# Helmets?



## WuLabsWuTecH (Jul 5, 2009)

So we were running a very critically injured patient today to the hospital and by the nature of what we were doing, none of us could be strapped in.

So I was holding bleeding control, a medic student was starting a line, and the In Charge was trying to assess for further injuries, bleeds that we missed and also trying to get vitals.

Well, it was the shakiest ride ever for me but it was a critical patient so we had to load and go (in the past we usually do all we need to before we go so we can be strapped in).  Well, someone turned out in front of us and the driver had to slam on the brakes.  I went into the wall and lost hold of pressure,  The IV medic student went tumbling into the airway chair (thank god it was padded), and my partner actually flew over my head and into the cabinet doors.

Luckily we were all still wearing our bulletproof vests so not much bruising.  There were a few other tosses but none as bad.

It got me thinking though.  We have helmets for the scene of a crash, does anyone here have helmets that they wear in the truck when they are not belted in?  I was anchored pretty well with my ankle so I turned to let my body (with the vest on) catch the full brunt of it.  The IV guy was lucky that his head went into a padded chair, and the Medic was lucky that she went into me to slow her down before she sent over me and into the cabinets.

So, once again, does anyone wear helmets inside the truck?


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## Shishkabob (Jul 5, 2009)

Well.. first question is "Bullet proof vest"?


Second, how fast were you going that a fully grown adult flew OVER you when brakes were hit?


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## VentMedic (Jul 6, 2009)

First, what is an IV medic?

You do realize that many of the deaths in the back of a truck are from unrestrained providers? 

You are all very, very lucky and a helmut would not prevent you from become a quad by a SCI. 

This is exactly what could have happened to the person hitting the seat head first as well as the person flying over you. 

Imagine if that had been your body crashing into and flying over the female medic. 

I take it this was a L/S run to the hospital. How fast were you going? 

Maybe it is time you get your company to install user friendly restraints in the back. Don't wait for someone to be killed or a resident in a ventilator facility. 

But then from the poll I posted recently, I guess it is just a matter of time before someone from this forum gets posted in the LODD section.


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## rmellish (Jul 6, 2009)

This reminds me of Emergency!


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## usafmedic45 (Jul 6, 2009)

> You are all very, very lucky and a helmut would not prevent you from become a quad by a SCI.



In fact, it could increase your risk of that if not applied in concert with proper restraints.  There is a lot of evidence (from NASCAR, IRL, etc) that says even a seat belt alone does not constitute "proper restraint" of someone wearing a helmet. 



> Second, how fast were you going that a fully grown adult flew OVER you when brakes were hit?



My thought exactly.



> First, what is an IV medic?



Likewise....what the heck?  Unless he's referring to the medic student assigned to getting the IV.


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## WuLabsWuTecH (Jul 6, 2009)

To answer all the questions:

Bulletproof vests - they stop bullets, but it turns out it prevents bruising from getting slammed into the side of the medic.  Since it was an assault, we wear our bulletproof vests on scene.  Its protocol.  Also, in case we stage a little too close or the situation gets out of hand and comes toward us.

I don't know how fast we were going but it was too fast.  From the driver's story, we were in the center lane and cars stopped to our right lanes, and some lady on her cell phone missed us in the center lane and thought they were waving her through.  If i were driving, something like this wouldn't have happened b/c i'm much more careful, but I have to prove that first since I'm still under 21 and this department doesn't let under 21s drive w/o special permission.  I drove a lot at the previous company I was with and did emergency runs and I'm much more careful and don't let adrenaline get to me.  But he saw the 1-2 liters of blood on the ground and kinda freaked is what I guess happened.  My female partner is very small maybe 110 lbs?

Yeah I know i was lucky, I was anchored in as best as I could, but there was no way to hold pressure and be belted in to anything.  I usually am belted into the bench seat, but in this case I'd have to have had the belt pulled so far out from the seat it wouldn't have made sense.  Probably do more damage and give me an abdominal injury if I wasn't wearing it right and we hit something.

Yes we were running hot to the hospital.  He was very critical in so far as to us deciding to run to a non-trauma center b/c he wasn't going to make it for the extra 10-15 minutes to the trauma center.

