A real life shooting video

[Veneficus]

This is an example of arrest being a symptom of death, not the cause. The cause was being shot many times in vital areas. Arrest protocols are worthless when you are exsanguinated, and/or lungs are shot through.

If we remember the great video shared by one of our members earlier this year, the cause of death (arrest if you will) of nearly all GSW subjects is bleeding. Maybe shot directly to the heart or the head might be different, and a usually less-than-lethal wound might precipitate shock, but usually its loss of blood. CPR, AED will not reverse nor address this.

In order to successfully treat shock you must restore delivery of O2 and mitigate the inflammatory response. (Which is where the game really begins)

The systemic inflammatory response is directly connected to the coagulation cascades, the kininogen cascades, and all of their respective mediating cascades. (like antiinflamatory and anticoagulation)

Additionally inflammation not only reacts to injured/dead tissue, it injures and kills healthy tissue.

Furthermore, it sets off an endocrine response and changes the body's metabolism.

Like I mentioned in the other post. Circa 1600s medicine (focused on O2 delivery only) will not save multisystem trauma patients. (or any patients in profound shock for that matter) That was pointed out as far back as a review of literature in the 1850s.

 

[Sandog]

Shocking. Did anyone find it odd how a guy shot half a dozen times was hand cuffed behind his back? Have you ever tried to breath while laying on your stomach with your hands behind your back?

The dude was obviously contained, were handcuffs behind the back really necessary? After a multiple GSW one would think the airway might just be important.

 

[RocketMedic]

Sandog, you always want to secure a GSW victim when you're in-close. In this case, the patient was dying and truly unconscious/unresponsive. Sometimes they're not. It's far safer to handcuff and then strip than it is to fight them and risk further injury or death by your own gun.

6 rounds of anything from a handgun is far from reliable in terms of killing someone.

 

[ExpatMedic0]

My answer, he's dead. It wouldn't matter.

+1 to that

Also, you can analyze this situation all you want from an EMS perspective, the fact of the matter is... nothing would have or could have changed the patients outcome by the time EMS made contact. The fact EMS even chose to work a traumatic cardiac arrests is another interesting situation.

 

[samiam]

6 rounds of anything from a handgun is far from reliable in terms of killing someone.

S&W Magnum 500...


Too bad we dont have anything to plug up the 6 holes that all of his blood was leaking out of during those great compression....Im being serious QuikCot?

 

[Sublime]

6 rounds of anything from a handgun is far from reliable in terms of killing someone.

That's highly debatable

From the video alone, I felt the cop reacted too quickly. Kinda made me sad to watch and rewatch that part.

Agreed. Pretty brutal watching him try to get up a few times then just collapsing.

Maybe "aid" is too specific of a word. I, however, doubt you'd just shrug your shoulders and walk back inside for some tea.

Yup, atleast the family has the consolation that someone tried to help him... and not just left on the lawn to die. If that even means anything.

I think you could justify working this either way.

 

[Veneficus]

I think you could justify working this either way.

I am not sure that a trained and "professional" healthcare provider has an obligation to flog a dead body in order to make somebody feel better.

As the knowledgable expert, I think healthcare providers have a responsibility to recognize and acknowledge the futility of treatment or the obviousness of death.

In this case, EMS served no beneficial purpose and simply disturbed a crime scene and subsequent shooting investigation.

It could also be said they wasted both man hours and equipment, both of which have financial implications. (Some argue this is not their concern, but since financial constraints can impact the health, safety, and prosperity of survivors, as well as the financial stability of your employer, and by extension you, I would think it should be a serious concern.)

The EMS response in this incident was both ineffective and wasteful. The one thing that had the most remote possibility of helping was not done.

 

[Veneficus]

+1 to that

Also, you can analyze this situation all you want from an EMS perspective, the fact of the matter is... nothing would have or could have changed the patients outcome by the time EMS made contact. The fact EMS even chose to work a traumatic cardiac arrests is another interesting situation.

I have no problem working a penetrating trauma arrest, but it has to be done right.

In this instance, from the EMS standpoint, that is a load and go. No spine boards, no CPR, just whatever you can get done in route, like a basic airway and possibly start some large bore IVs so the hospital can infuse blood if they so choose.

All the other EMS toys have no use here.

In fact I would argue that this "victim's" best chance of survival was one of those cops tossing him into a cruiser and driving to a hospital.

 

[mycrofft]

Where's the "gruesome" part? I just wasted 10 minutes of my life. Where I work, we'd of called him and gone back to the station to sleep.

You're a mensch, VCEMT!

 

[mycrofft]

Shocking. Did anyone find it odd how a guy shot half a dozen times was hand cuffed behind his back? Have you ever tried to breath while laying on your stomach with your hands behind your back?

Uh.......no...?:blink:
Actually, lay me supine and I'd suffocate.

 

[VFlutter]

It sounded like the officer who shot the suspect started to get more frantic about rendering aid after he could not find the knife that he was supposed to have on him. Also, with the officers running around in and out of the house and family members still screaming I would not really consider the scene secured/safe.

 

[mycrofft]

In order to successfully treat shock you must restore delivery of O2 and mitigate the inflammatory response. (Which is where the game really begins)

The systemic inflammatory response is directly connected to the coagulation cascades, the kininogen cascades, and all of their respective mediating cascades. (like antiinflamatory and anticoagulation)

Additionally inflammation not only reacts to injured/dead tissue, it injures and kills healthy tissue.

Furthermore, it sets off an endocrine response and changes the body's metabolism.

Like I mentioned in the other post. Circa 1600s medicine (focused on O2 delivery only) will not save multisystem trauma patients. (or any patients in profound shock for that matter) That was pointed out as far back as a review of literature in the 1850s.

