Patient impaled ... decision time ...

[spenac]

In scenario you said it was a cold night, just how cold was it? Was it cold enough maybe hypothermia saved her?

[spenac]

I agree they went outside the "never remove an impaled object" protocol, however, and as they stated, the patient was already in cardiac arrest. How is removing the object/s going to make this patients condition any worse?

Had they transported to hospital and the patient bled out and died the outcome would still be the same - for the patient. I think you would be able to defend these actions in that they were in the best interests of the patient. What was the alternative? Leave the patient impaled on the fence and still dead?

Let's look at this from the patients perspective, imagine you are this patient. What would you want done?

For the record, I personally would have called it based on the facts given.

In USA patient lives they sue. If patient dies family sues. Screwed if you broke standard of care. If met standard of care just a headache dealing with it.

[Dustdevil]

I agree they went outside the "never remove an impaled object" protocol' date=' however, and as they stated, the patient was already in cardiac arrest. How is removing the object/s going to make this patients condition any worse?[/quote']

You make an excellent point. It has been said that you can make a pretty good case for breaking the leg of a cardiac arrest victims leg if you think there is a chance it might stimulate electrical activity. As you say, dead is dead. I don't find "deader" in any dictionary.

Although I suspect I would have called this one before ever starting (based solely upon the sketchy info given here), I agree with you that removing her and attempting resuscitation is not an entirely unreasonable course of action either. Obviously, there is always a chance.

Unfortunately, Spenac sums it up nicely here. Had this happened in the US, and the patient not survived, there is about a ninety-nine percent chance that the medics would have been bent over and reamed out by everybody from their supervisor, to their medical director, to the chief of police. And by "reamed" I mean fired, if not criminally charged and sued. It all comes back to established standards, which may or may not be appropriate for a given situation. If you gamble and it pays off, you're good to go. But, if not, then you look like a complete idiot for performing an disimpalement against every standard you have ever been taught and for not having the competence to recognise injuries incompatible with life. And, of course, some dickwad cop is going to want to charge you with such nonsense as failing to obey a lawful order, tampering with evidence, and abusing a corpse.

You're just not going to find many people to think outside the box on these situations in the U.S. Sad, I know.

Had they transported to hospital and the patient bled out and died the outcome would still be the same - for the patient. I think you would be able to defend these actions in that they were in the best interests of the patient. What was the alternative? Leave the patient impaled on the fence and still dead?

Let's look at this from the patients perspective, imagine you are this patient. What would you want done?

For the record, I personally would have called it based on the facts given.

[sladey67]

In scenario you said it was a cold night, just how cold was it? Was it cold enough maybe hypothermia saved her?

Sydney, Australia .... not that cold!

[AnthonyM83]

I mean you could pull her off the poles and work her ,but if the poles are keeping something from bleeding and you pull her off what good are you doing anyway. If you wait for fire to get there to cut her how are you going to do good CPR while she is on the poles? I know you can start a line and push drugs and intubate her , but how are you going to get the drugs to circulate?

Not commenting on the scenario one way or the other at this point, but just commenting on the logic in this post.

If the patient is currently dead, then keeping the poles in place to prevent bleeding should not be of concern. What would bleeding do? Kill her twice? BUT if they happen to NOT be preventing large amounts of bleeding and you pull her out, you might be able to do effective CPR.

Deciding not to remove based on protocol or liability, I'd understand...based on the above logic, I would not.

[Just Plain Ruff]

There is a new and improved term out there for this lady

DRT---- Dead right there

[CBEMT]

If left there, and she dies, I'm curious what the autopsy would say (especially since she started breathing when her airway was opened).

[ericenglund]

Wouldn't the decision to move her from the pole (she's not getting any more dead than lying pulseless impaled by a pole) be the same as what they're teaching now as far as if you can't get an airway with the jaw thrust just go ahead and do a head tilt/chin lift? If they're DEAD then the slight risk of actual cervical spine injury would be worth the benefit of securing the airway.

[AZCEP]

Moving off the fence would constitute disturbing a crime scene. If you could open the airway without removing, then you might be justified in doing a resuscitation.

Nice twist on the legal/ethical concerns.

[CBEMT]

Moving off the fence would constitute disturbing a crime scene. If you could open the airway without removing, then you might be justified in doing a resuscitation.

Nice twist on the legal/ethical concerns.

Every time we transport a stabbing, shooting, etc victim we disturb the crime scene. A big one that comes to mind is extrications where there is a fatality- the scene is literally cut apart. But I digress.

My main concern was reading an autopsy report after the fact that said "cause of death: asphyxiation" or words to that effect. I mean, talk about "d'oh!"