# Good Samaritan - Rescue Vs. Medical



## DV_EMT (Jun 16, 2010)

Hi all,

Been a while since I posted up here, but I had a good question brought up to me the other day and I thought I'd share it with you.

Scenario:

Your driving down the highway (far from EMS/Rescue) when you see a car on the side of the road. The car has two occupants inside (one driver and one passenger). You pull over to help as a good Samaritan. There is smoke in the car, but no fire, and you see fluid running from the car down the road. You do not have any access to the passenger's side (not even from the windshield). the only way to get to the passenger is by removing the driver.

now here comes the fun part....

Your driver has an impaled object in his abdomen. He is not "pinned", and he is A/O x3 (or 4 - suffice to say he's talking and with it). 

Your passenger is out cold. You can't get to them without removing the driver, and you do not see any chest rise. The PT looks slightly gray/ashen.

The driver side airbag deployed, but the passengers did not.

As a 1st responder, what do you do? You have no backboard, no KED board, nothing but a bunch of BSI supplies and a pocket mask.


let me know if you want any additional information. I'm very interested to see the responses!


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## spinnakr (Jun 16, 2010)

I know there are some here would say they'd never stop.  I'm not one of them, so whatever.  For brevity/clarity, I'll say the driver is male and the passenger is female.

First, call 911 - of course.  Would mention being off-duty EMS/fire (well, that is, once I graduate as fire II in 2 weeks) and would say that lifeflight will almost certainly be needed.  Hopefully local LEO's would get there faster in order to make a landing zone - perhaps the road?  All depends on terrain.  If they've closed down the freeway to land lifeflight in Cleveland, then they can close a highway in the middle of nowhere.

Second:  I'd try to get a pulse on the passenger - which would unfortunately entail reaching across the driver.  Ideally I'd just figure out if she is breathing - but if I have zero access, look listen feel won't work very well.  To be honest, I'm not sure how it would be possible to have absolutely zero access to the passenger without her being completely entrapped and/or underneath the dash.  Either way, if I didn't get a pulse and breathing from the passenger in ten seconds, I'm going to call it a day with her.  Basic triage - better to save one than loose both, and if they don't have an airway, they're dead.  Since you said she doesn't look like she's breathing, I'll operate on the assumption that she isn't.

That leaves me to tend to the driver.  However, I need a little more info on the impaled object - what is it, is it caught on anything, etc etc etc.  How about my surroundings?  Is this a forest or the desert?  Is there a grade to the road?  Do I have a blanket in my car?  Where is the smoke coming from?  What color is the fluid and does it smell?  Is the wind direction with, against, or perpendicular to traffic?  What's the weather like?  Paint me a picture and I'll tell you a story...


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## atropine (Jun 16, 2010)

Given your senerio, I would wait for the fire, since this is clearly an extrication/rescue, and what I mean by that the car battery must be diconnected to prevent possible passeneger side airbag deployment. Many factors in this case come to play with saftey.


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## DV_EMT (Jun 16, 2010)

spinnakr said:


> That leaves me to tend to the driver.  However, I need a little more info on the impaled object - what is it, is it caught on anything, etc etc etc.  How about my surroundings?  Is this a forest or the desert?  Is there a grade to the road?  Do I have a blanket in my car?  Where is the smoke coming from?  What color is the fluid and does it smell?  Is the wind direction with, against, or perpendicular to traffic?  What's the weather like?  Paint me a picture and I'll tell you a story...



For Scene Purposes:

- it's nighttime (lets say around 9ish)
- lets say its in a desolate area (not a desert... but deserted)
- 0 wind

In order to "entrap the patient" lets say the driver lost control and hit a large boulder that has crushed the passenger side windshield and has made it impossible to access the passenger side (assuming its a 2 door coupe).

The smoke is of unknowns etiology, but it is inside the car (not billowing out of the engine). Note: the airbag did deploy.

The fluid is clear and odorless, but upon arrival you do not notice its presence because it is nighttime and no odor is present

Weather is around 55-65 degrees

The impaled object is not long, maybe a foot in length total, maybe 2-4  inches wide. It could be wood or metal... whatever it is, it isn't restricting the drivers ability to be extracted. It is in the drivers abdomen. right in the middle.


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## LucidResq (Jun 16, 2010)

I would call 911 of course. 

I had a friend who came upon an accident in which the driver was unconscious and the cab was rapidly filling with smoke. He simply punched a window out. I don't carry a window punch but this is something I would consider doing if smoke is also filling the passenger compartment in this scenario. Another set of friends got through a car window fairly easily with an avalanche shovel once... something I do carry in my trunk. 

Then I would quickly get the hell away from there.


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## LucidResq (Jun 16, 2010)

DV_EMT said:


> As a 1st responder, what do you do? You have no backboard, no KED board, nothing but a bunch of BSI supplies and a pocket mask.



What do you mean?! I always keep at least 2 backboards, a KED, a stair chair and a stokes in the back of Camry!


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## NYBLS (Jun 16, 2010)

Treat what you can without removing either patient. You moving the pt with the impaled object could cause a major abdominal bleed. If you move the one with the impaled object for the unconcious pt, you now risk having two dead patients and no way to help either (except basic CPR).


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## mycrofft (Jun 16, 2010)

*Window punch*






If there is actual smoke there is either fire or an electrical arc. This is a scene safety scenario. 
Call 911, of course! Ten points.

I know what I think I would do, but these "declare death ->triage" scenarios irk me.


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## firecoins (Jun 16, 2010)

Passenger is dead. Move on with it.  MCI protocols. Nothing you can do until 911 arrives. Sorry.


