# Ejected



## firecoins (Feb 16, 2007)

The worst accidents I have seen were always ejections from vehicles.

Witnessed a car slam into another stopped in traffic at a high rate of speed. The occupants of the car that did the slamming were partially ejected thru the windsheild and back into their seats. They both jumped out of their vehicle covered in blood.  I am surprised they were conscious.  

A 14 year old girl got ejected from the back of a mini van after a dispute between the driver and his mother. The mother had grabbed the wheel and the girl flew out of the back. She had signs of a major head injury and her R knee bone was visible after the skin was torn off. 

A motorcyclist and his passanger rear ended a car and were thrown into the back window of the car in front of them.


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## Airwaygoddess (Feb 16, 2007)

Dam..... I hate pedi trauma cases.  Are you doing o.k.?


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## firecoins (Feb 16, 2007)

I am doing great.  As far as I know the girl is fine today.  Her injuries were serious and potentially life threatening but I have every reason to believe she pulled through.  She got treated very quickly and was medivaced out to a level 1 trauma center.


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## Mercy4Angels (Feb 17, 2007)

ouch....had a rollover last night...all ok though.


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## mcaj0n (Feb 22, 2007)

i just passed my nremt and I really dont want to see any cases like this even though I know I will, how do I prepare for these scenarios, any suggestions guys, thanks in advance.


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## firecoins (Feb 22, 2007)

The best way to prepare for this is to make sure you work on the backboarding skills, you may need to put OPA in, NSAs are out, check your suction & O2 equipment.


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## Mercy4Angels (Feb 22, 2007)

99.99% of the time around here the medics are already there, fire is on scene and police are there first. We are volunteer so BLS is there last. by the time we get there the patients are out of the wreck and medics are working on them. once in a while we get there b4 medics but thats rare since medics are paid and always available.


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## firecoins (Feb 22, 2007)

Mercy4Angels said:


> 99.99% of the time around here the medics are already there, fire is on scene and police are there first. We are volunteer so BLS is there last. by the time we get there the patients are out of the wreck and medics are working on them. once in a while we get there b4 medics but thats rare since medics are paid and always available.



its the same in my system but you should never be medic dependant.  Airways, Breathing and Circulation.  Any ejection, your getting severe head injuries and spinal injuries.  Automatically your going to have this guy backboarded on high O2, possibly an OPA with suction ready. Youll be bagging if he isn't breathing with major bleeding bandaged. In the rig, you will expose for further injuries looking for internal bleeding and chest trauma.


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## premedtim (Feb 23, 2007)

Last class my instructors commented on a passenger vs. train call they had a couple years ago where this genius decided it'd be a good idea to go 100+ mph down the road, go past the guard rails (which were down since a train was coming obviously) and apparently saw the train at the last second, tried to turn, there was some gravel on the road and he dropped the bike & kept skidding and came to stop on the tracks....both legs severed, one foot was completely degloved so the skin from it was about six feet from the foot it was originally on, and yeah there were just pieces of him everywhere. 

So if you don't work near any train tracks, at least you won't have the chance of seeing that?


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## firecoins (Feb 23, 2007)

that is disgusting.  <_<   I am aware that on some occassions in NYC some people have fallen between a subway  and the platform.  It twisted them up. The only thing keeping them alive was the subway pinning them in.  They were gone once it was moved.


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## Mercy4Angels (Feb 23, 2007)

firecoins said:


> its the same in my system but you should never be medic dependant.  Airways, Breathing and Circulation.  Any ejection, your getting severe head injuries and spinal injuries.  Automatically your going to have this guy backboarded on high O2, possibly an OPA with suction ready. Youll be bagging if he isn't breathing with major bleeding bandaged. In the rig, you will expose for further injuries looking for internal bleeding and chest trauma.



