Proper treatment....read on.

[whitewolf]

Main dif between air amb and charter helo, air amb has all the equipment med crew needs, charter helo's crew need to bring all their on rig equipment with, as well as with some of the charter helo's I have seen, the pt. access once loaded is greatly reduced for providers.

Although good pick-up on air support is air support Anthony. For the sake of the scenario I was distinguishing the difference between an actual air amb and a charter crew with a medical crew due to the fact that alberta does have air amb coverage provided by 3 helicopter bases in the province, as well as military medical choppers out of one of our air bases in the East central part of the province. The area where this hypothetical is taking place is outside of coverage of any of these assets. Therefore medical crews must rely on charter helo operators who may or may not have medevac experience, in sometimes less than ideal aircraft for the operation (the a-star comes to mind.) The a-star is a great helo, just not when you have a boarded pt you are trying to fly out. And if the pt is over 6' you're screwed, as they won't fit, which is another consideration.

Anyways I digress. For sake of scenario, helo available is an a-star with an experenced pilot. Again, minimum 50 minutes out.

Add in for argument sake, the incident happens with less than 75 minutes til night fall. Helo is not equipped to fly at night. How does this change treatment options? Thoughts?

[Boolancedriver911]

Treat for shock and wait. If hes stable now, keep him that way.

I have to agree with you. Not an easy scenario though.

[p3medic]

As JP said on page 1, bilat tq's and haul ass. There is no benefit to waiting on scene for ALS, as an ALS provider, the first thing I would do before lifting the load would be to place the TQ's. In addition to the problem of uncontrolled bleeding, you also have the sudden return of blood flow from the lower extremities, with hyperakalemia, clots and other badness in addition to bleeding to worry about. The TQ's should help with all the above.

[DwayneEMTP]

Man, I'm truly shocked by the types of responses shown below. Yours isn't so different FD5, I'm simply picking on it because I know you're a good sport and like a good discussion.

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.

Based on what? You've done no lower extremity assessment, you're simply guessing here. If it's my life at stake, I'd prefer you went with an intelligent response based on verified info.

The cold weather might be an asset. Keep him warm but the cold may help if he is somewhat hypothermic.

Man, I’d like to see you try and explain that to med control. “See doc…I was pretty sure that this huge weight that crushed his legs was controlling the bleeding better than I could, plus, you know, the literature is full scientific data showing the benefits of leaving critically injured people lying on the subfreezing ground…..” At which point I’m guessing he’ll have you restrained and sent for a psych eval…

Guys! We’re talking hemorrhage control here! Many of you are condoning leaving a (Possibly!) terribly injured person lay on the freezing ground so you don’t have to contend with bleeding!!

High flow O2 is a must. Since you can't assess the extent of lower extremities you assume the worse.

The scenario makes it very clear that you CAN in fact do the assessment. You’ve simply chosen not to.

And you haven’t assumed the worst here. Next to not having any injuries at all, you’ve assumed the best; Crushed legs with complete hemorrhage control. How far wrong do you have to be for this patient to die? How large of an uncontrolled bleed do you need for this man to bleed to death while you wait for ALS to come and put pressure on it?

And how do you explain to his family later that his life was salvageable, but he exsanguinated because the medical professionals on site decided his fate was better left to chance than to their trained/educated efforts?

Also, what happens if the chopper can’t make it, or is very delayed? You have no drugs…what are you going to do with the possible acidosis and hyperkalemia when it comes time to remove the weight?

Anyway. Most of you know I have no right to be a “know it all.” And that's not my desire... this just seems like such an obvious decision to me. Dust is fond of saying (Something like) “There is only one truly important ALS skill, and that’s assessment.” (My apologies if I got it wrong) Yet most here chose to skip assessment, and wait for help based on their intuition that they already knew what was going on below the weight.

That seems crazy to me…but as is often the case…I could be wrong.

Have a great day all. I look forward to your thoughts.

Dwayne

[firedoc5]

There's a lot of "what if's". What if he's not crushed and just pinned? Chances are he is crushed. Leaving him on the frozen ground may not be the best course, but it might be the only thing you can do. Keeping the tamponade intact along with hypothermia might buy you extra time before ALS can get there, even if it's just by a few minutes. And we all know every minute counts. It's a tough situation that will probably have a poor outcome.

The only thing I can think of that would be around a rotary drilling rig that heavy that can fall on you is either the "kelly tool", which is a long square shaped pipe, or a section of boring drill stem pipe. The one other thing I can think of is a stack of the large bags of drilling mud, which can be removed quickly. The biggest issue is whether or not you can examine the lower extremities. That's the biggest obstacle. If you can just assess those injuries that would answer a lot of questions.

All in all, in this situation with all the "what if's" it's impossible to ascertain a correct definitive answer for care. You just got to do your best with what you've got. There's probably no absolute correct course of action.

[akroeze]

You guys are waiting for ALS to get there and do...... what?

[JPINFV]

You guys are waiting for ALS to get there and do...... what?

Pass off responsibility :?:

[DwayneEMTP]

If you can just assess those injuries that would answer a lot of questions.

Ok...I give up....

Dwayne

[firedoc5]

Ok...I give up....

Dwayne

Uh, give up on what, man? Sorry if I've made anything confusing. Guess what I'm trying to say is that if you can examine the extent of the injuries the best you can by not lifting the object is half the battle. It can determine what the best course of action can be.

[AnthonyM83]

You guys are waiting for ALS to get there and do...... what?

Transport