Thanks, Vene. It would be interesting to see parallel timelines of changes in different physiological paths after massive insult like this (metabolic, endocrine, respiratory, cardiovascular, neurological). Like that game at the fair where the mechanical horses run for the finish line....see which pathway kills you first. With six GSW I'm betting on hypovolemia/neurologic/cardiac.

It's all so holistic.:wacko:

 

[bigbaldguy]

Nothing to add on medical care end.

Interesting to note though that every comment made by people on scene including medics was recorded. Have you ever worked with one of those guys who just can't shut up with what he thinks are witty comments on scene? Or one of those crews that things discussing their dating life while working a patient is pefectly acceptable. Imagine if one of the medics had made a comment on scene like "man this guy must be a priest he's so holy" or similar. Just something to think about.

 

[mycrofft]

I have no problem working a penetrating trauma arrest, but it has to be done right.

In this instance, from the EMS standpoint, that is a load and go. No spine boards, no CPR, just whatever you can get done in route, like a basic airway and possibly start some large bore IVs so the hospital can infuse blood if they so choose.

All the other EMS toys have no use here.

In fact I would argue that this "victim's" best chance of survival was one of those cops tossing him into a cruiser and driving to a hospital.

Fact is, we have seen that in shootings at other scenes/incidents.*

Don't get me started about how EMS culture is molded by its start under NHTSA gingerly extricating spinal victims from 1950's and '60's era cars.


*Now I'm in for it, implying there are things you can do in a hospital which you can't in an ambulance....

 

[abckidsmom]

Nothing to add on medical care end.

Interesting to note though that every comment made by people on scene including medics was recorded. Have you ever worked with one of those guys who just can't shut up with what he thinks are witty comments on scene? Or one of those crews that things discussing their dating life while working a patient is pefectly acceptable. Imagine if one of the medics had made a comment on scene like "man this guy must be a priest he's so holy" or similar. Just something to think about.

This is a good point, BBG.

 

[mycrofft]

1. It sounded like the officer who shot the suspect started to get more frantic about rendering aid after he could not find the knife that he was supposed to have on him. 2. Also, with the officers running around in and out of the house and family members still screaming I would not really consider the scene secured/safe.

1. Yeah! Task one: find the weapon. Task two: then treat the guy you killed. (It's not called lethal force for nothing).
2. Agreed. Closing in on the subject with people still in the truck...not happening on purpose. The officer suddenly "caught the car" and had potential threats across nearly 180 degrees and no one with him, thought there was going to be a weapon...suddenly it's getting "complicated".

If there had been at least two officers this might have ended differently. As it was, its very lucky it only ended up in one person shot.

 

[mycrofft]

Too bad we dont have anything to plug up the 6 holes that all of his blood was leaking out of during those great compression....Im being serious QuikCot?

Joseph Wambaugh used a similar line in a novel, might have been one of his LAPD locker room stories. Badguy stabbed in heart or major chest vessel, falls down sort of out of sight of public. Officer puts subject's hat over the wound and starts compressing like mad....gets a decoration, too.

Well, research how QuikClot works and its side effects then compare that to the anatomy of six holes drilled through your body, all at different angles and through different systems. Anything theoretically strong enough to stop those would clot you solid throughout your entire body.

 

[Veneficus]

Thanks, Vene. It would be interesting to see parallel timelines of changes in different physiological paths after massive insult like this (metabolic, endocrine, respiratory, cardiovascular, neurological). Like that game at the fair where the mechanical horses run for the finish line....see which pathway kills you first. With six GSW I'm betting on hypovolemia/neurologic/cardiac.

It's all so holistic.:wacko:

The point is even if you restore hemostasis from hypovolemia, the patient may still die from the wounds.

The integration of these pathways in shock has been a 3 year full time PhD pursuit of mine. The information is simply not neatly packaged in one definitive source and new material is added almost daily. Infact, I just wrote an email to a doctor whos recent study adds yet another facet to this.

As I maintain, it must be a holistic approach. The seperation of surgical hemostasis and intensive medical management of resuscitation is just not going to change the results we see today. The recent wars have proved beyond any doubt closer integration improves outcomes.

 

[mycrofft]

Agreed. Pretty brutal watching him try to get up a few times then just collapsing.
Yup, at least the family has the consolation that someone tried to help him... and not just left on the lawn to die. If that even means anything.

I think you could justify working this either way.

Getting shot is brutal, not like TV.

Good notes on the family/friends.
First, they have a history with/against law enforcement, so this is "not good" on more than one level, especially afterwards. Also, even though this guy was a bad guy (not a shoplifter or wanted for parking warrants), and had a domestic dispute the prior evening, to them he was still family and was "murdered" by the "f^%king cops!!".

 

[mycrofft]

The point is even if you restore hemostasis from hypovolemia, the patient may still die from the wounds.

The integration of these pathways in shock has been a 3 year full time PhD pursuit of mine. The information is simply not neatly packaged in one definitive source and new material is added almost daily. Infact, I just wrote an email to a doctor whos recent study adds yet another facet to this.

As I maintain, it must be a holistic approach. The seperation of surgical hemostasis and intensive medical management of resuscitation is just not going to change the results we see today. The recent wars have proved beyond any doubt closer integration improves outcomes.

When I started to recognize the holistic or global approach, then I realized that order and timing of treatment is not like shuffling 3X5 cards, one has to try to find commonalities between cases then identify critical points to intervene; Pareto Principle at work, first 20% gets you 80%of results, but it keep resetting so yo keep finding more 20%'s.

More than once I've seen a patient with everything done well and right, laying there awaiting the coroner.