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## trevor1189 (Jun 16, 2010)

Passenger not breathing and trapped. Trauma arrest, move on. If this is really out in the sticks, then they are not going to have a pulse by the time they are extricated if they aren't breathing now.

Did anyone consider the smoke is just from the airbags?

^ Just read the OPs update. People often report the car is on fire or it's smoking when they witness these crashes early on. It's my understanding the airbags have a fine dust in them to assist with lubricating them on deployment. This is the dust that causes brush burns to the face on occasion.

Also fatality in the vehicle means driver obviously meets trauma center designation. Call 911 back and tell them you need a helicopter launched.


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## spinnakr (Jun 16, 2010)

mycrofft said:


>


Absolutely 100% agreed.  The butt of a knife would work, or the tool kit in your car (EVERY car these days has them - for changing flats and such).  There's a lot of things that can break tempered glass if you know where to hit it.  Try the metal pointy part of your headrest.



> If there is actual smoke there is either fire or an electrical arc. This is a scene safety scenario.


Agreed - but my fire training is telling me to get this guy out while the getting is good.  Fires, especially with modern synthetics, can spread EXTREMELY rapidly.  If you got flame impingement on the gas tank...  well, you might not get an explosion, but you'd have a hell of a fire.



> these "declare death ->triage" scenarios irk me.


Me too.

Back to the scenario:  is the abdominal impalement through and out, or is it just lodged?



trevor1189 said:


> Did anyone consider the smoke is just from the airbags?


Excellent point.  If it's night and it's dark, can we see any heat sources/where the smoke is coming from?  And, for that matter, what is the smoke like?  Is it thick, billowing?  Brown, black, or white?  Etc etc.



trevor1189 said:


> ^ Just read the OPs update. People often report the car is on fire or it's smoking when they witness these crashes early on. It's my understanding the airbags have a fine dust in them to assist with lubricating them on deployment. This is the dust that causes brush burns to the face on occasion.


Sort of.  It's the airbag itself that causes the burn - it's just like rugburn - friction, plain and simple.  The dust is harmless - usually talc or some such.  However, if you've ever seen an airbag deploy...  it doesn't look anything like smoke from a car fire, hence the above question.  However, the ignition charge FROM the airbag can and sometimes does catch the airbag itself on fire - in which case, you need to get the airbag away from the ignition charge, being careful not to burn yourself.

Agreed on the medivac.

Also, I really like this scenario.


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## Sandog (Jun 17, 2010)

No fair changing the scenario... 

First post.


> Your driving down the highway (far from EMS/Rescue) when you see a car on the side of the road. The car has two occupants inside (one driver and one passenger). You pull over to help as a good Samaritan. There is smoke in the car, but no fire, and you see fluid running from the car down the road.



Second post.



> The fluid is clear and odorless, but upon arrival you do not notice its presence because it is nighttime and no odor is present


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## spinnakr (Jun 17, 2010)

Nice catch, Sandog.

A couple more questions about the impalement:
Color of the blood?  Quantity?  Quality?  Any other fluids?
By right in the middle, do you mean (essentially) the navel?
What kind of pain is he in from the impaled object?

Somewhat unrelated question:  what kind of car am I driving (this is serious)


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## MidwestFF (Jun 17, 2010)

Scene Size-Up
Call Dispatch / 911 Report
Assume Command
Advise of accident with injuries while staged at a safe distance.
Request air to be put on standby, if out in the sticks.
Request LEO / Fire / Rescue / EMS

Put on my Bunker Gear
Approach and severe battery connections (Depending on model of vehicle Airbags may still be live for 30 + minutes)
Make patient contact, quick ABC's on both passengers.
If passenger has obvious injuries not conducive to life, given the MOI and the amount of damage described to the vehicle, passenger is probably un-salvageable especially if there is an extended transport time via helicopter or ground.
Leave patient(s) in place

Call dispatch back
Provide Scene size-up
Advise of probable fatality
Request ETA's of previously requested resources
Request Air, Immediate Launch (Our system if bird is available it will be off the ground in under 7 minutes, 2 if on standby.)

Triage driver in place to the best of your ability and availability of resources, only remove driver from the vehicle if there is imminent danger of fire, explosion, or your patient is crashing and you need access to attempt further stabilization.

When local AHJ shows up transfer command, continue to be involved only to the extent that you are requested to do so by command.

Even if not requested by LEO or other agency, write a 'report' so that you have a record of the events for your own personal file. You will probably never need it but it may save your butt if you get sued later.


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## Akulahawk (Jun 17, 2010)

Call 911, give them a situation update. Passenger is triaged dead/nonsalvable. Unless there's immanent danger, driver stays in the car. I would check for the best way to do an emergent rapid extrication of the driver in the event that I have to evacuate the car, but other than that... I just don't see an immediate need to do it.


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## Sandog (Jun 17, 2010)

spinnakr said:


> Nice catch, Sandog.
> 
> A couple more questions about the impalement:
> Color of the blood?  Quantity?  Quality?  Any other fluids?
> ...



Upon further thinking, what fluid leaking from the car would be clear and odorless? Only thing I can think of is the windshield wiper container... :wacko:

Sorry, if I were able to see this liquid, smell or not, I would be thinking gas. Other fluids would drain rather quickly, most likely before I arrive on the scene.

Strangely enough, my instructor posed a similar question and said this was a real situation that he responded to. hmm.


