Proper treatment....read on.

[DwayneEMTP]

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

Actually Doc, wondering about the MAST pants is what got me to thinking, "Based on what?"

We haven't moved the block, there's no assessment completed....shoot. We've got all of these great ideas based on worst case scenarios, when in fact, based on my limited experience to date, that is almost never the case.

Much more often I look at the MOI, see "Mr. Should Be Dead" laughing and dancing around, and think, "That is the luckiest bastard on the planet right there!" :shock:

Anyway...was this a real call? I don't remember now...But I think most of us made too many decisions with no information...this was a great learning question.

Dwayne

[whitewolf]

no...this ws not based on a real call to my knowledge, it was a question that was posed to me by one of my EMT class mates, due to my experience in the oil patch. She is working in an extreme remote area, and stdying for her registration exam, and she asked me the question based on a what if scenario.

I agree with Dwayne. Without actually being on scene and conducting an assessment, it is all conjecture. Several people did bring up good points, as in how soft the ground was, etc which could influence several factors/decisions such as moving the pt. and begining transport. Weather also places another factor. To my knowlegde -35 is not ideal flying weather, however not a huge issue. Weather and time of day are factors as well, with most helo's being unable to fly at night or in low visibility.

This did turn into a better learning question than I thoght it would. Interesting to see how different people look at this scenario. Thanks for the input everyone!

[firedoc5]

I guess I'll go with the crowd that says to not lift the weight off. You lose any tamponade and he'll bleed out quick. The cold weather might be an asset. Keep him warm but the cold may help if he is somewhat hypothermic. High flow O2 is a must. Since you can't assess the extent of lower extremities you assume the worse. Can the feet be exposed to check for circulation? Can someone dig out enough to check? That's about all you can do until ALS arrives. It goes without saying, two large bore IV's (some will argue LR with both, or one LR and one NS). Use MAST if available.

I was raised in the oil field. My father was an oil producer for many years. And I have seen those kind of injuries and almost any kind of injury you can think of associated to the oil field. I was going to get a bug shield on my truck that said "Fourth Generation Oilfield Trash" but my wife (my first one) wouldn't let me do it.

[JPINFV]

Ok, assuming worse case scenario, what are paramedics going to do? You can only infuse so much fluid before you flush out enough blood cells that the fluid level becomes meaningless. So, you've waited the 2 hours with him becoming hypothermic and bleeding out through any hole before the machine, and now you've still got a 2 hour drive to the hospital.

[Asysin2leads]

I'd say either way the guy is f---ed in the a-- with a big rubber d---. ALS or no ALS, if he is going to exsanguinate from wounds that can't be controlled, then he is going to die. 50 minutes to a trauma center in the air means approximately 120 mins before he even sees the ER trauma team, let alone surgery. I mean, I've had people with these types of injuries die enroute to the hospital after an ALS team and an emergency response physician respond and treat on scene and the transport time is less than 10 minutes. This guy is pretty much dead.

Large bore lactated ringers or normal saline won't help. High flow oxygen won't help. Tourniquets might help. If you want to be perfectly morbid about he whole situation I would say wait for ALS so they can give him a load of painkillers to get him nice and doped up before he meets his maker. Otherwise, pick 'em, pack 'em, and fire it up.

[AnthonyM83]

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

AK, I thought you were the one who added no air support into the scenario. We keep discussing air ambulance, because that consideration was part of the original scenario. Nearest hospital 2 hours by land. Nearest trauma center 3 1/2.

I think most those who said to wait for ALS did so based on original premise that ALS chopper is 50 minutes out. After, the no-air support part was added, then I said, load and go.

If ALS is on its way and it seems that his legs are crushed (based on ground hardness, equipment that fell on him, etc), I would hold off the 50 minutes. It's - 35, so I would imagine compartment syndrome would be slowed down. I would closely monitor for shock and would consider tourniquets if shock symptoms progressed. He could be bleeding out from injuries above where the object same to final rest.

[AnthonyM83]

I was raised in the oil field. My father was an oil producer for many years. And I have seen those kind of injuries and almost any kind of injury you can think of associated to the oil field. I was going to get a bug shield on my truck that said "Fourth Generation Oilfield Trash" but my wife (my first one) wouldn't let me do it.

Did you see the movie, "There Will Be Blood"?

[firedoc5]

Did you see the movie, "There Will Be Blood"?

Nope hadn't seen. Saw some previews from it. Seems intriguing.

[JPINFV]

AK, I thought you were the one who added no air support into the scenario. We keep discussing air ambulance, because that consideration was part of the original scenario. Nearest hospital 2 hours by land. Nearest trauma center 3 1/2.

I think most those who said to wait for ALS did so based on original premise that ALS chopper is 50 minutes out. After, the no-air support part was added, then I said, load and go.

If ALS is on its way and it seems that his legs are crushed (based on ground hardness, equipment that fell on him, etc), I would hold off the 50 minutes. It's - 35, so I would imagine compartment syndrome would be slowed down. I would closely monitor for shock and would consider tourniquets if shock symptoms progressed. He could be bleeding out from injuries above where the object same to final rest.

Scenario:

You are in the oilfield making extra cash as an industrial first aid attendant. You are working at EMR/ First responder level, which means no IV's, no meds, etc. You are 2hrs plus away from town/nearest ALS by ground. No nearby air amb.

No air ambulance was included in the original post.

[AnthonyM83]

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

Is there that much of a distinction (for purposes of our decision making) between an actual air ambulance and a charter helicopter with ALS crew? Either way it seems like "air support" to me... I'm using them mainly for transport time, not primarily for ALS anyway.

If I'm wrong, I welcome more info on difference (as it related to this scenario of course).