Ridryder 911 Posted July 11, 2006 Share Posted July 11, 2006 So I guess, FDNY has not heard the philosophy of .... "too many cooks will spoil a dinner"..... Geez, the first part of working on any patient is control of the scene, and this means the number of persons involved as well. I don't care if it NYC, Boomesville, Kentucky. Control the scene, don't let the scene control you!.... sorry, lost count after 10 helmets around one patient... "ever seen vultures fly over a carcass?"..they even have more respect. Looks like cluster f***, very glad, I am not involved in a system that demonstrates that... and I am sure there were plenty of bosses in Chiefs in proportion of Indians. It all comes down to common sense. Yes, I am arm chair quarterbacking, it easy to do on this one... try to count the number of firefighters in front of potential hazardous area. Are we still learning?.. R/r 911 Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted July 11, 2006 Share Posted July 11, 2006 So I guess, FDNY has not heard the philosophy of .... "too many cooks will spoil a dinner"..... Geez, the first part of working on any patient is control of the scene, and this means the number of persons involved as well. I don't care if it NYC, Boomesville, Kentucky. Control the scene, don't let the scene control you!.... sorry, lost count after 10 helmets around one patient... "ever seen vultures fly over a carcass?"..they even have more respect. Looks like cluster f***, very glad, I am not involved in a system that demonstrates that... and I am sure there were plenty of bosses in Chiefs in proportion of Indians. It all comes down to common sense. Yes, I am arm chair quarterbacking, it easy to do on this one... try to count the number of firefighters in front of potential hazardous area. Are we still learning?.. R/r 911 That i will agree with. Was it a slow call day in New York that day? Im sure people come out of the woodwork when they hear technical rescue, but this is impressive, to say the least. PRPG Link to comment Share on other sites More sharing options...
Ace844 Posted July 11, 2006 Share Posted July 11, 2006 1. The patients head was secured in an appropriate manner when the team reached EMS in an area which was no longer a clearly dangerous place. Look at the pics again. Pics #2 and 3, in 'scar's' post show no head blocks, because the patient is in the "well" of the stokes, ther is nothing preventing lateral movement of the head in the stockes and or board other than tape, which in these situations quickly loses it's 'Tackyness-stickyness' on the skin and 'breaks free'. Failure to properly secure the head with 'blocks' or other such device is a critical failure point on the Natlr registry and I'm sure your state exam FOR ALL EMS LEVELS!!. As far as the 'strapping', and such in those pics that does look to have been corrected. 2. The board was properly secured to the board (or vice versa actually) at the time where the subject reached EMS. Beyond the rapid extrication stage, when EMS care could be delivered. See above response 3. Patient lines and exposure? There is absolutely no reason why they couldnt wait 2 minutes and get him to the truck. Stopping in the middle of the street to expose this patient and start IV's is a ridiculous notion when they are no longer entrapped and their apparatus is close by. Exactly, among the basic tenets of assessment and trauma care are assess, correct life threats & potential life threats, if they can't be corrected stabilize them as best as possible, if not able don't move on, if able, move on. Then begin the assessment from the begining, and do as aforemnetioned. Exposing as necessary. If in the prescence of the above where soemthing wasn't secured properly, or you need to fix it, do so but be sure all is correctly done and placed before moving on. Next move on to the other interventions and assessmnet items as you were taught. This would include exposure to look for hiddeen life threats, BLI, an IV, etc... Oh, BTW because WE KNOW THIS PATIENT WAS IN AN EXPLOSION WHY IS NO ONE CONSIDERING BLI (bLAST LUNG INJURY, OR OTHER OVERPRESSURE INJURIES!?!?!?) and why not while we are fixing the board and since we are a new clinician in contact with this patient repeating our assessments and interventions as necessary?!?!?!! This should happen nearly ALWAYS! 4. The only issue present they did not do and should have was utilize the damn O2 bottle at his head for something more than extra weight to make the FD carry. See the above response, the patient should have gotten O[sub:c1fe223fdc]2[/sub:c1fe223fdc] I agree. Thats all i got. PRPG out here, ACE844 Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted July 11, 2006 Share Posted July 11, 2006 I agree and disagree with several points. 1. The spineboard was appropriately secured to the stokes basket when they reached EMS. Patient was also secured to the LSB. Again ace, relook at the LSB picture. He was secured to the LSB with green webbing, and secured to the stokes with orange straps. The green webbing system in place in a common fire service means of laching someone to an LSB for extrication. Matter of fact, I have a pre made rigging with all the appropriate knots to perform that rigging in my turnouts. 2. I cant speak for the head, Ive used tape with no blocks as a temporary measure until you get blocks in place. Without further idea as to what was delivered to the ED at the end, im going to step away from the blocks debate. 3. There is nothing in these photos to suggest this patient couldnt was for the primary assessment to be in the squad. Absolutely nothing. A's B's and C's then go! Time is tissue. Link to comment Share on other sites More sharing options...
