Car Crush

[CBEMT]

I believe it's open, not closed, chest wound that precludes MAST, but CPR in progress is ABSOLUTELY a contraindication.

Congratulations, your post just became Exhibit A.

We teach "Vowels in the MIST."

Adjunct to CPR

Edema (Pulmonary)

Isolated extremity fracture without shock

Open chest wound

"U pregnant?"

Myocardial

Infarct

Shock (Cardiogenic)

Tamponade (Cardiac)

[Dustdevil]

Sounds like a typical "Farmer Brown" situation to me.

Sure. Many of them live so far from where the ambulance or rescue truck is coming from that they just figure it'd be a lot quicker to get help from a neighbour. In a lot of cases, they're right. And in a lot of rural cases, the volly EMS guys are just "neighbours" anyhow, so they are not viewed with as much professional respect as if they were calling real EMS professionals.

But, of course, this is not exclusive to rural scenarios. When Heath Ledger's housekeeper found him in full arrest in Los Freakin Angeles, did she call 911? No, she called Mary Kate Olsen first. Stupidity is not limited to hicks.

And open chest injuries would not be the only chest injuries that preclude the application of MAST, even back in the days we used them. It doesn't take an open chest wound to cause intrathoracic haemorrhage. If you're bleeding in the chest (from an aortic tear, aneurism, flail chest, etc...), MAST is a huge no-no, regardless of whether the wound is open to the surface or not.

[firedoc5]

I'm just curious but isn't it contraindicated to use MAST pants with a chest and head injury?

This was about 18-20 yrs. ago so I'm not sure if that certain service even carries them anymore. Medical control instructed to apply MAST. And MAST, at least at that time, WAS indicated for CPR, medical or trauma wise. The only contraindication was cerebral edema or pulmonary edema. (I might be wrong, may have killed off too many brain cells since then) It was believed that the increase of vascular resistance was aided by lessening the circulation in the lower extremities.

The time are-a-changin'.

[Dustdevil]

This was about 18-20 yrs. ago so I'm not sure if that certain service even carries them anymore. Medical control instructed to apply MAST. And MAST, at least at that time, WAS indicated for CPR, medical or trauma wise. The only contraindication was cerebral edema or pulmonary edema. (I might be wrong, may have killed off too many brain cells since then)...

That is exactly how I remember the conventional wisdom and prevalent protocols to read from twenty years ago, so I believe you are correct. I am extremely bothered by the thought of how many people I may have killed by following those protocols.

[Richard B the EMT]

Oops, Dust!

But, of course, this is not exclusive to rural scenarios. When Heath Ledger's housekeeper found him in full arrest in Los Freakin Angeles, did she call 911? No, she called Mary Kate Olsen first. Stupidity is not limited to hicks.

Mary Kate Olsen was in Los Angeles, Heath Ledger and the housekeeper were in the SOuth of HOuston Street (SoHo) area of Manhattan, NYC NY.

I do agee with your statement that

Stupidity is not limited to hicks

is quite accurate, however. Why call 9-1-1, when you can call the famous girlfriend, TWICE, to have the girlfriend call her body guards ro respond, and they end up calling 9-1-1?

I posit that the nationwide 9-1-1 systems are a victim of their own success, as no matter what the "emergency", the folks are going to call, and the system gets jammed up with both actual emergency calls, and "presumed true emergency" calls.

(Now I add a new wrinkle to the mix, unrelated to the actual subject. There is Houston, pronounced "Hugh Ston" in Texas, and a street in NYC called Houston Street, pronounced "How Ston". I know that they are named after 2 different individuals, but the Noo Yawkers and the Texans have been duking it out for years, and probably will be for many more to come.)

[firedoc5]

That is exactly how I remember the conventional wisdom and prevalent protocols to read from twenty years ago, so I believe you are correct. I am extremely bothered by the thought of how many people I may have killed by following those protocols.

You're exactly right. In the last five years, the very few times I have spoke to a class on shock, and luckily it's been ALS classes, I have barely mentioned MAST. Large bore IV's, ET, compressions if needed and blood loss control. And the very few times I did mention MAST was to assist in lower extremities fractures and/ or pressure to reduce blood flow.

[wbgraidermom]

i know most areas have rescue trucks in their fire department. in the county that i grew up in, if a call came in about anything having to deal with a car, the fire department was dispatched to the scene along with ems. my question is why didn't family just pick up the phone and call to ask for help and explain what had happened instead of trying to do it themselves?

[firedoc5]

i know most areas have rescue trucks in their fire department. in the county that i grew up in, if a call came in about anything having to deal with a car, the fire department was dispatched to the scene along with ems. my question is why didn't family just pick up the phone and call to ask for help and explain what had happened instead of trying to do it themselves?

In the small town I grew up in, and have moved back to a couple of years ago, their "rescue truck" is actually their "grass truck". The only thing rescue on it is a generated and I think two port-a-powers. That's it. They say why do they need more because the ambulance carries everything else that might be needed. And they don't get called out unless someone scanner jumps or the ambulance requests them for man power.