# Dropping like flies...



## EMSpassion94 (Oct 7, 2012)

Dispatched for Traffic Accident on our way back from the hospital from a previous call. Supplemental info: 21 y/o male ATV vs tree head on with no helmet, caller advises he's "breathing funny", and is bleeding from his mouth and out of his ears. Halfway there dispatch tells us "the mother has passed out, is still unconcious and choking on her own vomit." 

Arrived on scene about 5 mins behind two other agencies and fire department, both already working on both patients. I hopped up into the ambo to assist the medic with hooking up a few lines and such, wheel the patient up into the rig and BAM....I see it! Femur fx, R leg. I never saw a true femur fx before, so it was interesting to see how short the R leg really was from the L. 

Patient was beginning to get combative and restless. Was initially unconcious but was beginning to come around. Multi-system trauma, facial injury (mainly oral, comprimising airway) head injury, pupils were pearrl, though i did see two black eyes coming on(Raccoon Eye's?? Not sure...) Did not think to look for battle signs. Harder to auscultate left lung. Crepitus in the right hip. 

At this point I knew we were going to fly him out. The medic then tells me to pull traction on the R leg, and instructs someone to get the hare traction. I almost said something about "Aren't we life flighting him?" Because as far as I know the choppers in our area wont accept a PT with a hare traction. BUT....I didn't. 

About this time, my chief opens the door and says..."Ummm....we have a little situation." Oh good lord, what now. "The dad is having an MI out here..." ................:mellow:. You've got to be kidding me. With all the screaming 20 something family members and friends running around everywhere....the mom vomiting all over the place....chopper landing....this guy becoming combative and practically kicking me in the face....NOW here goes the Dad. Thank God we called in for extra resources when we did. Whew. 

About that time(we have the hare traction all hooked up and ready to go) the flight medic gods step on the rig and say "We shall not permit this man to ride on our chariot. Hare traction must come off."

....................:censored::censored::censored::censored::censored::censored::censored::censored::censored::censored::censored::censored::censored:.

You have GOT to be KIDDING ME. You can imagine the noise in the back of the rig at this point. 

Eventually everybody gets to the hospital, and we have ALOT of cleaning up to do. So what would you have done on this call differently, or what is your opinion of it? I'll be honest, this was one of the most cluster screwed calls i've been on.

Excuse any spelling or not making any sense. If something needs to be clarified or elaborated on, please let me know. Definitely not used to this whole new "night shift" thing. :]


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## leoemt (Oct 7, 2012)

I don't know what resources you had on scene but I would treat it as an MCI incident. Sounds like a real cluster. I wouldn't have used the Hare as it would be Contraindicated per our protocols.


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## Handsome Robb (Oct 7, 2012)

leoemt said:


> I don't know what resources you had on scene but I would treat it as an MCI incident. Sounds like a real cluster. I wouldn't have used the Hare as it would be Contraindicated per our protocols.



Wait, I only count three patients... If you're in BFE then sure but that's just me.

OP, no Sager traction splint? Those fit in the chopper and that's the exact reason why we use them over the Hare. 

OP sounds like you handled it well, I would've spoken up about the traction splint though, who's the poor SOB that has to remove the traction splint and make this guy even more angry.

I'm guessing you aren't a medic but this guy sounds like a fantastic candidate for versed at least or RSI if you or the flight crew can do it. Combative with a head injury, no doubt sending his ICP through the roof while ya'll wrestle with him. 

Racoon eyes and Battle's sign are late signs, if you were really seeing them and not just bilat black eyes from smashing his face on a tree this guy is buggered. 

As far as resources go now that the HEMS crew is there hand them your kid and work dad up for his "MI", if he really is a STEMI lets get movin' if not, lets still move but let's see who needs to go first, sounds like it's going to be mom... I'm guessing she was riding on the ATV as well? One ambo can take both, depending on mom's condition and dad's condition for that matter but if they are both "stable" no reason to tie up two units.


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## hibiti87 (Oct 7, 2012)

applying traction of any kind is contraindicated in this call as the patient showed signs of an unstable pelvis. Pulling traction in a patient with an unstable pelvis will not work as the pelvis serves as one of the anchoring points of traction. By pulling and releasing traction in a patient with an unstable pelvis you also placed the patient at a greater risk of internal bleeding as the pelvic is very vascular. 

I completely agree with utilizing RSI in this scenario if the region permits it. I believe the time spent splinting the femur fracture could have been better utilized by being aggressive in establishing an advance airway and providing iv therapy to the patient.


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## Milla3P (Oct 8, 2012)

This kind of :censored::censored::censored::censored: Show requires RSI for everybody. The the Lvl 1 ED sort it out.


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## FDJohn (Nov 12, 2012)

_flight medic "You shall not pass!!"_ Sounds like med flight here in the Tennessee valley. I want to go slightly off topic and place my ICP bid on about 40


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