Mast trauma pants

[JLO1965]

Can anyone help me? I'm researching a legal case. This is such a long story. Anyway my question is a 21 year old male in a bar fight was stabed in the chest. On arrival of a BLS crew the patient pulse was weak. The placed mast trauma pants on him. When the EMT arrived they screamed to remove these pants. All the research I've read said this is never to be done in the field. The patient crashed and died. The patient had attacked someone he was also on cocaine at the time. The person he attacked was defending himself. So my question, I mean you don't have all the details but is putting these pants on someone with a chest wound something any of you would do. Any help you can provide with be greatly apprechiated.

[FireMedicChick164]

First I need you to clear up a few things for me:

1. You said the BLS crew arrived and put the MAST on the patient. Did they inflate them right away?

2. Then you said the EMT arrived and started yelling for them to remove MAST from the patient. Was the "EMT" an ALS provider? What about the EMT that arrived with the BLS crew?

If the BLS crew inflated the pants then they should have NOT been removed in the field.

3. What state are you from?

Here in NY our protocols are for the MAST are for hypotension secondary to suspected pelvic fx and severe traumatic hypotension. They are NEVER removed in the field. (Compartment Syndrome comes into play here as well if they are left on long enough also)

In the 9 years I had been an EMT Basic and the 2 years I have been an AEMT I have never had to use the MAST. Our main hospital is pretty close to our district and even the trauma center is only 15-20 minutes away (5 minutes by chopper).

**The NY State Dept Of Health placed in their protocols recently the results of a study done on MAST. I have copied the recommendations below:

MAST (PASG) are "usually indicated, useful, and effective" (Class I evidence) for:

· None.

MAST (PASG) are "acceptable, of uncertain efficacy, [although the] weight of evidence

favors usefulness and efficacy" (Class IIa evidence) for:

· "Hypotension due to suspected pelvic fracture;

· Severe traumatic hypotension (palpable pulse, blood pressure not obtainable). *"

MAST (PASG) are "acceptable, of uncertain efficacy, may be helpful, probably not

harmful" (Class IIb evidence) for:

· "Penetrating abdominal injury;

· Lower extremity hemorrhage (otherwise uncontrolled); *

· Pelvic fracture without hypotension; *

· Spinal shock. *"

MAST (PASG) are "inappropriate, not indicated, may be harmful" (Class III evidence)

for:

· "Adjunct to CPR;

· Diaphragmatic rupture;

· Penetrating thoracic injury;

· Pulmonary edema;

· To splint fractures of the lower extremities;

· Extremity trauma;

· Abdominal evisceration;

· Acute myocardial infarction;

· Cardiac tamponade;

· Cardiogenic shock;

· Gravid uterus***

It basically states above that for a penetrating thoracic injury (such as a stab wound to the chest) that the MAST is inappropriate, not indicated, may be harmful.

The website that the information from the above study is on: http://www.health.state.ny.us/nysdoh/ems/pdf/2008-11-19_bls_protocols

In the PDF file the info is on page 123.

Hope I was helpful.

Meri

Edited May 14, 2011 by FireMedicChick164

[paramedicmike]

What legal case are you researching? Why are you researching it? What kind of student are you? Why are you so vague with the details of this particular story? If you're going to be so vague about additional details of this particular case why include the details of self defense and cocaine?

Something about this just doesn't seem right.

[JLO1965]

Parmedicmike please do not respond if you can't be helpful. I hate when people get off tast on the question. It's a long story like i said. If you're not helpful dont respond please.

I was asking if it is ok to place these pants on a man and inflate them then deflate them in the field? Everything I've read says this is a big no. This happened in New York state. It resulted in death and a murder trial for the person that was attacked by this guy.

Yes they were inflated by the BLS crew. When the Emt's arrived they screamed to remove the pants. They did not however put any of these details in their report that these pants where used. The only time it was mentioned was at trial by a police officer that arrived on the scene. The person was high on cocaine at the time also. I know this changes heart rate/ pulse ect. I'm trying to find out if the wound was life threatening, or was there change of recovery. The attorney for the accused said there was but he did not push this point about these pants.

First I need you to clear up a few things for me:

1. You said the BLS crew arrived and put the MAST on the patient. Did they inflate them right away?

2. Then you said the EMT arrived and started yelling for them to remove MAST from the patient. Was the "EMT" an ALS provider? What about the EMT that arrived with the BLS crew?

If the BLS crew inflated the pants then they should have NOT been removed in the field.

