# Patient Unresponsive, 1 more down



## trauma1534 (Oct 18, 2005)

A couple of weeks ago there was a call in our city that came out "Pt. Unresponsive", a few min latter, dispatch came back and said, "One unresponsive, 1 more down, they are in a basement, there is no entrance to it other than a ladder, no window access either.  

You arrive, there is a fire department there, you get down to the patient, someone is doing CPR, you assess the patient, you find that this one does have a pulse and is breathing, they were doing CPR with out knowing any better....

Now, go with it.
1.  From the info given, what do you think is going on here?
2.  How would you go about getting the patient's out?
3.  Would you go into the basement upon arrivle?
4.  What would you suspect is the illness with both patients
5.  What would you do to treat it...

Have fun... I'll give you more info as we go...


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## MMiz (Oct 19, 2005)

1.  I'd have lots of guesses, but Carbon Monoxide?  Electrocution?  Gas of some sort?
2.  Are you FF/EMT?  FF on scene?  There is only ladder access?  Then I'd strap them on a backboard of scoop and carefully lower them up.
3.  I'd love to say no, but i'm not sure how I'd react on scene.
4.  See #1
5.  CPR on the one not breathing, bag the other.  I'm BLS though.  ALS would be on scene with me doing their ALS stuff.

I'm dying to know what happened.


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## mine-rescue-emt (Oct 19, 2005)

In a basement, 2 individuals down.  I'm thinking some kind of noxious gas.  CO, possibly hydrogen sulfide.  could be any number.  If the FD is already there, I'd ask them if they had checked for any gases.  If the FD is already there, and none of them seem to be experiencing any problems, I would consider going in, making sure that someone is on the ladder.  This needs to be treated as a confined space rescue.  I thnk first priority would be to get the pt's and rescuers out of that area as quickly as possible.


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## emtbuff (Oct 19, 2005)

Okay I would agree with mine-rescue-emt that there is something hazardous in the air.  Depending on what is noted in the air it should be treated as a Hazmat scene.

I personally probley wouldn't go down to the Basement until I have been told that they checked for any and all hazards.  And if I did go down and it was something possibley hazardous I would be using a SCBA as the firefighter should also cuz it doesn't do the pt much good if we become pts ourselves. I would also consider some type of chemical suit just in case.

To get the pts out I would use the stokes basket or secure the pt well to a backboard and since there is only a ladder to get into the basement I would create an A-frame to lift the pts out in a vertical maner.  For the pt that is unresponsive I would also use a c-collar.  Cuz You don't know if he fell and hit anything or just collapsed.

For treatment since there is a firefighter already down there or if I was down there I would look for a causing agent so we can report what the possible exposure could be.  But I wouldn't spend any more time down there than I needed to properly secure and lift the pts out.  I would secure my airway in the unresponsive pt.  I would probley strip the pt to get rid of the contaminant that is left in the clothing and if needed I would be preforming decon for all that were involved.  
Then I would start monitoring Vitals, O2 administration, start IVs for those that can.  Perform any other interventions that maybe needed as in splinting, CPR if loss of pulse,  and watch for any changes better or worse and treat acordingly.  

If is is a Hazmat situation I would have someone move stuff in the rig to prevent contaminating objects that really shouldn't get contaminated.  

This is my 2 cents.


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## CaptainPanic (Oct 19, 2005)

1.) both pts are inhaling poionous gases cuasing the airway to shut down, possible CO

2.)Call  for Rescue and treat this as a confined space rescue, stokes basket both of them out. c-collar for both if neither are able to maintain their own airway

3.)No, not unless FD/PD has deemed the area safe for me, until then I will stage near the scene.

4.)Carbon Monoxide inhalation since in mose basements the air just tends to hang around and not circulate well.

5.)Yes, considering one went down, and the other probably went to the basement to check on the first one, putting themselves at risk, and became a pt themselves.

6.)With the pulseless and apneic pt Im going to start CPR/continue CPR and request for ALS, will RSI this patient to get an airway and bag them with 100% o2.

With the pt that has a pulse and breathing, NRB with high-flow o2. and transport both.

Im ready for more info. What are my baseline vitals?? With this I can give better and more appropriate treatment.


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## Jon (Oct 19, 2005)

Ok. First - Check the CO meter on my jumpkit, and have the FD get a multigas meter in the building. Next, call for Heavy rescue, possibly a high angle/rope rescue/confined space team. Also, depending on your area, an EMS supervisor should roll on this, as well as second ALS and BLS rigs. at least 2 medics, 3 BLS busses (3rd BLS for standby for rescuers).

If warented by meters.... wear airpacks.

verify both patients have pulses, assess respirations... if needed, provide ventilatory and cirulatory support.

Assume a fall involved, so both pt's get full spinal immobilization if possible.