How would a helmet do more damage?  Would you not suggest us getting helmets then?

IV medic was referring to the medic student starting an IV.  To differentiate from the "driving medic" and the "in charge medic"  I could have called him the Basic doing the IV, but then ppl would be up in arms like the thread on "Basics have no business starting IV!"  I guess in avoiding that confusion, I created more!

Lastly, I appreciate all of you guys' concerns.  I have long been an advocate of personnel safety.  Today was the first time I have ever not been restrained and not have all of my equipment restrained in the back.  (The equipment was unintentional, we though everything was secure but missed a battery, luckily the battery missed us)  There was just no better way for me to hold pressure than to keep as low as possible to the ground and anchor my foot onto the cabinet and wheelwell (although if you guys have suggesstions I'd be happy to hear them!)

Thanks!
-Wu


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## JPINFV (Jul 6, 2009)

I'm confused by this.



> Yes we were running hot to the hospital. He was very critical in so far as to us deciding to run to a non-trauma center b/c he wasn't going to make it for the extra 10-15 minutes to the trauma center.



So, if he wasn't going to survive going to a trauma center, how well is he going to fare at a hospital not set up to handle critical traumas?


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## Sasha (Jul 6, 2009)

> Yes we were running hot to the hospital. He was very critical in so far as to us deciding to run to a non-trauma center b/c he wasn't going to make it for the extra 10-15 minutes to the trauma center.



Not to be nitpicky, but why are you running l/s for a dead person?


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## ClarkKent (Jul 6, 2009)

Sasha said:


> Not to be nitpicky, but why are you running l/s for a dead person?



I am taking it if he was not at a hospital very quickly, he would be dead.  The trauma hospital was an extra 10-15 minutes add on to the call, and that would make him dead.


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## Shishkabob (Jul 6, 2009)

Clark, you don't take patients to a hospital that cannot do anything for them, which is why trauma centers have certain designations labeling them as such.

They'll need to be taken to the trauma center to survive, and any delay spells certain death.


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## Sasha (Jul 6, 2009)

ClarkKent said:


> I am taking it if he was not at a hospital very quickly, he would be dead.  The trauma hospital was an extra 10-15 minutes add on to the call, and that would make him dead.



Still, likely if he wouldn't have made it 10-15 minutes to a specialty hospital and was taken to to a hospital not equipped to deal with trauma, do you really think he lived?

THe driver put the crew in back, himself, and the public in danger for a likely dead person.


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## usafmedic45 (Jul 6, 2009)

ClarkKent said:


> I am taking it if he was not at a hospital very quickly, he would be dead.  The trauma hospital was an extra 10-15 minutes add on to the call, and that would make him dead.


Wu, wasn't it you that was in the chatroom saying you still had your rookie "white cloud"?


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## WolfmanHarris (Jul 6, 2009)

The helmet is not going to be what you need in an incident such as this. What you need is some conservative driving and like all of us in North America, some better designed trucks. (ability to reach equipment and patient while belted, no squad bench, etc.)

My biggest piece of advice would be maintain a good "cushion of safety" while driving that includes a 4-5 second following distance. When I'm driving L/S and see that someone doesn't seem to be moving over I start decreasing speed way ahead of time. I know you weren't in the front, but I perhaps your partner may have been driving too aggressively.


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## ClarkKent (Jul 6, 2009)

usafmedic45 said:


> Wu, wasn't it you that was in the chatroom saying you still had your rookie "white cloud"?



"White Cloud, I have not clue what you are talking about.  

What was covered in my EMT-B class is you take the patient to a trauma hospital if time allows.  If not, and the patient is circling the drain, take the patient to the closest hospital that has an ED.  

I have not been out in the field and that's what I was told to do.  If I was told something that was wrong, please let me know.  I am new and I am here to learn.

Please PM me your replys, I do not want to take this to go off topic, or as Sasha once said, "threadjacking".


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## usafmedic45 (Jul 6, 2009)

ClarkKent said:


> "White Cloud, I have not clue what you are talking about.
> 
> What was covered in my EMT-B class is you take the patient to a trauma hospital if time allows.  If not, and the patient is circling the drain, take the patient to the closest hospital that has an ED.
> 
> ...