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## spinnakr (Jun 17, 2010)

Sandog said:


> Upon further thinking, what fluid leaking from the car would be clear and odorless? Only thing I can think of is the windshield wiper container... :wacko:
> 
> Sorry, if I were able to see this liquid, smell or not, I would be thinking gas. Other fluids would drain rather quickly, most likely before I arrive on the scene.
> 
> Strangely enough, my instructor posed a similar question and said this was a real situation that he responded to. hmm.



I guess if you want to split hairs, clear and colorless are two different things.  If it's summer, it could be condensate from the A/C; it could also be the working fluid from the A/C, possibly brake fluid, engine oil if newly changed, engine coolant, WW fluid (AS YOU said), etc etc etc.  I'm going to assume at least combustible no matter what (possibly flammable, but the only flammables in a car I would THINK you'd be able to smell.  But I might feel at least a little better about the situation if I couldn't smell anything.

Because of the smoke, there's definitely a risk to life within the car.  Depending on the answer to the questions I asked last night, it might or might not justify removing the driver from the vehicle...

MidwestFF - by the OP, I'd say you cheated - "As a 1st responder, what do you do? You have no backboard, no KED board,* nothing but a bunch of BSI supplies and a pocket mask*."


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## nemedic (Jun 17, 2010)

spinnakr said:


> MidwestFF - by the OP, I'd say you cheated - "As a 1st responder, what do you do? You have no backboard, no KED board,* nothing but a bunch of BSI supplies and a pocket mask*."



Not necessarily. The bunker gear could arguably be considered part of BSI gear and basic protection that would normally be carried by someone in a "desolate area" by a "first responder" as a good portion of the rural areas of the country are staffed by predominately volly fire/ems, who may or may not be responding POV with bunker gear in the trunk


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## mcdonl (Jun 17, 2010)

nemedic said:


> Not necessarily. The bunker gear could arguably be considered part of BSI gear and basic protection that would normally be carried by someone in a "desolate area" by a "first responder" as a good portion of the rural areas of the country are staffed by predominately volly fire/ems, who may or may not be responding POV with bunker gear in the trunk



Not me. I would be too worried someone from www.emtlife.com would show up on duty and see me there with my bunker gear on in the middle of the night, in a desolate area at the scene of an accident 

My first call as the EMT a few weeks ago had an Intermediate, a Basic (Both full time FD) and two RN's on scene in traffic when we got there with rescue. None of them had any equipment at all.

I keep my jump kit in by truck as I live on the remote end of town and when I am on duty (Actually on duty, legally, on the schedule...) I respond with my POV but my bunker gear stays at home when not on duty. I only keep the jump kit in the car as I have two kids who are mouthy so bleeding control could happen at any moment.


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## spinnakr (Jun 17, 2010)

nemedic said:


> Not necessarily. The bunker gear could arguably be considered part of BSI gear and basic protection that would normally be carried by someone in a "desolate area" by a "first responder" as a good portion of the rural areas of the country are staffed by predominately volly fire/ems, who may or may not be responding POV with bunker gear in the trunk



Okay, but that wasn't the scenario.  The scenario was that you were off-duty, just driving by, and that is what you have.  Otherwise, I'd have a jump bag with me, along with various short-term and long-term wilderness survival items, etc etc.


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## MidwestFF (Jun 17, 2010)

If I got involved in that type of scene and I didn't have all my PPE on my chief would rightfully have my head on a pike(ouch). Yes, even as a firefighter I am concerned with scene safety. Hmmm smoking car, leaking fluids; rule of thumb applies no PPE, I do not approach the scene any closer than what I can cover it with my thumb at the end of my outstretched arm. I will call it in and wait for the AHJ. I don't always have my bunker gear with me but more often than not it is.


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## spinnakr (Jun 17, 2010)

MidwestFF said:


> If I got involved in that type of scene and I didn't have all my PPE on my chief would rightfully have my head on a pike(ouch). Yes, even as a firefighter I am concerned with scene safety. Hmmm smoking car, leaking fluids; rule of thumb applies no PPE, I do not approach the scene any closer than what I can cover it with my thumb at the end of my outstretched arm. I will call it in and wait for the AHJ. I don't always have my bunker gear with me but more often than not it is.


I dunno, if approaching at night and not immediately noticing the leaking fluid, I'm thinking more along the lines of what I was taught for HAZMAT:  calculated risk.  If there's a good chance of rescuing a savable life, then that's worth some risk.*  Plus, if the car catches, the driver is completely screwed.

*Please note:  I'm talking about SFPC and full SCBA when it comes to HAZMAT, which is still considered Level D HAZMAT protection (aka, no protection at all).  But, 75% of the threat is inhalation.


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## DV_EMT (Jun 18, 2010)

very good questions all! 

To answer a few of them. 

Impaled object - its just in the person's body (they're not pinned to the seat), not impeding them from being extricated. Like I said though, you don't really have the equipment to do a proper c-spine (KED) extrication.

Smoke - VERY GOOD to those who answered Airbag! The smoke is due to an airbag deploying

Fluid from the car - I used the example clear/odorless to provide detail that it was not gasoline. Therefore, its safe to say it could be wipre fluid, water from the radiatior, or possibly freeon from the A/C (though that has a slight odor)

Blood Perfusion - the driver has lost about 250-500 mL of blood (judging from the impaled object site and the blood that has run into the seat). The blood is currently slowly seeping out from around the impaled object. It is bright red in color.


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## DV_EMT (Jun 18, 2010)

spinnakr said:


> Nice catch, Sandog.
> 
> A couple more questions about the impalement:
> Color of the blood?  Quantity?  Quality?  Any other fluids?
> ...



