Good Samaritan - Rescue Vs. Medical

[MidwestFF]

If I got involved in that type of scene and I didn't have all my PPE on my chief would rightfully have my head on a pike(ouch). Yes, even as a firefighter I am concerned with scene safety. Hmmm smoking car, leaking fluids; rule of thumb applies no PPE, I do not approach the scene any closer than what I can cover it with my thumb at the end of my outstretched arm. I will call it in and wait for the AHJ. I don't always have my bunker gear with me but more often than not it is.

 

[spinnakr]

If I got involved in that type of scene and I didn't have all my PPE on my chief would rightfully have my head on a pike(ouch). Yes, even as a firefighter I am concerned with scene safety. Hmmm smoking car, leaking fluids; rule of thumb applies no PPE, I do not approach the scene any closer than what I can cover it with my thumb at the end of my outstretched arm. I will call it in and wait for the AHJ. I don't always have my bunker gear with me but more often than not it is.

I dunno, if approaching at night and not immediately noticing the leaking fluid, I'm thinking more along the lines of what I was taught for HAZMAT: calculated risk. If there's a good chance of rescuing a savable life, then that's worth some risk.* Plus, if the car catches, the driver is completely screwed.

*Please note: I'm talking about SFPC and full SCBA when it comes to HAZMAT, which is still considered Level D HAZMAT protection (aka, no protection at all). But, 75% of the threat is inhalation.

 

[DV_EMT]

very good questions all!

To answer a few of them.

Impaled object - its just in the person's body (they're not pinned to the seat), not impeding them from being extricated. Like I said though, you don't really have the equipment to do a proper c-spine (KED) extrication.

Smoke - VERY GOOD to those who answered Airbag! The smoke is due to an airbag deploying

Fluid from the car - I used the example clear/odorless to provide detail that it was not gasoline. Therefore, its safe to say it could be wipre fluid, water from the radiatior, or possibly freeon from the A/C (though that has a slight odor)

Blood Perfusion - the driver has lost about 250-500 mL of blood (judging from the impaled object site and the blood that has run into the seat). The blood is currently slowly seeping out from around the impaled object. It is bright red in color.

 

[DV_EMT]

Nice catch, Sandog.

A couple more questions about the impalement:
Color of the blood? Quantity? Quality? Any other fluids?
By right in the middle, do you mean (essentially) the navel?
What kind of pain is he in from the impaled object?

Somewhat unrelated question: what kind of car am I driving (this is serious)

To clarify

dead center, right in the navel!

Pt complains of a pain 7/10 that is dull and achy, but extremely painful according to the patient.

The Car.... to be fair to all parties, lets make it a Jeep Wrangler, 6 cylinder. with mud tires and offroad lights! There is a tow package with a D ring and or trailer hitch.


Sorry about the fluid leaking portion of the scenario... i had to change it because I made the circumstances a night accident. So, to clarify, There is a clear odorless fluid that you don't notice at first, but upon approaching the vehicle, you notice it is present. there is not much fluid present... just enough to know its there. hope that clarifies!

 

[looker]

Being that i am not even an EMT, i would continue driving. Depending on how many people are around, i might call 911 and report the emergency

 

[reaper]

Then it would not matter. There is no way that a jeep would not have any access to the passenger!

So treat as you would any other MVC!

 

[ah2388]

i prob remove the impaled object, perform rapid extrication on both patients, and try my hardest to turn the "black" patient into a red as soon as possible.

Rinse Repeat when current yellow patient becomes black

 

[TransportJockey]

call 911 and keep on driving

 

[ah2388]

call 911 and keep on driving

incorrect

 

[TransportJockey]

incorrect

Really? You're telling me that me deciding what I'd do is incorrect? How?

 

[ah2388]

i prob remove the impaled object, perform rapid extrication on both patients, and try my hardest to turn the "black" patient into a red as soon as possible.

Rinse Repeat when current yellow patient becomes black

clearly the correct plan of action

 

[spinnakr]

i prob remove the impaled object,

I sure hope not. That object is occluding blood flow and saving the patient's life. Removing it will kill the patient. There's a damn good reason that in every EMT and medic class you take - as well as any fire class - they will tell you NOT to remove an embedded object.

No offense man, but especially in a remote setting, you just killed both patients. You'd also be open to lawsuits from the family, because negligent behavior (ie, removing the impaled object) isn't covered by Good Samaritan laws (and for good reason).