White cloud = opposite of being an "excrement magnet"


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## Hockey (Jul 6, 2009)

Man, why do you guys rip apart every little thing somebody says?


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## VentMedic (Jul 6, 2009)

Hockey said:


> Man, why do you guys rip apart every little thing somebody says?


 
You have a problem with people discussing safety or appropriate facilities?


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## Sail195 (Jul 6, 2009)

I know in the area I work its useless to drive crazy the transport times are 20 min max and you really don't save that much time. It really is not worth the risk.... I think the question here is less about having to wear helmets and more of a question of should we have more involved driver training.... I have had my Class B cdl for 6 years now and drove buses for the first 5 of those years and it really troubles me how they will just let anyone drive emergency vehicles with little to no training. Personally I feel you should be made to go through a class B program or a modified but similar program that will properly train you but thats just my 2 cents!


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## medichopeful (Jul 6, 2009)

Hockey said:


> Man, why do you guys rip apart every little thing somebody says?



Heck, even I don't have a problem with what I have seen in this thread.


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## JPINFV (Jul 6, 2009)

Hockey said:


> Man, why do you guys rip apart every little thing somebody says?



Hey, if someone wants to rip apart one of my treatment choices (and I do consider destination and the use of lights and sirens on a transport to be a treatment decision, then so be it. You can't fix what you don't know is broken and you might learn something from someone else.


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## VentMedic (Jul 6, 2009)

Back to the topic.

This near tragic event should be used as an opportunity learn from it. I am hoping that a formal report was also made so a paper trail can start to boost your arguments in the future or in the event one of those passengers find they may have more lingering serious injuries than just a little soreness post event.

The call itself should be reviewed to see if anything could have been done differently. Was there something else that could have been done in the stabilization and was the closest facility really the best option? Did the speed of the ambulance also prevent you from providing adequate patient care since it is noted that CPR is almost useless in a speeding vehicle? Did inexperience in the vehicle play a role in the speed and patient care decisions? 

The issue with using L/S and speed may also require the supervisors/managers to determine if additional training or retraining might be necessary concerning the operation of an emergency vehicle for all involved.

The company may also have to explore the idea of investing in different patient compartment restraint devices.

Helmets by themselves will not prevent injury as an unrestrained passenger in the back of an ambulance.

Essentially there were many factors involved.


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## marineman (Jul 6, 2009)

Sail195 said:


> I know in the area I work its useless to drive crazy the transport times are 20 min max and you really don't save that much time. It really is not worth the risk.... I think the question here is less about having to wear helmets and more of a question of should we have more involved driver training.... I have had my Class B cdl for 6 years now and drove buses for the first 5 of those years and it really troubles me how they will just let anyone drive emergency vehicles with little to no training. Personally I feel you should be made to go through a class B program or a modified but similar program that will properly train you but thats just my 2 cents!



Drove semi's for 5 years and I couldn't agree more. Too many people get in the ambulance and drive it like a car failing to realize that it weighs roughly 15,000lbs. 

For the topic at hand pass on the helmet and get ready for a harness and tether system that should be coming sometime. 

I do however agree with the fact that if the patient is in that bad of shape that you can't make it to a trauma center when you had 2 medics on board then it's senseless to drive to the hospital l&s


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## Pudge40 (Jul 6, 2009)

I would not advise wearing a helmet while in motion. I know NFPA was either working on or has passed a *STANDARD** that all new fire trucks must have compartments to put in the personnel's helmets because in crashes they were detrimental.

*They are not laws and you can not be fined for not following them, however if the case is taken to court your case my be lost if you are not in compliance with them.


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## WolfmanHarris (Jul 6, 2009)

marineman said:


> For the topic at hand pass on the helmet and get ready for a harness and tether system that should be coming sometime.



Stop management from wasting money on a harness and tether. I don't have a text source as it was a webinar, but Dr. Nadine Levick has some very interesting things to say on these. She strongly advises against them. If I get the chance later I will look for a linkable source.