To clarify 

dead center, right in the navel!

Pt complains of a pain 7/10 that is dull and achy, but extremely painful according to the patient.

The Car.... to be fair to all parties, lets make it a Jeep Wrangler, 6 cylinder. with mud tires and offroad lights! There is a tow package with a D ring and or trailer hitch.


Sorry about the fluid leaking portion of the scenario... i had to change it because I made the circumstances a night accident. So, to clarify, There is a clear odorless fluid that you don't notice at first, but upon approaching the vehicle, you notice it is present. there is not much fluid present... just enough to know its there. hope that clarifies!


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## looker (Jun 18, 2010)

Being that i am not even an EMT, i would continue driving. Depending on how many people are around, i might call 911 and report the emergency


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## reaper (Jun 18, 2010)

Then it would not matter. There is no way that a jeep would not have any access to the passenger!

 So treat as you would any other MVC!


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## ah2388 (Jun 18, 2010)

i prob remove the impaled object, perform rapid extrication on both patients, and try my hardest to turn the "black" patient into a red as soon as possible.

Rinse Repeat when current yellow patient becomes black


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## TransportJockey (Jun 18, 2010)

call 911 and keep on driving


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## ah2388 (Jun 18, 2010)

jtpaintball70 said:


> call 911 and keep on driving



incorrect


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## TransportJockey (Jun 18, 2010)

ah2388 said:


> incorrect



Really? You're telling me that me deciding what I'd do is incorrect? How?


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## ah2388 (Jun 18, 2010)

ah2388 said:


> i prob remove the impaled object, perform rapid extrication on both patients, and try my hardest to turn the "black" patient into a red as soon as possible.
> 
> Rinse Repeat when current yellow patient becomes black



clearly the correct plan of action


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## spinnakr (Jun 18, 2010)

ah2388 said:


> i prob remove the impaled object,



I sure hope not.  That object is occluding blood flow and saving the patient's life.  Removing it will kill the patient.  There's a damn good reason that in every EMT and medic class you take - as well as any fire class - they will tell you NOT to remove an embedded object.

No offense man, but especially in a remote setting, you just killed both patients.  You'd also be open to lawsuits from the family, because negligent behavior (ie, removing the impaled object) isn't covered by Good Samaritan laws (and for good reason).


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## ah2388 (Jun 18, 2010)

spinnakr said:


> I sure hope not.  That object is occluding blood flow and saving the patient's life.  Removing it will kill the patient.  There's a damn good reason that in every EMT and medic class you take - as well as any fire class - they will tell you NOT to remove an embedded object.
> 
> No offense man, but especially in a remote setting, you just killed both patients.  You'd also be open to lawsuits from the family, because negligent behavior (ie, removing the impaled object) isn't covered by Good Samaritan laws (and for good reason).



I thought I made it pretty clear that I was being sarcastic, in fact..I'd prob do something very similar to what jt is advising


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## TransportJockey (Jun 18, 2010)

ah2388 said:


> clearly the correct plan of action



Oh hell no. You do not remove an impaled object unless it interferes with the airway. Ever. And if a patient is black, they're staying that way. You say you're a medic student? Then tell me what's the probability of getting back a trauma arrest in a trauma room, much less prehospital with no equipment.

EDIT: Just read the post you posted above this. Your post didn't sound very sarcastic. I've seen sparky new EMTs come in and post stuff exactly like that and be 100% serious


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## ah2388 (Jun 18, 2010)

jtpaintball70 said:


> Oh hell no. You do not remove an impaled object unless it interferes with the airway. Ever. And if a patient is black, they're staying that way. You say you're a medic student? Then tell me what's the probability of getting back a trauma arrest in a trauma room, much less prehospital with no equipment.
> 
> EDIT: Just read the post you posted above this. Your post didn't sound very sarcastic. I've seen sparky new EMTs come in and post stuff exactly like that and be 100% serious



i apologize for not making myself clear, I thought the vocabulary involving "triage tagging" would indicate that I at least have something resembling an idea what I'm doing...

Just trying to have a little fun fellas


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## spinnakr (Jun 18, 2010)

ah2388 said:


> i apologize for not making myself clear, I thought the vocabulary involving "triage tagging" would indicate that I at least have something resembling an idea what I'm doing...
> 
> Just trying to have a little fun fellas


Phew.  You had me reaaaally worried there.

For the record... Look at the "smoke" (powder) color in the bottom right corner of this picture:





Compared with the smoke color in this picture:





It's pretty easy to tell which one is from an airbag.  Generally speaking, nothing _on fire_ these days is going to have a light gray smoke...  it'll have a nice, black, disgusting smoke.

As for the scenario, I see no reason to extricate the driver when you have pt. access and no indications of immediate threat to life.  Make the 911 call, dress the driver's wounds, pad the impaled object, and wait for help to arrive.  Monitor until that time.


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## Cory (Jun 18, 2010)

looker said:


> Being that i am not even an EMT, i would continue driving. Depending on how many people are around, i might call 911 and report the emergency



Please tell me you were being sarcastic too... You _might_ call 911?




> call 911 and keep on driving



Why keep driving? If there is something you can do, and you are trained to do it, why the hell wouldn't you do it? Why would you have spent time and money educating yourself in EMS courses if you were only going to use them for work? Seriously, I can't even begin to understand this train of thought. There are no immediate scene safety issues, besides being on what I would imagine is a dark road. If nothing else, I would try and comfort the pt who is still conscious. But I guess since you are big tough emtlife anti-"whacker" man, patient care has nothing to do with actually caring about the patient.

