical ICU for weeks and underwent about 18 surgeries. She was then discharged to a regular patient room for several more weeks, and then moved to Methodist Rehabilitation Hospital just next door to the university. She turned 28 while she was in the hospital, and on Dec. 5 she was discharged to go home. She is still receiving out-patient physical therapy and, while she still relies on a wheelchair, she can now take a few steps with a walker.
The night of the incident, her parents had already loaded up the car to come visit from their hometown of St. Louis, MO. They were bringing her wedding dress as part of planning for their wedding set for October 4, 2014. “Her commitment is that she’s going to walk down the aisle,” Pollard says. As of 1-2 weeks ago she was able to take quite a few steps with a walker during physical therapy.
“She has an iron will and she loves what she does so much,” Pollard says.
Managing the Situation
“That night was one of those nights you don’t want to go through and we’re thankful to Providence the worst didn’t happen,” Pollard says.
The management team collaborated through the usual chain of command, he says, and made sure the family’s needs were covered. They included Jennifer’s parents, three sisters and brother—one of the most tight-knit and supportive families that Pollard says he has ever seen. Jennifer’s parents essentially relocated for months, Pollard says. Her father retired a month earlier than planned and her mother just recently had to go back to St. Louis to resume work there.
Immediate gestures included assigning a primary contact to the family, getting them a hotel suite, getting them breakfast when they hadn’t eaten and offering transportation.
Other immediate actions included notifying the staff of the incident, telling them they would provide updates, and asking them to be careful not to violate Jennifer’s patient privacy or pass along any information they did not personally know to be fact. Social media was “afire with information, some of it not entirely accurate,” Pollard says.
As calls from the public came in offering donations, management pointed the family toward options for creating a fund at a bank.
Another way they were able to assist the family was by providing wheelchair transport to allow Jennifer to get back to her apartment for a family Thanksgiving dinner.
Management also offered stress management support to crew members who had been in close proximity to the incident, which included three ambulance crews and a supervisor that had responded to the scene.
Close colleagues created hundreds of ribbons in Jennifer’s favorite colors of blue and pink that virtually the entire staff of 300 wore for weeks, Pollard says. “It was a show of solidarity and a constant reminder to take care of yourself and your partner.” Incredible support was also shown by Monterey VFD, where Jennifer is a member.
As time stretched on, the outpouring of support from the medical community continued with fundraisers. Prior to a pancake breakfast, Pollard says, the organizers announced the event would include moving Jennifer from a third-floor apartment to a first-floor, wheelchair-accessible apartment.
Through it all, Pollard says he was tremendously grateful to have the EMS Line of Duty Death Handbook to guide them.
“The document is a contribution of the highest order to the EMS field in my opinion,” he says.
“My biggest piece of advice is—any supervisory team ought to dedicate time to go through that document and anticipate who will be doing what. It’ll pay off, I guarantee it.”
As the coordinator for the creation of the handbook, AMR’s Tawnya Silloway, writes in the introduction: “I hope you never have to use this handbook, but I encourage you to look it over and implement the planning stages. Being prepared is an important part of what we do.”
For more on Jennifer, see her website at teamjenniferh.com and on Facebook at facebook.com/prayingforjen.