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## SurgeWSE (Jul 6, 2009)

marineman said:


> I do however agree with the fact that if the patient is in that bad of shape that you can't make it to a trauma center when you had 2 medics on board then it's senseless to drive to the hospital l&s



I don't follow.  I would imagine that most EDs that you see will have blood, central lines, RSI, etc. I'm certainly not arguing that we should regularly stop at smaller hospitals with our criticals, but I can easily sit here and brainstorm scenarios where it would be prudent.

As to the original question, no helmet is going to do anything about the massive axial load your spine is gonna take when you go head-first into the cabinets.  I certainly understand that the currently prevalent box designs make it nearly impossible to stay restrained 100% of the time. I have to unbuckle to adjust wall mounted O2, cycle NIBP, repeat EKGs, start IVADs in the right extremities, and on and on.  As a side effect, I spend way too much time unrestrained.


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## WuLabsWuTecH (Jul 6, 2009)

Ok, in response one by one to what everyone has said as much as possible without quoting each message.

@ JPINFV - He was hemodynamically unstable.  Injuries were a punctured carotid and Jugular.  He would have fared well at the trauma center, but would have bleed out by then.  He got that I'm about to code look on his face twice during the 7 minute transport.  We had a long discussion about choice of hospital.  In Charge Medic first called for us to go to the Level I trauma center.  The other medic said closet hospital, they reevaluated and decided on closest hospital.

@ Sasha - Patient was not dead.  Still talking to us the whole way there, but was rapidly deteriorating.  Alert, but only oriented to person as much as we could tell.  Its been a few years since I've spoken spanish but he was having trouble even giving us his name.  He was obeying commands but coudn't tell us the date or where he was.

@ clarkkent "I am taking it if he was not at a hospital very quickly, he would be dead. The trauma hospital was an extra 10-15 minutes add on to the call, and that would make him dead."  That is precisely what we feared.  Blood loss was too great.  We estimated 1-1.5 Liters on the pavement of arterial blood (it was a hot day with hot pavement do some of it was already coagulating).  Bystanders estimated he staggered into the parking lot and had been down for 10 minutes.  Patient estimated an hour which to us indicated confusion.

@ Linus, ClarkKent, Sasha.  The difference around here between Level I and Level II trauma centers is just hours of staffing and research.  It being a Holiday weekend sunday, it was probably not likely for there to be a trauma surgeon avaliable, but had we gone the extra 20 minutes, chances are the trauma surgeon wouldn't have been able to do a thing b/c the blood loss was so great.  Once again, the patient was still alive when we got there--no dead patient.  We actually did get lucky and a trauma surgeon happened to be there.  They did have to call in the cardio though.

@Sasha and others, yes the driving was too aggressive.  But I think going lights was the right choice here.  The 7 minutes was considerably shorter since there were probably 15-25 traffic lights between us and the hospital.  I think that had we gone lights, but at a slower speed, we would have been just as well off.  It was not having to stop and wait 3 minutes at each light that decreased our transport time, not the going fast.

@JPINFV - I also agree, please give constructive criticism, this was a situation that was going to break 6 eggs one way and a half a dozen the other.  If you think you had a way that would have only cracked 5 eggs, I'd like to know about it.  There was absoluately no way for me to be restrained in this situation or for the Medic starting the IV to have been restrained.  The In charge may have been able to strap in and I think she should have.

@VentMedic, Marineman, Surge - Yes I am thinking of filing a formal report.  One of the reasons I asked here was to determine whether I should make a reccomendation for helmets.  I will make one for better restraints, but short of harnesses, I doubt there is much we can do for that situation.  This was just a bad situation.  We discussed after the call (not in the presence of the driver) that we thought lights and sirens was the way to go, as was the choice of hospital.  Yes, we took a chance, but at least we could get whole blood into him at the hospital.  We had a chopper called in and standing by.  We lucked out and there was a trauma surgeon there so we cancelled the chopper and the MICU (we also called for a MICU incase the chopper couldn't fly for some reason).

The driver was the ranking paramedic.  He does not take criticism kindly which is why we didn't tell him to his face.  For the time being I have not signed up for any shifts with him until this can be resolved but didn't tell him this was why I removed myself form some shifts.  The official reason I gave was "personal scheduling conflicts."  I think he might need retraining on driving the rig and understanding what is acceptable and what is not.