You wouldn't even bother to stay and try to assist rescue crews?


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## Trayos (Jun 18, 2010)

I'd call 911, and if the scene could be determined safe, talk through with the victims to keep them (more or less) calm. Other then that, there's sadly not much more I could do in the ways of extrication given my current level/equipment.


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## Lifeguards For Life (Jun 18, 2010)

Cory said:


> Please tell me you were being sarcastic too... You _might_ call 911?
> 
> 
> 
> ...







cool story, bro!


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## busmonkey (Jun 18, 2010)

For me, I would call 911, pad the impaled, dress the wounds until it got to dangerous. If I was worried about the smoke, I would call 911 punch the window with whatever was available to keep venting and get the hell back. Let the guys with SCBA go in and extract. Your patient on the otherside has no airway which means they are clinically dead, basic triage means so sorry buddy. That's about it for me.


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## TransportJockey (Jun 18, 2010)

Cory said:


> Why keep driving? If there is something you can do, and you are trained to do it, why the hell wouldn't you do it? Why would you have spent time and money educating yourself in EMS courses if you were only going to use them for work? Seriously, I can't even begin to understand this train of thought. There are no immediate scene safety issues, besides being on what I would imagine is a dark road. If nothing else, I would try and comfort the pt who is still conscious. But I guess since you are big tough emtlife anti-"whacker" man, patient care has nothing to do with actually caring about the patient.
> 
> You wouldn't even bother to stay and try to assist rescue crews?



Forgetting the fact that he said we have basic BSI gear... 

I don't carry anythign in my truck for use on another person. The little kit I have is for my use only and doesn't have any form of BSI. And you don't consider a dark back country road a danger enough? I don't carry a reflective vest and without a big red housemarker blocking off a lane for me, some extra light, and reflective safety gear, I'm not gonna stand on the side of the road. Screw that. My life is more important to me than anyone else's, and it's simply not my emergency. I would call 911. That's enough. 

And don't dare accuse me of not caring about the patient. If I have a patient I put my all into taking care of them and getting them to definitive care in one piece. But I also know how to separate my work life from regular life.

And how could I assist the rescue crews? I don't have extrication gear, no medical gear, no ppe. Nothing. They are better off without a sparky little EMT on scene getting in the way.


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## Lifeguards For Life (Jun 18, 2010)

jtpaintball70 said:


> Forgetting the fact that he said we have basic BSI gear...
> 
> I don't carry anythign in my truck for use on another person. The little kit I have is for my use only and doesn't have any form of BSI. And you don't consider a dark back country road a danger enough? I don't carry a reflective vest and without a big red housemarker blocking off a lane for me, some extra light, and reflective safety gear, I'm not gonna stand on the side of the road. Screw that. My life is more important to me than anyone else's, and it's simply not my emergency. I would call 911. That's enough.
> 
> ...



What about a sparky non EMT?


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## TransportJockey (Jun 18, 2010)

Lifeguards For Life said:


> What about a sparky non EMT?



That could possibly be even more annoying


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## ah2388 (Jun 18, 2010)

Im with Cory on this one, i pull out my portascope, endorectal tube, and sterile jaws of life and perform Invasive surgery on the spot


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## Cory (Jun 18, 2010)

> Forgetting the fact that he said we have basic BSI gear...



But that's the scenario...



> don't carry anythign in my truck for use on another person. The little kit I have is for my use only and doesn't have any form of BSI. And you don't consider a dark back country road a danger enough? I don't carry a reflective vest and without a big red housemarker blocking off a lane for me, some extra light, and reflective safety gear, I'm not gonna stand on the side of the road. Screw that.



Fair enough.



> and it's simply not my emergency



So someone is only worth saving if you get dispatched to save them while on duty? Please explain what you mean...



> I also know how to separate my work life from regular life.



What if it was a birghtly lit road, in the middle of the day? Would you still bother to help anyone, or do you only help people on duty?



> And how could I assist the rescue crews? I don't have extrication gear, no medical gear, no ppe. Nothing. They are better off without a sparky little EMT on scene getting in the way.



According to the OP, this is a very rural area. I was only suggesting that if the respone times are spread out, then the first responders may need an extra hand. Isn't it even worth checking?


Lifeguards: As always, grow up.


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## Cory (Jun 18, 2010)

ah2388 said:


> Im with Cory on this one, i pull out my portascope, endorectal tube, and sterile jaws of life and perform Invasive surgery on the spot



Thats exactly what I said.


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## ah2388 (Jun 18, 2010)

Cory said:


> Thats exactly what I said.



glad we're on the same page


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## TransportJockey (Jun 18, 2010)

If it was during the middle of the day my truck would have a fully equipped inflateable surgical suite from Galls  

But nope, I don't stop when off duty. It's that simple.


EDIT: Would you think less of an MD/DO or RN that doesn't stop at an accident when off work?


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## Cory (Jun 18, 2010)

jtpaintball70 said:


> But nope, I don't stop when off duty. It's that simple.



Why?


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## Cory (Jun 18, 2010)

> Would you think less of an MD/DO or RN that doesn't stop at an accident when off work?



No, I would be just as ashamed.


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## LucidResq (Jun 19, 2010)

Cory - 

Check this out. 

Many an EMS provider has been hit and killed while on-duty on the side of the road. At least in that scenario, their death will likely be covered by life/accidental death insurance. I refuse to die, doing something stupid like putzing around at a scene in the middle of the night without the proper safety equipment, lights, etc and I'm not going to leave a family behind with nothing. 

