# Facial wounds bleed. A lot.



## adamjh3 (Jan 9, 2011)

5150 out of CMH tried to run on me about an hour ago. When I took him to the ground he conked his head, got about a half inch laceration just above his browline. 

This produced a puddle of blood on the pavement about 3 feet by 1 foot. Looked a lot worse than it was.


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## Shishkabob (Jan 9, 2011)

They didn't tell you how vascular the head was in school?


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## adamjh3 (Jan 9, 2011)

I knew about it. My partner seemed pretty shocked, though. Figured I'd throw this up for future EMTs wondering why facial wounds look a lot worse than they are.


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## medichopeful (Jan 10, 2011)

adamjh3 said:


> 5150 out of CMH tried to run on me about an hour ago. When I took him to the ground he conked his head, got about a half inch laceration just above his browline.
> 
> This produced a puddle of blood on the pavement about 3 feet by 1 foot. Looked a lot worse than it was.



I remember we got called to a head vs. concrete, assisted by stairs.  The patient was pretty much sitting in a puddle of his own blood, all from a maybe 1 inch scalp laceration.  Head and face injuries bleed.  A LOT :wacko:


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## exodus (Jan 10, 2011)

That's why company policy is to restrain all CMH 5150 patients


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## adamjh3 (Jan 10, 2011)

exodus said:


> That's why company policy is to restrain all CMH 5150 patients



There's no way I work with you and don't know it, there's only like 8 people down here  

He was restrained, we undid the legs so he could bend his knees so I could actually load his freakishly tall self into the ambulance, and those wrists were so old he just popped right out of 'em.


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## LucidResq (Jan 10, 2011)

I loved this display of the vasculature of the head from Body Worlds.


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## 18G (Jan 10, 2011)

I always thought it wasn't a job of EMS to run after patients and subdue them. They don't pay me enough to engage in chasing after patients and fighting with em. I would have stood and waved while calling it in on the radio. 

But yeah, the head is very vascular. Sounds like it took awhile to get some direct pressure going if you had a 3ft wide puddle of blood.


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## medic417 (Jan 10, 2011)

adamjh3 said:


> those wrists were so old he just popped right out of 'em.



Umm how did you explain your patient arriving missing his wrists?  In fact maybe the blood was shooting from the missing wrists rather than the head?:unsure:


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## 18G (Jan 10, 2011)

medic417 said:


> Umm how did you explain your patient arriving missing his wrists?  In fact maybe the blood was shooting from the missing wrists rather than the head?



That sounds much more plausible... lol... a 3ftx1ft trail of blood leads me to believe more of a bilateral hand amputation then head lac.


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## adamjh3 (Jan 10, 2011)

18G said:


> I always thought it wasn't a job of EMS to run after patients and subdue them. They don't pay me enough to engage in chasing after patients and fighting with em. I would have stood and waved while calling it in on the radio.
> 
> But yeah, the head is very vascular. Sounds like it took awhile to get some direct pressure going if you had a 3ft wide puddle of blood.



Didn't think it was mine, either. But the last 5150 who ran here took the two EMT's jobs with him. And it didn't exactly chase him, it was more of a struggle in the back of the ambulance that spilled out to the 

And yes, direct pressure did take some time, maybe a full minute, kind of hard to treat him when he's flailing around and trying to bite you.


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## JPINFV (Jan 10, 2011)

medic417 said:


> Umm how did you explain your patient arriving missing his wrists?  In fact maybe the blood was shooting from the missing wrists rather than the head?:unsure:



Wanted for questioning:


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## adamjh3 (Jan 10, 2011)

JP, you're a Cali man, and much-the-wiser than I. Are we as EMS personnel obligated to make sure the 5150 doesn't go free?


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## JPINFV (Jan 10, 2011)

I honestly don't know if there's a legal obligation. I'd argue that there's some sort of ethical obligation to, at a minimum, track and report if they do. The sticky part about this is not every patient on a 5150, 5250, TCon, or conservatorship needs to be transported in restraints.


