Proper treatment....read on.

[AnthonyM83]

If no air transport available, then you better do your best to get going as fast as possible to limit compartment syndrome and try to save his legs, if possible. Tourniquet and go. BLS trauma care. O2 and warmth. Detailed exam. Reassess.

[whitewolf]

"Its cheaper to not have ALS and there are endless amounts of EMR willing to do the job for lesser rates." -akflight medic

I was being rhetorical, just blows me away that companies can operate this way.

[fallout]

I would be of the remove the pinning object and go camp.

Exsanguination is a major risk in this case. The femoral arteries and the femur can do a significant amount of bleeding. Might the bleeding prove fatal? Yes.

Approximately an hour of developing anaerobic metabolic wastes as well as exposure to -35 degrees Celcius cannot be good for the critically injured patient. Add in extra flight time for the helo since I doubt weather conditions resulting in -35 deg C are ideal for flying. Then, add in time where the ALS crew has to stablize before the object is removed. Hypothermia and severe trauma have a much higher change of mortality for the patient.

Either way, the patient is a bad position.

[Fluffpaw38]

Treat for shock and wait. If hes stable now, keep him that way.

[akroeze]

You should not wait for ALS. What is ALS going to do for this patient? Provide some fluid that will make no difference in the long run? All you are doing is wasting time by waiting on scene.

Having said that, when in doubt call your doc and have them decide.

[DwayneEMTP]

Treat for shock and wait. If hes stable now, keep him that way.

But BLS treatment for shock is to elevate feet, keep warm, O2 right? How are you going to do these things?

I also say he has to go. It's too cold to stay and dink around, as well as the fact that you might as well be driving in case the helo doesn't show up.

Also, the "stay" crowd seems to be assuming that because his legs are crushed (how do we know? They might not even be broken.), that all bleeding has also been controlled? What leads you to that conclusion? I'm not saying it's impossible, but you've bet this man's life of a fact that you have chosen not to verify.

He may be bleeding, he is certainly going to freeze to death (No way you can heat the ground under him), it's time to make the hard decisions folks. This is what you've trained for, practiced for....Go to work!

Get him out. I can't decide what's killing him if I can't assess him.

Get him naked. With 4000# on his legs, do you suppose he might also be injured elswhere?

Get his life threats under control. Elevate his legs, pressure on bleeding areas, if necessary we're going to use tourniquettes to stop the bleeding. Hell, they might have stopped, if they had in fact ever started, by the time you get him out.

Get him warm while you're driving.

You can't assume that because something big and scary is on his legs that you have to wait for the "oh shit!" people. On this scene you are the oh shit people.

So for those of you that chose to leave him based on your worst case scenario...

You wait an hour for ALS to arrive by helicopter. By this time your patient is a trauma code. ALS ceases attempts at resuscitation. After removing the object you discover that the sandy loam below the man obsorbed most of the weight of the falling object, but a large bolt sheared off his left foot. The uncontrolled bleeding combined with the sub-zero ground temp. caused the pt to die while you waited for "someone else" to do something.

All he really needed was the elevation and pressure that could have been offered by a first week basic and he might have lived for days....

Just sayin....

Dwayne

[emt322632]

Good points Dwayne.

I say get him to the local small town hospital and arrange for air txp to meet you there. No point in making a bad situation worse, and if you get him to the local hospital at least there they can do some stabilization that you are unable to do before he is transported by air.

[ERDoc]

Does anyone think MAST pants might be a good idea in this situation? :shock: :shock: :shock:

[akflightmedic]

For what??

Inflating them to lift the object off the guy?? LOL

Just kidding. Actually no where in the state of FL do we carry those anymore and we did not carry them in Alaska either. So quite frankly they did not pop up immediately in my mind as I have not had them for many years now.

Plus, once again, this is an EMR not an EMT B, so I doubt he has been trained on them. (I could be wrong).

And everyone who keeps saying air support this or air support that...per the original poster, there is NO air support.

You are looking at a minimum of 4 hours road time plus however long it takes to extricate him and stabilize before moving.

But yes, doc...MAST pants may come in handy provided he does not have any of the other contraindications...or would there be any when it is your only choice to try and stabilize a life for transport??

[rock_shoes]

DwaynEMTB thank you for putting the weather factor out there. It's -35 celcius he's talking about. What's the point making sure your patient doesn't bleed out if you let him freeze to death in the process. An EMR should have the ability to control major bleeding of the extremeties and if they can't they should hand there license back to their governing body.