Like I said, my involvement would be limited to calling 911 and punching a window out if the cab was filling with smoke (I'm not going to stand by and watch someone die from inhalation/asphyxiation when the solution takes about 2 seconds)... yeah, there's a noticeable difference in the smoke from an airbag and "real" smoke because airbag smoke settles fairly quickly while "real" smoke tends to increase over time. If it was just airbag debris then I'm not getting anywhere close to the scene.


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## TransportJockey (Jun 19, 2010)

Cory said:


> Why?



Easy, my safety trumps everyone elses. I don't carry gloves or BSI, so what can I do other than call 911? I can give them all the info I see as I slow down and then keep going.


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## LucidResq (Jun 19, 2010)

Cory said:


> No, I would be just as ashamed.



Yeah, one time I watched my psychiatrist drive by an accident scene. What a jerk. 


I'll tell you that the doctors I work with, who are surgeons that would knock us all out of the park as far as ALS, managing hemorrhage, etc... I can guarantee they would almost never stop at an accident scene. Does that make them bad people? No. They just recognize that there is only so much one can do while "off the job" and the risks of stopping likely outweigh the benefits. Plus they have families to go home to.


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## TransportJockey (Jun 19, 2010)

LucidResq said:


> Yeah, one time I watched my psychiatrist drive by an accident scene. What a jerk.
> 
> 
> I'll tell you that the doctors I work with, who are surgeons that would knock us all out of the park as far as ALS, managing hemorrhage, etc... I can guarantee they would almost never stop at an accident scene. Does that make them bad people? No. They just recognize that there is only so much one can do while "off the job" and the risks of stopping likely outweigh the risks. Plus they have families to go home to.



What exactly would a psychiatrist do?  It's like a podiatrist stopping on an MVC scene

But you nailed it exactly on the head.


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## Cory (Jun 19, 2010)

jtpaintball70 said:


> Easy, my safety trumps everyone elses. I don't carry gloves or BSI, so what can I do other than call 911? I can give them all the info I see as I slow down and then keep going.



I understand, but the fact that you wouldn't even get out of your car in order to provide the 911 dispatcher with some detailed information on both pt's does no sit right with me. Clearly, these people are in need of ALS or even medevac. No one would know that if you don't even leave your car. I'm not saying that you have too spend any time there, especially if you don't have any euiptment. But for God's sake, you can't even tell the conscious pt that help is on its way?

If I were in this situation, I would stop in the safest place possible, get on the phone as I was moving to the car, check for smoke or leaking gas, check to see if they're conscious, at least try and get an understanding of their situation, relay it all to the operator, tell the man that help is on the way, return to my car. Whether or not I would leave the scene, well, I can't honestly say. I probably would.


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## spinnakr (Jun 19, 2010)

I'm with Cory, completely.  It's risk/benefit, plain and simple.  I positively abhor the culture of danger that pervades EMS and oftentimes Fire, but there is a difference between thinking danger is "cool" and knowing that you are entering a potentially dangerous situation with the purpose of saving a life.

To put it bluntly, my impression of the vast majority of medical personnel that I have met _in real life_ who have insisted that they would *never* stop for something, is that they do EMS because they think it makes them look cool.  I'm not saying that is true of anyone here;  however, in my personal experience, that's the nature of it.

Doctors, generally speaking, and again in my own anecdotal experience, don't stop for a number of reasons.  Oftentimes they don't notice, sometimes they don't care.  Sometimes they're just scared by situations without controlled environments.  But above all, they are afraid of being sued for malpractice.  You aren't covered by institutional insurance if you aren't working.  Furthermore, how many doctors do you know that would actually know what to do in a true emergency as it unfolds in front of them?  I know plenty of docs - even ER docs - that I wouldn't want doing pre-hospital care on me.  There is a fundamental difference between hospital and ER care, surgery, and pre-hospital care.  The best trauma surgeon in the world is just an over-glorified nurse without his OR, and he quite possibly does not have the experience in the field that a paramedic does, either.

Let's be honest:  if you keep your brain about you, how much of a risk are you taking by stopping?  Park your vehicle upstream of the crash; put on your hazards;  keep your lights on; point your wheels away from the crash.  Don't stand in the middle of the road.  Pay attention to your surroundings.  Scene safety isn't just about what it's like when you arrive; it's about maintaining situational awareness constantly.  If you do that, you'll see the car coming long before it has a chance to hit you.

Human beings have a remarkable ability to inflate the unlikely but grotesque and ignore the commonplace but benign.  How many people are afraid of flying?  How many are afraid of driving?  And yet which kills more people?

Maintaining scene safety is critical, and you need to know when to cut your losses and run.  But we must be careful not to throw the baby out with the bathwater:  a little risk to save a savable life is, like it or not, the nature of the game.  Anyone who says otherwise - anyone who claims to keep themselves 100% out of risk by only entering a "100% safe scene" - is either lying to themselves, or has never set foot in a vehicle.

25% of firefighter line-of-duty deaths occur in an apparatus.  EMS is no different.  The risk you take by stopping off-duty is the same you take every day when you go to work, for the same purpose.  It's calculated risk management, and REALISTIC risk assessment, that should dictate whether or not you stop, and not some set-in-stone personal rule.  And what if you were the driver of that car?  What would you have me do?