3. What state are you from?

Here in NY our protocols are for the MAST are for hypotension secondary to suspected pelvic fx and severe traumatic hypotension. They are NEVER removed in the field. (Compartment Syndrome comes into play here as well if they are left on long enough also)

In the 9 years I had been an EMT Basic and the 2 years I have been an AEMT I have never had to use the MAST. Our main hospital is pretty close to our district and even the trauma center is only 15-20 minutes away (5 minutes by chopper).

**The NY State Dept Of Health placed in their protocols recently the results of a study done on MAST. I have copied the recommendations below:

MAST (PASG) are "usually indicated, useful, and effective" (Class I evidence) for:

· None.

MAST (PASG) are "acceptable, of uncertain efficacy, [although the] weight of evidence

favors usefulness and efficacy" (Class IIa evidence) for:

· "Hypotension due to suspected pelvic fracture;

· Severe traumatic hypotension (palpable pulse, blood pressure not obtainable). *"

MAST (PASG) are "acceptable, of uncertain efficacy, may be helpful, probably not

harmful" (Class IIb evidence) for:

· "Penetrating abdominal injury;

· Lower extremity hemorrhage (otherwise uncontrolled); *

· Pelvic fracture without hypotension; *

· Spinal shock. *"

MAST (PASG) are "inappropriate, not indicated, may be harmful" (Class III evidence)

for:

· "Adjunct to CPR;

· Diaphragmatic rupture;

· Penetrating thoracic injury;

· Pulmonary edema;

· To splint fractures of the lower extremities;

· Extremity trauma;

· Abdominal evisceration;

· Acute myocardial infarction;

· Cardiac tamponade;

· Cardiogenic shock;

· Gravid uterus***

It basically states above that for a penetrating thoracic injury (such as a stab wound to the chest) that the MAST is inappropriate, not indicated, may be harmful.

The website that the information from the above study is on: http://www.health.st...9_bls_protocols

In the PDF file the info is on page 123.

Hope I was helpful.

Meri

Thank you, you were. This happened in upstae New York. However the BLS crew/ EMT no one put it in there report. Someone was put in prison for murder. This was self defense and an injury that I believe was survivable. The only time it was put on record that these pants where used was when a police officer testified. The attorney for the accused never followed up on why this was not included in there report. he was also angrey the person that was attacked refused to accept a plea deal. The person has been in prison 18 years because of this. This young man should not have died that night.

Parmedicmike please do not respond if you can't be helpful. I hate when people get off tast on the question. It's a long story like i said. If you're not helpful dont respond please.

I was asking if it is ok to place these pants on a man and inflate them then deflate them in the field? Everything I've read says this is a big no. This happened in New York state. It resulted in death and a murder trial for the person that was attacked by this guy.

Yes they were inflated by the BLS crew. When the Emt's arrived they screamed to remove the pants. They did not however put any of these details in their report that these pants where used. The only time it was mentioned was at trial by a police officer that arrived on the scene. The person was high on cocaine at the time also. I know this changes heart rate/ pulse ect. I'm trying to find out if the wound was life threatening, or was there change of recovery. The attorney for the accused said there was but he did not push this point about these pants.

Thank you, Mari for being so kind, you were very helpful. This happened in upstate New York in 1992. However the BLS crew/ EMT no one put it in there report. Someone was put in prison for murder. This was self defense and an injury that I believe was survivable. The only time it was put on record that these pants where used was when a police officer testified. The attorney for the accused never followed up on why this was not included in there report. he was also angrey the person that was attacked refused to accept a plea deal. The person has been in prison 18 years because of this. This young man should not have died that night.

[hatelilpeepees]

He is a lawyer not a student. But if MAST were ripped off after being inflated, then it probably hastened death, but there is just as good a chance that the patient would have bled to death on the way to the hospital with or without MAST. MAST would not stop bleeding from a major artery or organ in the torso, in fact, putting them on could make you bleed out faster from a penetrating wound. Imagine poking a tiny hole in a balloon that is inflated, and then start squeezing it harder and harder. The reason it wasn't pursued is probably because the patient was killed by the assailant who stabbed him, the emts could not do surgery, which is what the patient needed. Its like the old saying, guns dont kill people, people kill people, the gun is just the instrument. There is only so much we medics can fix in the field, and this isnt one of those things.

Edited May 14, 2011 by hatelilpeepees

[BAYAMedic]

Holy Monday morning quarterback Batman! If he has been in jail for 18 years then this happened 1993 or before. As you know medical literature and research changes on a continual basis. If I did 5:1 CPR now people would question me bit if I did it years ago, I was considered the best practice. The point is, the protocols listed are current, based on best current evidence. It's a tragedy if some one died because of a misunderstanding of equipment, and I could see if the oncoming emt understood the contraindications for Thorassic trauma, not wanting them to be placed and not understanding the results of a rapid field removal. I have not been in EMS long enough to know old protocols, perhaps there is someone here that can reflect to the Time frame in question.