Ace844 Posted July 11, 2006 Share Posted July 11, 2006 "Prpg, & Everyone," Here are some links to learn more about this type of situation, and the associated injuries.. http://www.emedicine.com/emerg/topic63.htm http://www.bt.cdc.gov/masscasualties/explosions.asp http://www.cdc.gov/masstrauma/preparedness/primer.pdf http://www.dvbic.org/blastinjury.html http://www.wramc.army.mil/fieldmed/Pulmonary/index.htm Next lets address the other things. If you take the pictures and 'blow them up' so to speak you will see the following: For the sake of clarity and example here’s Pic #2: [align=center] As you can see in this picture above, the patient does have straps on, but….. is crooked on the board and head is unsecured, and appears to be ‘leaning on an angle’ on the ‘board’ to the left about 10 degrees or so. The c-collar at this point is also ‘crooked’ and improperly applied. the patient is fully clothed and still no O2.. :roll: there are 5 EMS personel and one DOC around the patient. Just standing there, Are you really suggesting to me that working as a team togther they couldn't-wouldn't be able to accomplish all of the tasks I mentioned in a rapid, safe, appropriate, timely manner. I see Trauam teams in ER's do it all the time with that many and some times less people. :shock: 8) Some where I think that assertion doesn't hold water #3 [align=center] The patient appears to be ‘better secured, and properly secured to the board and stokes’ in this pic, yet the collar is still crooked and no blocks…If you look closely at the picture you will see a NRB inflated and hooked up to the O2 cylinder blowing O2 into the atmosphere. Also none of the other ‘standard if care interventions have been undertaken as well. They did manage to ‘pad the ‘occiput’ though so it’s strange they ‘didn’t have time’ as you suppose to do other things in this ‘rapidly evolving situation.’ Seems to me that if you have the time to pad the occiput of a critical patient you have time to take care of ALL of your ABCD interventions and management….. If you look down towards the 'wheels and bars of the stretcher' you'll also see the unfastened stretcher straps hanging as well. As I mentioned these are just a few things I noticed… HTH, Ace844 Link to comment Share on other sites More sharing options...
whit72 Posted July 11, 2006 Share Posted July 11, 2006 Look someone stole his watch........lol I would agree, where is the O2, looks like he has some decent burns on his upper extremities, possibly inhalation burns? I believe I see someone carrying an IV bag. My god my eyes hurt. Link to comment Share on other sites More sharing options...
ncmedic309 Posted July 11, 2006 Share Posted July 11, 2006 The only things that should be visable to us in these pictures is this patient placed correctly in full-spinal immobilization, high-flow oxygen being applied or ventilations being assisted (which ever is more appropriate based on his presentation) and him moving very rapidly to the awaiting ambulance, at least that's how it would work on my scene. Everything else from that point on (intubation, chest decompression, IV, monitor, secondary assessment, etc.) would be done in the back of my truck and enroute to the appropriate facility. After looking at these pictures, the only thing I can see wrong after he was rescued, is no oxygen being applied to the patient as he is being moved (to the assumed awaiting ambulance?)... Edit: Just to clarify about interventions, I don't see anything wrong with someone wanting to intubate before loading the patient or with dropping a 14 ga. in the chest, but if the airway can be managed effectively with a BVM, let's get this patient into a more optimal environment and take care of business... Link to comment Share on other sites More sharing options...
Ace844 Posted July 11, 2006 Share Posted July 11, 2006 Look someone stole his watch........lol I would agree, where is the O2, looks like he has some decent burns on his upper extremities, possibly inhalation burns? I believe I see someone carrying an IV bag. My god my eyes hurt. The NRB is above the pt's R forehead area.... Link to comment Share on other sites More sharing options...
whit72 Posted July 11, 2006 Share Posted July 11, 2006 I agree once the pt. was moved from the hazardous area. You have no excuses. Its odd if you have time to put an IV in someone, why not the O2? Link to comment Share on other sites More sharing options...
ncmedic309 Posted July 11, 2006 Share Posted July 11, 2006 I just noticed the IV bag... Link to comment Share on other sites More sharing options...
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