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## Trayos (Jun 19, 2010)

> Maintaining scene safety is critical, and you need to know when to cut your losses and run. But we must be careful not to throw the baby out with the bathwater: a little risk to save a savable life is, like it or not, the nature of the game. Anyone who says otherwise - anyone who claims to keep themselves 100% out of risk by only entering a "100% safe scene" - is either lying to themselves, or has never set foot in a vehicle.
> 
> 25% of firefighter line-of-duty deaths occur in an apparatus. EMS is no different. The risk you take by stopping off-duty is the same you take every day when you go to work, for the same purpose. It's calculated risk management, and REALISTIC risk assessment, that should dictate whether or not you stop, and not some set-in-stone personal rule. And what if you were the driver of that car? What would you have me do?


+100

In a similar note, has anyone here actually been in a situation where they rendered more care then a civilian/MFR in an emergency incident?


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## DV_EMT (Jun 19, 2010)

Alright alright, We know that there are many EMT, and Medics alike on this forum that wouldn't stop, but instead call 911. Likewise, there are the others that would stop to assist. Lets not thread-jack here as there are many other threads that discuss stopping vs. not stopping.

The purpose of this scenario was merely to see everyone's response to how they would "deal" with a situation provided that they were the only medical personnel on scene and it would take a long duration of time for EMS authority to get on scene.

Furthermore.... the thread was named "Good Samaritan - Rescue Vs. Medical" for a reason. I discovered that there was an instance similar to the one in this thread. An EMT, stopped his vehicle, attempted a rapid extrication (though there was no imminent threat to the vehicle) in order to "save the life" of the passenger. Now, the driver (though not impaled) did sustain a neck injury and ended us suing the EMT... even though the EMT was attempting to save his life. The court boiled it down to this

RESCUE VS. MEDICAL

If the car was a blazing inferno and death was imminent, and the EMT risked his life to save "both lives" because he knew they'd both die. A rapid RESCUE extrication would be covered under "Good Samaritan".

Due to the circumstances I presented, it would have been in ALL parties best interest to treat, but DO NOT extricate because it would have breached the Rescue vs. Medical Argument. The passenger should be triaged as a "DRT" due to the fact that there was limited information, and he was not able to be reached. The scene I painted was not that the car was ablaze, but moreover, had airbag smoke and a radiator/windshield wiper fluid on the ground -- not a Life or Death situation. 

Therefore, leaving the PT's in the vehicle and treating as much as possible to maintain airway, control bleeding, and immobilize the impaled object. As negligent as it may seem, the Pt in the passenger seat is probably a goner. gotta remember your 30-2-can do's!. 

Any comments or questions?


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## spinnakr (Jun 19, 2010)

DV_EMT said:


> Any comments or questions?



Just one that I forgot to ask before -
What color underwear was the good Samaritan wearing?


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## DrParasite (Jun 19, 2010)

some of you guys are really funny.  sterile jaws?  remove the penetrating object?  extricate the patient?  wow.

call 911, get the AHJ there pronto.  give the 911 dispatcher (which I happen to be) the best possible location, and a call back number.  whether you are in an urban city with many many roads, a long winding back road where you are miles from anyone, or an interstate, giving the exact location for help to arrive is the best thing you can do.  then waiting as said location until the first arriving unit arrives, to confirm help did make it, as well as allow dispatch to call you back i case the AHJ units have trouble finding the place is the best practice.

you want to control the bleeding until help arrives?  sure, I won't hold it against you, and you might save someone's life.  maybe even do a prelim scene assessment so you can tell dispatch (I need fire/rescue/blsx2/ALSx2/PD for traffic or AI/helicopter/etc) what is needed, great, even though they may listen to you, or they may ignore and follow their protocols as a layman calling 911.

but getting super involved in the scene once help arrives?  or before help arrives?  nah, let the AHJ handles patient care, documentation and deal with everything once they get on scene


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## spinnakr (Jun 19, 2010)

DrParasite said:


> but getting super involved in the scene once help arrives?  or before help arrives?  nah, let the AHJ handles patient care, documentation and deal with everything once they get on scene



Except in situations where, as the NFPA puts it, the environment is immediately dangerous to life and health.  EX:  burning building, burning car, etc.  Of course then, you'd be justified if you refused to help from a scene safety standpoint.

I'm hoping you caught that much of what you alluded to was sarcasm...


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## ah2388 (Jun 19, 2010)

DrParasite said:


> some of you guys are really funny.  sterile jaws?  remove the penetrating object?  extricate the patient?  wow.



I dont get it...


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## MidwestFF (Jun 19, 2010)

Just to clarify my previous responses. I always keep a football size first aid kit in my vehicles with basic BSI stuff you never know when you, your kids, or someone else might need it. Unless I'm on station and my gear is there, it is normally with me. Per our local protocols if I witness something like this I am required to stop and call it in unless EMS and or Fire is already on scene. 

As soon as I stop, I am on duty(read -> covered by department insurance), and therefore subject to Department SOP's and SOG's which dictate PPE based on the scene. For the scene that was described per our protocols I must at least to attempt to call the local AHJ and then don my PPE prior to getting within 100 feet of the vehicle. Our SOP's dealing with PPE requirements are fairly rigid. That type of crash scene would require per our SOP's full turnout gear, jacket, pants, boots, helmet, traffic vest, etc. If I was responding in a engine or rescue SCBA would be required as well; there is a small exception in our SOP's if responding POV and you are first on scene it is left to the individual whether there is a 'reasonable' risk vs benefit to the patients & the responder regarding mandatory SCBA use in the absence of one.