[JLO1965]

He is a lawyer not a student. But if MAST were ripped off after being inflated, then it probably hastened death, but there is just as good a chance that the patient would have bled to death on the way to the hospital with or without MAST. MAST would not stop bleeding from a major artery or organ in the torso, in fact, putting them on could make you bleed out faster from a penetrating wound. Imagine poking a tiny hole in a balloon that is inflated, and then start squeezing it harder and harder. The reason it wasn't pursued is probably because the patient was killed by the assailant who stabbed him, the emts could not do surgery, which is what the patient needed. Its like the old saying, guns dont kill people, people kill people, the gun is just the instrument. There is only so much we medics can fix in the field, and this isnt one of those things.

yeah, they also should get someone to the hospital in a timely manner. Not waste time

[paramedicmike]

Parmedicmike please do not respond if you can't be helpful. I hate when people get off tast on the question. It's a long story like i said. If you're not helpful dont respond please.

I was asking if it is ok to place these pants on a man and inflate them then deflate them in the field? Everything I've read says this is a big no. This happened in New York state. It resulted in death and a murder trial for the person that was attacked by this guy.

Yes they were inflated by the BLS crew. When the Emt's arrived they screamed to remove the pants. They did not however put any of these details in their report that these pants where used. The only time it was mentioned was at trial by a police officer that arrived on the scene. The person was high on cocaine at the time also. I know this changes heart rate/ pulse ect. I'm trying to find out if the wound was life threatening, or was there change of recovery. The attorney for the accused said there was but he did not push this point about these pants.

Thank you, you were. This happened in upstae New York. However the BLS crew/ EMT no one put it in there report. Someone was put in prison for murder. This was self defense and an injury that I believe was survivable. The only time it was put on record that these pants where used was when a police officer testified. The attorney for the accused never followed up on why this was not included in there report. he was also angrey the person that was attacked refused to accept a plea deal. The person has been in prison 18 years because of this. This young man should not have died that night.

There is so much that's wrong with this thread.

The case you're investigating is almost 20 years old? Seriously? What makes you think that information about treatment guidelines or protocols that are in effect today are going to be the same as they were almost 20 years ago?

Why are you avoiding my questions? Are you a law student? Are you a lawyer? If so, you're not a very good one.

Are you a family member looking for ammunition for a lawsuit? Or are you looking for information that could help get your friend/family member off the hook for murder? This, I believe, would be a first.

Why is wanting to know why you're researching a case involving EMS providers before answering any of your questions a bad thing? The fact that you're not answering is enough to raise suspicion about who you are, your motives and whether it's smart to actually provide information that could help you.

The questions you asked imply that you're not an EMS provider. It also appears that you have no idea of the structure or provider levels of EMS providers. This raises even more suspicion as to who you are and what your motives may be.

And if, by chance, you're really looking for justice in this case you're researching you need a lawyer. Not an internet discussion forum.

[JLO1965]

There is so much that's wrong with this thread.

The case you're investigating is almost 20 years old? Seriously? What makes you think that information about treatment guidelines or protocols that are in effect today are going to be the same as they were almost 20 years ago?

Why are you avoiding my questions? Are you a law student? Are you a lawyer? If so, you're not a very good one.

Are you a family member looking for ammunition for a lawsuit? Or are you looking for information that could help get your friend/family member off the hook for murder? This, I believe, would be a first.

Why is wanting to know why you're researching a case involving EMS providers before answering any of your questions a bad thing? The fact that you're not answering is enough to raise suspicion about who you are, your motives and whether it's smart to actually provide information that could help you.

The questions you asked imply that you're not an EMS provider. It also appears that you have no idea of the structure or provider levels of EMS providers. This raises even more suspicion as to who you are and what your motives may be.

And if, by chance, you're really looking for justice in this case you're researching you need a lawyer. Not an internet discussion forum.

It's just research. get a life dude

[paramedicmike]

It's just research. get a life dude

A murderer is in jail for killing someone. This is after the legal process had played out and found him guilty of murder. All of this took place 18+ years ago. Presumably the appeals process has been ongoing. Since it sounds like he's still in jail there has been nothing new in more than 18 years to question the validity of the original verdict.

Yet you're still harping on an 18+ year old murder conviction.

Who needs the life?