Proper treatment....read on.

[WANTYNU]

Ok...I give up....

Dwayne

LMAO, this has gotten surreal, I was waiting for the “Saw his legs off with some barbed wire found at the site” answer.

But I just can’t wait any longer, I’ve been to a number of conventions / trade shows and have always joked it would be the worse place to have a medical emergency…. This thread has just proven that point.

Dwayne said it 4 posts back, everybody has ASSUMED the worse or this or that (I don’t mean to dis folks here), there were a few good answers based on assumptions, and this is after all one of the ways we learn, however NONE that suggested wait were remotely correct (I really hope that’s clear by now).

Let’s break it down:

You know it’s cold, you know the Pt is in great pain. And yes Virginia there is NO air support.

Answer: (A) Transport

How about adding some info? Say our Pt has gone AMS?

Answer: (A) Transport

How about change in vital signs? Say tachycardia (because he’s already bleeding out by that rod underneath that punctured his femoral artery with the ground soaking up his blood, that you can’t see)?

Answer: (A) Transport

Drop in B/P?, Change in pain?, Skin signs? You can now assess his feet (pluses or not, motor / neuros or not)?

Answer: (A) Transport

Anything else you can think of?

Answer: (A) Transport

In fact let’s say the crane breaks down and now you can’t extract him? This would depend on the medical telemetry support you have and whether or not you can keep him warm until you can get him out in one piece, and your local laws, but remember the hiker that got trapped by a bolder and had to cut his arm off to escape?

Someone said it earlier, Life over limb.

Bottom line, you’re the medical person on the scene, your patient has an injury, it’s your job to get him as stable as you can and onto definitive medical care with as little delay as possible.

I once had a teacher put it this way, it doesn’t matter what you face, you job is simple, ASSESS and then TREAT, how complicated you make it is up to you.

As always IMHO

Be Safe,

WANTYNU

[AnthonyM83]

For traumatic arrests, ours is pretty clear. It says in big letters "RAPID TRANSPORT IS THE HIGHEST PRIORITY"

All that transport theory doesn't matter, though, because transport wasn't yet available. Removing or not removing the object can't be based on transport, because your transport (the helicopter in original scenario) isn't there, yet. You still wouldn't be transporting if you freed him. Like I said, you're waiting for the chopper for transport, not for ALS.

(Your only argument could be that you were going to intercept, but scenario didn't really tell us what direction they were coming from in relation to hospital and landing zones, etc.)

[fiznat]

1) Get all your gear together, open your supplies up and position whatever means of transport you have near the patient.

2) Extricate the patient

3) Control bleeding the best you know how and move ass.

There really is no other choice. If he really does have severed arteries, definitive treatment is surgery, not an IV line. Assuming the worst, you need to move towards that goal as quickly as possible.

[WANTYNU]

.... You are 2hrs plus away from town/nearest ALS by ground. No nearby air amb.

...., however it will be minimum 50 minutes before a charter helo with an als crew can arrive, due to no air amb in area.

The consultant on the site says that they have another piece of equipment that can be used to lift the object off the patient, then you can package him and meet ALS enroute.

...

I reread the initial post and under my first impression there was NO air ambulance available, having access to one makes for a different scenario. Although 50 minutes is a long time, in all reasonable scenarios, safely lifting a object off a victim would take a minimum of 15 minutes (and that’s saying all rigging was ready to go BEFORE the accident) more likely 30 minutes with everything going just right.

Fair to say 15 – 30 minutes before patient extraction is completed. Now your patient is on long board with bleeding controlled and your air transport is 20 – 35 minutes out.

Under this scenario it makes no sense to start a two hour ride, when waiting for air transport with a shorter ETA that ultimately equates to a faster delivery to treatment time, during which you are of course building upon your previous patient treatment, warming, treating for shock, up through application of a tourniquet (if required and allowed or advised by telemetry).

All that transport theory doesn't matter, though, because transport wasn't yet available. Removing or not removing the object can't be based on transport, because your transport (the helicopter in original scenario) isn't there, yet. You still wouldn't be transporting if you freed him. Like I said, you're waiting for the chopper for transport, not for ALS.

(Your only argument could be that you were going to intercept, but scenario didn't really tell us what direction they were coming from in relation to hospital and landing zones, etc.)

This makes sense except for the intercept, which would be a zero sum gain, when held against the logistics as stated above.

Still, if there is no air transport, I stick to my original post, and in either scenario transportation of the patient is the highest priority.

-w

[AnthonyM83]

I'm not sure if I missed something that's making this more complicated.

If there's faster air transport (original scenario): Wait for air transport.

If there's no air transport (added by AK): Immediate ground transport.

What else? Leave him there indefinitely? Take off on ground just so you're technically transporting? Yeah, right.

The only thing we have to decide on is:

If waiting for air transport, do you wait until helicopter is nearby to remove object so patient packaging is finished as chopper is landing? Or you remove the object 20-30 minutes earlier, then continue to wait?

I said wait off a bit, so if bleeding cannot be completely controlled, bleeding time is reduced (if it's totally uncontrollable, then he dies either way). If heat cannot be controlled, then that would take priority. Tourniquets either way, in case he IS bleeding out under the object.

[Just Plain Ruff]

I think a important piece of the information has been glossed over.

Helicopter 50 minutes out

75 minutes to darkness

Helicopter cannot fly at night.

What are we supposed to do, keep him under the load until first light?

We now have als there after 50 minutes but what are we gonna do with him from nightfall to daybreak?

[emsjunkie80]

I would package him and run because if you dont he could freeze to death when the shocks sets in

[AnthonyM83]

That night time thing was added later on, right? If chopper's not going to be able to transport, then you transporting takes precedence over getting ALS there. They can intercept us or whatever they'd like (could be useful for IVs to maintain permissive hypotension at a reasonable pressure?), but priority is fastest transport time by whatever level provider.

[mrmeaner]

There are a few keys in this scenario:

1, -35 C or just below 0 F is damn cold. Too cold to wait for anyone.

2, Two crushed legs is a significant MOI, not a death sentence.

3, Bleeding control and treatment for shock are BLS skills.

4, The goal for treatment of a major trauma is rapid transport to a trauma center, not to an IV.

5, Extrication will take twice as long as you expect.

The problem, I think, is that a paper scenario gives you time to think yourself out of the right answer. Imagine sitting for two plus hours in the freezing cold with a patient that has two tons of weight on their legs and telling the patient, "Sure you're in a lot of pain now, but you have to think long term." Even if you had thought this was a good idea initially, after ten minutes you'd be digging him out with a spork if you had to.

[rock_shoes]

All that transport theory doesn't matter, though, because transport wasn't yet available. Removing or not removing the object can't be based on transport, because your transport (the helicopter in original scenario) isn't there, yet. You still wouldn't be transporting if you freed him. Like I said, you're waiting for the chopper for transport, not for ALS.

(Your only argument could be that you were going to intercept, but scenario didn't really tell us what direction they were coming from in relation to hospital and landing zones, etc.)

Not 100% if this was in the original post or not but any drive in remote site in BC or Alberta with a medic also has ground transport available on site. This would be a control bleeding, board, treat shock, transport situation. If ALS is available to meet you enroute great. You guys are over complicating things. Yes the situation sucks but you can only do the best you can with what you have available.