Call Review, feeling bad…

[Timmy]

LMAO - thats so cool

Its a "stent" buddy :wink:

OOoohh Bugger! Questioning this scenario is probably even less of a good idea then :? If working in industry has taught me one thing its that it is possible to be lower than a st john forst aider, and that anybody working in private EMS

Lol well I aint complaing about the pay!!! And yes before anyone asks we were fully covered by insurance and if anyone would like to see a copy of the plan then I would be more than happy to sent it to you, it’s better than St Johns insurance put it that way.

And even if I was on duty with St John there still wasn’t anything more I could have done for the patient…

[zippyRN]

<snip>

As far as the event was concerned it was a car festival with a crowd of 48,000 each day. There was only 3 first aid staff for the duration of the event, no ambulance or anything only a room with basic first aid supplies. No it wasn’t with St John. I was privately employed by the event to be there first aider.

crikey mate!

48 k on site and 3 FAs

just plugged it through the algorithm SJA in the UK uses for event cover requirement calculations and got 42 points out

which puts the cover required as up to

4 ambulances + 4 extra crew members , 40 Personnel, 3 doctors, 6 Nurses, 2 Ops managers and a Equipment support tender

that would cover up to 60,000 though you could/ would get away with fewer FA personnel if you knew that there would 'only' be 48 k

if you can get the score below 40

3 ambulances + 4 extra crew members ,20 Personnel, 2 doctors, 4 Nurses, 1 Ops managers

scored as

- Public exhibition (3)

- in 'other outdoor' location (3)

- mixture of standing and seating (2)

- full mix of ages attending, predominantly not family groups (3)

- past Hx of low casualty rate (-1) - (medium = +1 , high = +2, no data =+3)

- expected attendance 30-60000 (28)

-queueing less than 4 hours(1)

- time of year spring / autumn (1) - Winter / summer =2

- nearest Emergency Dept <30 minutes(0) (>30 minutes +2)

-Choice of Emergency dept (1) - Large ED (2 ) small ED only (3)

- additional hazard -motorsport (1)

- no on site extras(0) (wound closure, Plastering, X ray, Primary care, minor ops / mobile surgical team)

That said UK event licensing guidelines require that you minimise the impact on the Statutory NHS services from any event. The general crowd event rules are less onerous that the Sports stadia rules which are 'tombstone' follwing Heysel (crowd crush), Bradford City (stand fire) and Hillsborough (crowd crush, 90 + fatalities) in the 1980s

[Timmy]

Wow that would have been a waste of time…. We only treated 20 and sent 3 to hospital via ambo…

Although the year before St John did cover the event with 30 first aiders + doctor. They were bored out of there brains!

All the event is, cars doing burnouts, people come sit there and watch it, safety to competitors and spectators is taken to the extreme so it’s not really classed as a high risk event. It’s alcohol free and most of the crowd is under the age of 40. Only problem we had was heat related as it was 40 degrees but they were given out free bottles of water like there was no tomorrow and there was plenty of shade.

[BushyFromOz]

Yes

Because St John wouldn't over inflate their presence and the coverage in order to stroke their own ego's :roll:

[Timmy]

Yes

Because St John wouldn't over inflate their presence and the coverage in order to stroke their own ego's :roll:

This sir is exactly why the event didn’t get St John back thus turning them off employing a first aid provider and getting their own first aid that they can control and know that there wont be any ‘ego’ / 'look at me with my commander vest' problems! Plus St John charge too much lol

[BushyFromOz]

This sir is

Sir? LMAO....righto man! I think you mispelled it, shouldn't that be "curr"??? :wink:

[zippyRN]

Yes

Because St John wouldn't over inflate their presence and the coverage in order to stroke their own ego's :roll:

it's an appropriate level of coverage to minimise the impact on statutory services ...

Large event cover should equal or exceed the cover available to the ordinary person on the street, while also not depleting that cover for the local population.

Perhaps the UK is the only Nation to have guidance for event licensing that works to this idea.

would you be happy to have a town of 48k people with 3 first aiders as it's sole EMS provision?

the challenges posed by crowd events should not be underestimated, even with good maps on site you will generally only be albe to give a rough location for an incident and have to guide additional resources in... never mind the difficultues of achieving safe and sensible provision while relying on external provision

[ERDoc]

Timmy, did this man ask you to call the ambulance? Did you ask him if he wanted one called? As far as hypertension and epistaxis being linked, the jury is still out on that one. There is literature to support both sides of the arguement. Here's an emedicine article on it and a few absracts from the literature:

http://www.emedicine.com/emerg/topic806.htm

http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/query.f...ist_uids=339142

http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=10650229

http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=10401851

There are quite a few more out there if you go to pubmed.

[bbbrammer]

I think you did the right thing. People underestimate the amount of blood you can loose through a nosebleed, especially if it has been going on for awhile. Not to mention the risk of aspiration while he is sleeping. I would say that since he had been bleeding for that long, working in the heat, and being pale were all indicaters that he was probably volume depleted to some degree. I would hazard that his pulse was a little rapid, and he may have failed a tilt test. I can't say for sure, but just from what you are saying I would have tried my darndest to get him checked out. Course some people really can't be convinced, and from there you just have to 'threaten' them to at least try to drink as much as possible. The medics shouldn't be giving you a hard time about what you did.

I ran on an epitaxis a couple of weeks ago and when I got there I found a 52yoM who had a hx of nosebleeds and had been bleeding for awile. The reason they called us is because he had blood coming from his left eye like tears and that had never happened before. We took him in and they discovered that he had an aneurysm behind his sinuses that was slowly bleeding out. Everything with him pretty much checked out normal too. Just like your guy. So you never know what may be going on, but since you are not a doctor, if you don't know for sure what is going on, then turn it over to someone who might.

[Timmy]

Timmy, did this man ask you to call the ambulance? Did you ask him if he wanted one called?

Of course I asked him if he wanted the ambulance, after some gentle persuasion lol. I pulled on the ‘I’m only a first aider’ act. I just told him that the paramedics would come to check him out then it was up to them if they transported or not = I covered myself.

Look if he refused that much I would have just got him to sign the refused treatment form and he could have been on his way. I think he was pulling on the macho man act in front of his family so it did take some persuasion but in the end the decisions made all worked out to benefit the patient and he received the best care possible.