OPA only if unconsious. NPA otherwise. Your gonna bag even if he is breathing if the breathing is too shallow to sustain life its a judgement call. And yea medic dependant is bad i look to them like the big brother not GOD. remember you cant be a medic unless your a basic. everyone comes from the same place some just lose their basic skills and rely too much on ALS skills when not needed.

oh and i have train tracks that run through my town. yippee !


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## firecoins (Feb 23, 2007)

You won't use an NPA because your assuming a skull fracture.


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## Jon (Feb 25, 2007)

firecoins said:


> You won't use an NPA because your assuming a skull fracture.


NPA's have a MUCH lower risk than nasal intubations at penitrating through a basal skull fracture.

If the patient could tolerate an OPA, I'd use an OPA. If the patient REALLY needed an airway, and the jaw was clenched... I'd probably lean towards a NPA, at least until the Pt. could be RSI'd.

Rid -  Your thoughts?

Jon


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## Nycxice13 (Feb 26, 2007)

Jon said:


> NPA's have a MUCH lower risk than nasal intubations at penitrating through a basal skull fracture.
> 
> If the patient could tolerate an OPA, I'd use an OPA. If the patient REALLY needed an airway, and the jaw was clenched... I'd probably lean towards a NPA, at least until the Pt. could be RSI'd.
> 
> ...



Cant do that according to NY protocol, always have to assume skull injuries (cant say fracture, thats a diagnostic term  lol) in trauma cases


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## firecoins (Feb 26, 2007)

Yes NY State protocol prevents me from considering an NPA if skull fractures can suspected. Okay skull injuries. NY state is like that.


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## Ridryder911 (Feb 26, 2007)

Long time ago a neuro/trauma surgeon Dr. Shea from Chicago taught me a valuable lesson, when we did a trauma autopsy. He demonstrated to me on how fragile the palate was. Since it is actually made of ethmoid, sphenoid, fused together (remember the butterfly pattern) this are commonly open in facial and head trauma. 

The point he made to me was in regards in nasal intubation on trauma and even NG tubes. Albeit, it is probably a very low chance of increasing trauma, he did demonstrate with slight pressure of how easy it was to intubate the brain stem. He claims that NG tubes are often accidentally placed more than one would expect, finding documentation on this is hard, since many cases are settled out and the file is closed. 

I do believe with safety, a very soft NP could be passed easily, however; I personally would not perform it or suggest anyone to. Murphy's law persist with me.. I would forgo the NP. 

R/r 911


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## Recycled Words (Mar 3, 2007)

That would be on more of the Metro-North trains. The regular train lines don't have that big a gap so all they could do is fall off the platform in which case they'd just be crushed.

....not that that's much better, but I doubt it's less painful


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## firecoins (Mar 4, 2007)

Recycled Words said:


> That would be on more of the Metro-North trains. The regular train lines don't have that big a gap so all they could do is fall off the platform in which case they'd just be crushed.
> 
> ....not that that's much better, but I doubt it's less painful



its happaned with both.


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## Nycxice13 (Mar 4, 2007)

firecoins said:


> its happaned with both.



Very small gap on the NYC trains, had to be some small people :sad:


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## firecoins (Mar 4, 2007)

Nycxice13 said:


> Very small gap on the NYC trains, had to be some small people :sad:



I dont think all cases involved falling in a gap but just somehow became wedged between the subway and platform. I don't know specifics. I know it has occured on NYC subways.  Its happaned on Metro North probably more often.


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## Jon (Mar 6, 2007)

I know SEPTA (Philly's Public Transit) had an issue about 3 years ago with a woman running for a Regional Rail train on a "high platform" who ended up with her foot amputated after it became mangled after being caught between a moving train and the platform when she missed the door. SEPTA has had a HUGE "don't run for trains" ad campagin ever since.. and the conductors ALWAYS close all doors before the train starts moving.


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## Recycled Words (Mar 6, 2007)

Yeah...some woman got crushed in the gap on the LIRR a few weeks ago. They were talking about fixing the gap, but who knows if that'll ever happen....


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