Just Plain Ruff Posted December 12, 2008 Posted December 12, 2008 You respond 30 miles outside of your base for a man entrapped in a piece of farm equipment Weather is crappy and there are severe thunderstorms all around your area and no helicopter pilot in his right mind would attempt a flight in that weather. Your hospital is a 76 bed facility with a 10 bed ER. No orthopedic surgeon nor trauma surgeon is available today. What do you want to know. By the way, there will be a lively discussion with this one I'm sure.
mobey Posted December 12, 2008 Posted December 12, 2008 Is he pregnant?? hahaha What kind of equipment is he entrapped in? Is fire enroute? How long has he been entrapped? Can you describe the scene?
Just Plain Ruff Posted December 12, 2008 Author Posted December 12, 2008 you arrive on scene to find a array of farm equipment all around the scene. There are 5 combines, 7 tractors and a plethora of other pieces of equipment but you are motioned over to a very large combine with only the head of the victim seen. You approach the equipment and you see a 75year old male trapped in a combine at about the mid-femur level. There is a large amount of blood on the ground and splatters of blood inside the combine. You also notice that you see both femurs protruding from the thighs. The patient is still conscious but incoherent. Fire is 13 minutes out and the combine still sounds like it's running but not loudly.
Eydawn Posted December 12, 2008 Posted December 12, 2008 Cut power to the combine. First step. This might be an appropriate place to use tourniquets, if his lower limbs are hamburger already. O2, wait for Fire with extrication gear, and get the helo on the way. Wendy CO EMT-B
mobey Posted December 12, 2008 Posted December 12, 2008 Pack the stubs with dressings, try turn the machine "Backwards" assuming he is stuck in either the pickup or the concave. Bilat large bore I.V.'s, O2. How is his Breathing? any pressure on his abd from the machine? OK I am quick to assume there is nothing below the femurs?? Are his legs missing? or just open fractures?
Just Plain Ruff Posted December 12, 2008 Author Posted December 12, 2008 read my original post - NO Helicopters - just consider that you are in the eye of a hurricane and the next bout of weather is coming fast. But seriously there is no hurricane - just terrible weather. NO HELICOPTERS guys I know we rely on them entirely too much but.;...... NOPE nada, none no no no helicopters. Power is OFf to the combine
Eydawn Posted December 12, 2008 Posted December 12, 2008 So I missed the thing about no helos, so sue me... I'm still calling dispatch and putting in a request in case we get a weather let-up. So there! We need to stop the bleeding... and get him out if possible. How stuck is he? Wendy CO EMT-B
Just Plain Ruff Posted December 12, 2008 Author Posted December 12, 2008 his legs are hamburger, the bones are crushed but there is a significant amount of tissue still in there. There is no way you are gonna get him out till at least fire gets there.
fireflymedic Posted December 12, 2008 Posted December 12, 2008 I'm going to start a line of NS and one of LR and titrate to maintain a systolic BP of 80 - 90 I don't want it much higher than that to prevent more blood loss than I can compensate for causing him to bleed out faster. If we've got a respectable BP, then I'll give a little in the way of pain meds to keep him at bay until FD shows up. Do we have a reasonable airway? Can I please maintain that or what is he like? How shocky is he at the moment? If blood loss is out of control and still active, I'll consider tourniquets as this is one case where most likely he's going to lose those lower extremities anyway and with prolonged extrication, he may be a candidate. Lets hope that keeps him stable until we can get this guy out which hopefully is soon. I can deal with no helo, but if there were a candidate for one - this guys it.
Arctickat Posted December 12, 2008 Posted December 12, 2008 RuffEMS...just wondering...do you actually know all that much about combines and how they are constructed? I don't ask to be facetious, I ask because it would be a relatively simple extrication that could be completed long before Fire arrives. I work in a rural agricultural setting, the scenario you describe is not all that dissimilar from my experiences. Is sounds as though you are describng him trapped under the header auger and pulled into the feeder belt, is this correct? If so, how far into the feeder has he gone?
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