Check patients for signs of trauma.

Don't trust the ladder in place.

Check for an old coal chute, or an old window..... maybe boarded up, but might be an easier way out.

Jon


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## TTLWHKR (Oct 20, 2005)

Be inventive!

Remember the movie Roxanne? They drove the fire truck into the fire hall with the ladder up?

Well, cut holes... put the ladder into the cellar!


**KIDDING**

First, give the info of two people down, assume it's bad, and don TOG and SCBA. Given a cellar, it could be anything this day in age. Could be CO, meth lab, chemicals that consume oxygen, chlorine, hell they could have fallen off the ladder, or been bitten by their secret pet - a momba, hanging electrical wires, wife could have pushed him off the edge.. Never know, so take it slow. I always say that when I'm teaching scene safety.. Feel free to take notes.   

Evac: Strip em, take all the clothes off, and wrap them up, put on a board - assume they fell, hold the oxygen - in case of chemical reaction, put them in a stokes and here's where all that rescue training helps. Get a two story ladder in there, i don't care if you have to break windows, or walls, get it inside. lay it at a 45% slope, have ropes to the top, w/ lots of help. Put the patient on the ladder, attach the rope. Support the ladder. you all can't go up. so the ones left behind should give support to the ladders slope, and the fire/ems/rescue pull the stokes up the ladder. The ones upstairs should have TOG and SCBA also. Get the patients out, give oxygen, decon if necessary, take off your TOG, put on Tyvek suits if you think it's necessary, unless you can confirm it is CO, etc. and transport.

I actually did that once, new home, no furnace, electric heat. What would be the cause of their CO poisoning you ask? Power outage.. Had a generator in the cellar, no stairs. Someone noticed the exhause hose came unhooked, went down to reconnect, on the way back up they went down, and took the ladder with them. Treated 13 patients in the house for 6-8 hours of CO exposure. Talk about draining your O2 systems...


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## hfdff422 (Nov 11, 2005)

Is the second person down a firefighter? CPR does no good in a hazardous or oxygen deficient environment. Of course it does no good on a patient with a pulse either.

Masterful TTLWHKR


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## trauma1534 (Dec 8, 2005)

CPR was being done on the first patient... WHO STILL WAS ALIVE WITH A PULSE!!!  The one doing the CPR was a bystandard.  The second person going down was the patient's brother.  It was carbon Monoxide poisoning.  Both patients were stabilized and shiped out to Duke.


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## PhillyMedic (Dec 9, 2005)

I would have guessed they both did heroin, and OD.


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## Jon (Dec 12, 2005)

PhillyMedic said:
			
		

> I would have guessed they both did heroin, and OD.


Spent a little too much time running our of "Medic 8 - the Narcan Strike Force"????? 

Occasionally people fall down without drugs being involved.....this is usually a rural thing, though.


I am joking.... don't be offended.. I've had my personal attack this week:embaressed_smile:


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## hfdff422 (Dec 12, 2005)

MedicStudentJon said:
			
		

> Spent a little too much time running our of "Medic 8 - the Narcan Strike Force"?????
> 
> Occasionally people fall down without drugs being involved.....this is usually a rural thing, though.
> 
> ...




Where, when?


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## hfdff422 (Dec 12, 2005)

hfdff422 said:
			
		

> Where, when?


Never mind, I found it. Poor guy, trying to save a man a buck or 20 and you get called an uppity medic.


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## FFEMT1764 (Dec 19, 2005)

First thing I do, call our rescue team. I'm not one for confined spaces with unknown gases...I like being intact and plan to stay that way. Once we determine why they are down, we(the rescue team) get the people out using full spinal precautions- no questions asked- and we decon them, if needed. If its simple CO then once they are out in the air they are decon., provide rapid o2 therapy and prepare to intubate. If they are pulseless then adress that, if they ahve a pulse prepare for all sorts of wonderful cardiac ruthmns, including VT/VF/Torsades...etc. I would not enter the basement, again I am not confined space rated, however I AM a HAZMAT Tech...if 2 people are down assume they are both suffering from the same condition, especially if they were found together...and most definately have a 2:1 or 3:1 medic to pt ratio with these pt's, and if RSI is needed(which I sorta doubt they would need paralyzed) go with 3:1.  I suspect that witho2 and BVM/ETT the hypoxia would be treated as best you can in the field.  ALWAYS check a BGL! for all you know they are heating this basement with kerosene and dropped their sugar to boot.  Transpo both to a level 1 trauma center WITH hyperbaric capabilities, even if it means you call the helo in to transpo, provided they are decon'd appropriately.  

Ok now I need more info too, thats all I can give ya without some feedback.


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## TTLWHKR (Dec 19, 2005)

What was the topic? I'm too lazy to look back.


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