What Do You Do In This Fictional Situation?

[rpcarnell]

Not really, it's about as good as it gets here too.

Panama doesn't have the cold Wisconsin weather. All I needed was to be a little less lazy and look at older posts. Removing the person's clothes once inside the ambulance to avoid hypothermia is the answer to that. A guy I knew from a chatroom committed suicide with a shotgun, and that's why I chose Wisconsin (a dedication to him).

Choosing Panama would've been easier, but if a guy traveling from one small town to another suffered an accident like the one I described around here, a helicopter would be needed to take him to the capital, where the good hospitals are. Either that, or someone would have to take him to a small clinic using a regular car. Not exactly what you need when 6,000 words is the limit for a short story publisher.

Thanks for your help!

[FormerEMSLT297]

to quote Willy Wonka. "GOOD DAY SIR."

[crotchitymedic1986]

I am not scared: The first order of business is alway Airway with cspine control, breathing, and then circulation. The first trained persons on the scene would most likely hold manual C-spine, while others do a primary survey of the whole body. At some point the patient would be immobilized and moved to the back of the ambulance, where a more detailed assessment could be performed. IV access would be obtained enroute to the hospital, as well as further care that would be dictated by his injuries. If his ribs had punctured a lung, the patients pneumothorax or tension pneumothorax would be addressed. His leg would be splinted, but the type of splinting would vary by which bone was fractured. He may or may not require oxygen. He would be transported to a trauma center, should such a thing exist near where he was injured.

[Richard B the EMT]

Item 1.

Forgive my ignorance on the subject, but is a Scoop-Stretcher necessary in a case like this?

That depends on where the incident happens. I know New York protocols, as that is where I have been trained and work, but do not know Wisconsin protocols, which is where this episode is supposed to take place. Per my local protocols, which might or might not be the same in Wisconsin, spinal precautions will be done on a spinal long board, not a Scoop. Use the Scoop, the NY State Department of Health (DoH) is going to come after you for operating out of protocols, and could end up with either or both a fine and loss of certification.

Item 2.

I am a newbie in need of professional help.

Can I refer you to your local Psychiatric Advisory board for referrals? (LOL)

[Just Plain Ruff]

Forgive my ignorance in advance. I am a newbie in need of professional help.

What do you do in this situation?

Driver crashes against a tree. His right leg is fractured and a few ribs are broken. He climbs out of the car even though the dashboard shot forward and is pinning him against the steering wheel.

It is raining, and since he is unable to walk because of a broken leg, he drags himself close to the road while getting wet. This is Wisconsin, so the rain is cold.

I am assuming that the paramedics arriving at the scene will stabilize his right leg first. Then they will use a cervical collar to stabilize the neck. They will do all this while asking him questions just to test his mental faculties.

That's what my research says, but it seems dealing with a C-cord injury is the first thing that must be done. I am assuming checking for signs of hypothermia is a must as well.

Forgive my ignorance on the subject, but is a Scoop-Stretcher necessary in a case like this?

I'm gonna make him walk his sorry butt over to my ambulance. If he had the unmitigated gall to get out of the car on his own, thereby preventing me from playing with my extrication tools then he can walk his sorry ass to the ambulance. As a matter of fact, he can start his own IV and decompress his own freaking chest.

but I digress

[TJZ]

I am in Wisconsin, the rain is cold and I prefer the now. So anyway, since Wisconsin protocol was brought up. It is not much different from those that others have cited for their states. A big no on the scoop stretcher. Those are for elderly on the floor with broken hips (many times a day, they are very handy for that). So, airway and c-spine first, breathing (oxygen just because it never has killed anyone yet), circulation. Full rapid trauma exam while boarding (long board) and deal with anything found as it comes up. Full immobilization no matter how they were when I arrived. I will board you standing up if that is how you are when I get there after a crash. Hell, I will board you even if the first EMT's didn't when they brought you from the scene and I am taking you from small town ER to my town level 1 trauma. I will not punish anyone for not laying there and waiting for me. Sometime people do not think straight when injured.

[tniuqs]

I'm gonna make him walk his sorry butt over to my ambulance. If he had the unmitigated gall to get out of the car on his own, thereby preventing me from playing with my extrication tools then he can walk his sorry ass to the ambulance. As a matter of fact, he can start his own IV and decompress his own freaking chest.

but I digress

I am so with you on this Ruff ... if buddy can drag is lame ass that far whats a few more feet ! If he did get that far I would clinically clear C Spine quite obvious to me ... BUT tie his legs together (so that this tourist) will not get out of paying his bill.

Ladymedic250 : Has the best advice of all ... she obviously has worked in 3 rd World countries, as I have you would be dang LUCKY to get an ambulance with a locally fabricated wooden spine board ... more like a local "rich" farmer with a beat up toyota 1/4 ton and an old out shit house door as a stretcher and just push the pig going to market over a bit.

To the OP rpcarnell ... good luck with your law suit ... in Panama / Wisconson, as for the suicide by shotgun in a chatroom (a deadication ?) ... well yea know that is quite a stretch too ... so good luck with that.

The thing about the truth is that it is repeatable and does not change midstream, you may go away with one thing about this EMT city site ... most experianced EMTs/ Paramedics have an excellent BS indicators built in because we have heard most all of it before.

GDay

[cpat1723]

How did he get out of the car if the dashboard pinned him in like you said?

[Monhae]

A scoop scretcher is a tool. One of many in a limited arsenal of tools available on an ambulance. Spinal immobilization can be done with a scoop, a long board, a short board, and KED, a Vacuum board, a set of board splints and a few other creative things, in conjunction with a C-collar or CID or other neck and head stabilizing devices. There is not a definitive answer to your question. From the limited information to create a mental imsge, several of the aforementioned devices could be used and all be appropriate. Only the medical professionals onscene could determine what the "best" device of choice is/was. the rest of us can give conjecture and opinion, but nothing concrete. Each device having it's pros and cons, limit our opinions even more. Considering the mental picture I developed from your story, I would say a scoop is acceptable, but no more or less acceptable that a long board. The term "best" is and always will be a subjective term and again falls to the primary care giver's impression of the scene to make that determination. The short of it is, we can't answer that question.

Jimmy

[rpcarnell]

I'm gonna make him walk his sorry butt over to my ambulance. If he had the unmitigated gall to get out of the car on his own, thereby preventing me from playing with my extrication tools then he can walk his sorry ass to the ambulance. As a matter of fact, he can start his own IV and decompress his own freaking chest.

but I digress

Well, the character in question wants his son to face three kids bullying him. He thinks every woman wants to date him. He thinks he is the best psychiatrist in the US, and everyone else is mediocre, so, in a perfect world, that's exactly what any EMT should make him do.