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## exodus (Jan 21, 2011)

Do you work at the big blue ambulance in SD?  If you don't want to say you can PM me! And policy is only 2 point restraints, unless you just mean the seatbelt  Which I do all the time with 5150's. Bend those feet up, then strap it down on the ankles until they're inside.

Btw. if I restrained, and he still got away, I'd bust out my phone and call 911 while chasing the pt. Keep an eye on him and try to talk him back onto the gurney.  But I'm not gonna risk my job by tackling them unless they put me in danger


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## Veneficus (Jan 21, 2011)

yell:

"Run Forest! Run!"

then have the cops bring them back.


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## adamjh3 (Jan 21, 2011)

exodus said:


> Do you work at the big blue ambulance in SD?  If you don't want to say you can PM me! And policy is only 2 point restraints, unless you just mean the seatbelt  Which I do all the time with 5150's. Bend those feet up, then strap it down on the ankles until they're inside.
> 
> Btw. if I restrained, and he still got away, I'd bust out my phone and call 911 while chasing the pt. Keep an eye on him and try to talk him back onto the gurney.  But I'm not gonna risk my job by tackling them unless they put me in danger



I assume you mean Pacific? Naw, we get your CMH hand-me-downs on the weekends. What's up with those two and three hour ETAs? 

Didn't tackle him, per se, I don't really remember what exactly happened, my partner says we (the patient and I) fell out of the back of the ambulance, and I just happened to be on top.


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## MediMike (Jan 22, 2011)

Veneficus said:


> yell:
> 
> "Run Forest! Run!"
> 
> then have the cops bring them back.



Agreed. Its not in my job description to tackle patients. Thats why we have the big guys with shiny shield looking thingies on their chests.  I will assist in taking down a pt. if they are present, otherwise that guy/gal is on their own.  You run the risk of a serious lawsuit otherwise. Now I know a LOT of things are different in Cali, so maybe thats another one...


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## adamjh3 (Jan 22, 2011)

If this was a hospital discharge, transfer from a SNF to a hospital or dialysis center, etc. and the patient bolted "Have a nice day, sir" would have been our response. 

The patient was on an involuntary 72 hour psychiatric evaluation known as a 5150. This is used for people who have been determined to be a danger to themselves or others, or gravely disabled to judge what further, if any, treatment they need. To put it plainly, most of these psych hospitals are basically jails with medical staff. 

If he had gone free and hurt himself or others, I venture to say there would be plenty of lawsuits there...


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## Pittma (Jan 22, 2011)

What is a CMH 5150 for all us East Coasters? Is it a "Section 12"?


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## JPINFV (Jan 22, 2011)

Pittma said:


> What is a CMH 5150 for all us East Coasters? Is it a "Section 12"?



Yes, a 5150 is comparable to a Section 12 in Massachusetts or a Baker Act in Florida. It's a 72 hour legal hold for the initial evaluation and treatment of mental disorders resulting in an individual who is a danger to self, danger to others, or gravely disabled. The name "5150" comes from the section of the California Welfare and Institutions code that covers it.


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## Pittma (Jan 22, 2011)

Thanks bud! Yeah, typically with my company we either restrain or sometimes have had a cop ride with us if they choose not to restrain them, just for safety's sake. That head lac is gonna hurt in the morning I bet.


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## exodus (Jan 23, 2011)

adamjh3 said:


> I assume you mean Pacific? Naw, we get your CMH hand-me-downs on the weekends. What's up with those two and three hour ETAs?
> 
> Didn't tackle him, per se, I don't really remember what exactly happened, my partner says we (the patient and I) fell out of the back of the ambulance, and I just happened to be on top.



When you only have 2, sometimes 3 units on, and 3 or 4 CCT's holding. It happens XD Longest ETA I gave was 90


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