 

[ah2388]

I sure hope not. That object is occluding blood flow and saving the patient's life. Removing it will kill the patient. There's a damn good reason that in every EMT and medic class you take - as well as any fire class - they will tell you NOT to remove an embedded object.

No offense man, but especially in a remote setting, you just killed both patients. You'd also be open to lawsuits from the family, because negligent behavior (ie, removing the impaled object) isn't covered by Good Samaritan laws (and for good reason).

I thought I made it pretty clear that I was being sarcastic, in fact..I'd prob do something very similar to what jt is advising

 

[TransportJockey]

clearly the correct plan of action

Oh hell no. You do not remove an impaled object unless it interferes with the airway. Ever. And if a patient is black, they're staying that way. You say you're a medic student? Then tell me what's the probability of getting back a trauma arrest in a trauma room, much less prehospital with no equipment.

EDIT: Just read the post you posted above this. Your post didn't sound very sarcastic. I've seen sparky new EMTs come in and post stuff exactly like that and be 100% serious

 

[ah2388]

Oh hell no. You do not remove an impaled object unless it interferes with the airway. Ever. And if a patient is black, they're staying that way. You say you're a medic student? Then tell me what's the probability of getting back a trauma arrest in a trauma room, much less prehospital with no equipment.

EDIT: Just read the post you posted above this. Your post didn't sound very sarcastic. I've seen sparky new EMTs come in and post stuff exactly like that and be 100% serious

i apologize for not making myself clear, I thought the vocabulary involving "triage tagging" would indicate that I at least have something resembling an idea what I'm doing...

Just trying to have a little fun fellas

 

[spinnakr]

i apologize for not making myself clear, I thought the vocabulary involving "triage tagging" would indicate that I at least have something resembling an idea what I'm doing...

Just trying to have a little fun fellas

Phew. You had me reaaaally worried there.

For the record... Look at the "smoke" (powder) color in the bottom right corner of this picture:

Compared with the smoke color in this picture:

It's pretty easy to tell which one is from an airbag. Generally speaking, nothing on fire these days is going to have a light gray smoke... it'll have a nice, black, disgusting smoke.

As for the scenario, I see no reason to extricate the driver when you have pt. access and no indications of immediate threat to life. Make the 911 call, dress the driver's wounds, pad the impaled object, and wait for help to arrive. Monitor until that time.

 

[Cory]

Being that i am not even an EMT, i would continue driving. Depending on how many people are around, i might call 911 and report the emergency

Please tell me you were being sarcastic too... You might call 911?

call 911 and keep on driving

Why keep driving? If there is something you can do, and you are trained to do it, why the hell wouldn't you do it? Why would you have spent time and money educating yourself in EMS courses if you were only going to use them for work? Seriously, I can't even begin to understand this train of thought. There are no immediate scene safety issues, besides being on what I would imagine is a dark road. If nothing else, I would try and comfort the pt who is still conscious. But I guess since you are big tough emtlife anti-"whacker" man, patient care has nothing to do with actually caring about the patient.

You wouldn't even bother to stay and try to assist rescue crews?

 

[Trayos]

I'd call 911, and if the scene could be determined safe, talk through with the victims to keep them (more or less) calm. Other then that, there's sadly not much more I could do in the ways of extrication given my current level/equipment.

 

[Lifeguards For Life]

Please tell me you were being sarcastic too... You might call 911?




Why keep driving? If there is something you can do, and you are trained to do it, why the hell wouldn't you do it? Why would you have spent time and money educating yourself in EMS courses if you were only going to use them for work? Seriously, I can't even begin to understand this train of thought. There are no immediate scene safety issues, besides being on what I would imagine is a dark road. If nothing else, I would try and comfort the pt who is still conscious. But I guess since you are big tough emtlife anti-"whacker" man, patient care has nothing to do with actually caring about the patient.

You wouldn't even bother to stay and try to assist rescue crews?

cool story, bro!

 

[busmonkey]

For me, I would call 911, pad the impaled, dress the wounds until it got to dangerous. If I was worried about the smoke, I would call 911 punch the window with whatever was available to keep venting and get the hell back. Let the guys with SCBA go in and extract. Your patient on the otherside has no airway which means they are clinically dead, basic triage means so sorry buddy. That's about it for me.