As to the question if I have ever stopped on a scene the answer is yes. My spouse is an experienced health care provider (read well beyond Medic & or floor nurse but not a MD either) and we stopped on a scene once several years ago, solo MC rider, no helmet vs guardrail and then pavement at 70+ mph. At the time we where the only other vehicle on the road and we stopped to assist. The pt had two full extremity amputations thanks to the guardrail, major closed head injury,  and was generally hamburger head to toe. We called it in and did the best we could dealing with bleeding, and shock until help could arrive. We originally requested Air but it was not available due to weather conditions, 911 dispatch couldn't call for Air due to their protocols, so I called and got much further with Life-Flight direct until the closest crew declined due to weather and density altitude at our location. AHJ took almost 30 minutes to show with Fire and EMS and even then all they had were a couple of BLS providers. They wound up letting my spouse run PT care while I helped with PT packaging and loading, I followed the ambulance with my spouse in it 35+ miles to the communities Doc-In-A-Box(express sized at that) and then spent another three hours their while my spouse helped stabilize the patient so that the PT could get flown out. We learned that the PT did regain consciousness but died a few weeks later due to the head injury and massive infection due to the incident.


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## TransportJockey (Jun 19, 2010)

I'm seeing lot o acronyms in this thread, most I know but wth is AHJ?


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## spinnakr (Jun 19, 2010)

jtpaintball70 said:


> I'm seeing lot o acronyms in this thread, most I know but wth is AHJ?



Authority having jurisdiction


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## Stephanie. (Jun 19, 2010)

DV_EMT said:


> For Scene Purposes:
> In order to "entrap the patient" lets say the driver lost control and hit a large boulder that has crushed the passenger side windshield and has made it impossible to access the passenger side (assuming its a 2 door coupe).





DV_EMT said:


> The Car.... to be fair to all parties, lets make it a Jeep Wrangler, 6 cylinder. with mud tires and offroad lights! There is a tow package with a D ring and or trailer hitch.



Changed the scenario again. Therefore there is at least some access to passenger, given that they are NOT entrapped.


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## spinnakr (Jun 19, 2010)

Stephanie. said:


> Changed the scenario again. Therefore there is at least some access to passenger, given that they are NOT entrapped.



No, he was talking about your car as the responder.  Also, the no entrapment was on the driver, not the passenger.


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## Sandog (Jun 19, 2010)

MidwestFF said:


> As to the question if I have ever stopped on a scene the answer is yes. My spouse is an experienced health care provider (read well beyond Medic & or floor nurse but not a MD either) and we stopped on a scene once several years ago, solo MC rider, no helmet vs guardrail and then pavement at 70+ mph. At the time we where the only other vehicle on the road and we stopped to assist. The pt had two full extremity amputations thanks to the guardrail, major closed head injury,  and was generally hamburger head to toe. We called it in and did the best we could dealing with bleeding, and shock until help could arrive. We originally requested Air but it was not available due to weather conditions, 911 dispatch couldn't call for Air due to their protocols, so I called and got much further with Life-Flight direct until the closest crew declined due to weather and density altitude at our location. AHJ took almost 30 minutes to show with Fire and EMS and even then all they had were a couple of BLS providers. They wound up letting my spouse run PT care while I helped with PT packaging and loading, I followed the ambulance with my spouse in it 35+ miles to the communities Doc-In-A-Box(express sized at that) and then spent another three hours their while my spouse helped stabilize the patient so that the PT could get flown out. We learned that the PT did regain consciousness but died a few weeks later due to the head injury and massive infection due to the incident.



Look at this way. You and your wife extended this persons life an additional two weeks. This afforded his family and friends a chance to say goodbye before passing.

You did good.


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## TransportJockey (Jun 19, 2010)

Sandog said:


> Look at this way. You and your wife extended this persons life an additional two weeks. This afforded his family and friends a chance to say goodbye before passing.
> 
> You did good.



And let the pt and his family wrack up one hell of a medical bill


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## Sandog (Jun 19, 2010)

jtpaintball70 said:


> And let the pt and his family wrack up one hell of a medical bill



So, your the glass half empty kind of guy...


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## firetender (Jun 19, 2010)

*A Philisophical Moment from a firetender*

With each and every thing you do, each and every treatment you render, each and every thing that happens, never forget the *#1 Rule of Life:
*
_*Could be good
Could be bad

(Your **interpretation is what makes the difference in the moment. Long-term, whatever happens is just an initiating ripple that can morph into anything. Quit your squabbling, kids, do your honest best and enjoy the wonder, just enjoy the wonder!)
*_


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## TransportJockey (Jun 19, 2010)

Sandog said:


> So, your the glass half empty kind of guy...



Especially when consuming ETOH as I've been doing today


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## Stephanie. (Jun 19, 2010)

spinnakr said:


> No, he was talking about your car as the responder.  Also, the no entrapment was on the driver, not the passenger.



Thank you for clarifying. My apologies.


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## ah2388 (Jun 20, 2010)

jtpaintball70 said:


> And let the pt and his family wrack up one hell of a medical bill



wat


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## thatJeffguy (Jun 30, 2010)

jtpaintball70 said:


> Oh hell no. You do not remove an impaled object unless it interferes with the airway. Ever. And if a patient is black, they're staying that way. You say you're a medic student? Then tell me what's the probability of getting back a trauma arrest in a trauma room, much less prehospital with no equipment.
> 
> EDIT: Just read the post you posted above this. Your post didn't sound very sarcastic. I've seen sparky new EMTs come in and post stuff exactly like that and be 100% serious




This "ever" stuff is a bit much.

W-EMT teaches, and Wilderness protocols allow for, the removal of objects impaled through *extremities*, if they aren't near a major vessel.


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