@VentMedic - No CPR was being performed, i'm not sure where you got that from b/c it hasn't been mentioned in this thread.  He didn't code on us, but he might have if we went to the level I trauma center.  At that point CPR is worthless since he has no blood left to circulate.  As stated in the original post 1 Medic Student was starting an IV, I was trying to control the bleeding as best as I could, and the in charge medic was assessing for other injuries.  I might PM you when I get back from studying for more info on what to include in the report.

@marineman - we had 2 experienced medics, a medic student, and a basic.  Even so, medics are still just that, medics, not doctors.  They were both experienced (one with decades of experience and an instructor, the other with just shy of 3 years) but there are some things a medic just cannot do.  Of these, the two most important ones were administering whole blood, and repairing the tear, something a doctor can do, but not a medic.  Lights and sirens here was prudent.  The transport time to the same facility would have been extended by probably about 10 minutes or more.  Since he lost about a liter to 2 of blood in the first 10 minutes and we were having trouble controlling the bleeding, another 10 minutes and we might be looking at a different story.  The human body only has about 5 liters of blood.  The speed was uncalled for, but the Lights and sirens I believe was justified in this case as it was very certainly possible (and I might go out on a limb and say probable) that it did make the difference between life and death.

Just for reference, he was in surgery as we left and we have later heard that he is expected to survive this ordeal.  But I know that just because he's going to make it, it doesn't mean that we did everything right, although it means we did SOMETHING right!  Anyways, I value all of your opinions on this (and we're slightly off topic but it's ok) and appreciate the constructive criticism and opinions!

------- Slightly unrelated below------
@USAFmedic - yes, I got my card exactly 365 days ago as of last shift.  I guess when I lost my rookie status, the white cloud left in a hurry.  Also ran on a MVC - Van vs. Motorcycle later that day (only two runs, the ambulance was such a mess after this run we're talking about now that we were out of service for nearly 3 hours afterwards cleaning ourselves up and then the ambulance.  One of my partners was soaked in blood.  I had it all over too, but not as bad.  The cot was bright red as was the floor of our truck)


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## VentMedic (Jul 6, 2009)

WuLabsWuTecH said:


> @VentMedic, Marineman, Surge - Yes I am thinking of filing a formal report.
> 
> @VentMedic - No CPR was being performed, i'm not sure where you got that from b/c it hasn't been mentioned in this thread. He didn't code on us, but he might have if we went to the level I trauma center. At that point CPR is worthless since he has no blood left to circulate. As stated in the original post 1 Medic Student was starting an IV, I was trying to control the bleeding as best as I could, and the in charge medic was assessing for other injuries. I might PM you when I get back from studying for more info on what to include in the report.


 
The report should already have been done. Usually 24 -48 hours is the time frame. The person who flew over you and the one who hit his head on the seat should definitely have already filed a report. It is not counted against them but does provide documentation that something did occur and they had the potential for serious injury that may result in disability later. Unfortunately, many spinal cord and nerve injuries do not show up immediately and quite often those in EMS who start getting aches and pains later can attribute it to some incident months or years past that was not reported or checked. 

If you ever get the opportunity to have a thorough spinal exam, including an MRI, you would be surprised as to what a good neurologist can tell you. He/She will read your life story in the films and ask you questions that will bring back memories of every accident and stupid thing you have even done to influence the health of your back, neck and head.


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## WuLabsWuTecH (Jul 6, 2009)

VentMedic said:


> The report should already have been done. Usually 24 -48 hours is the time frame. The person who flew over you and the one who hit his head on the seat should definitely have already filed a report. It is not counted against them but does provide documentation that something did occur and they had the potential for serious injury that may result in disability later. Unfortunately, many spinal cord and nerve injuries do not show up immediately and quite often those in EMS who start getting aches and pains later can attribute it to some incident months or years past that was not reported or checked.
> 
> If you ever get the opportunity to have a thorough spinal exam, including an MRI, you would be surprised as to what a good neurologist can tell you. He/She will read your life story in the films and ask you questions that will bring back memories of every accident and stupid thing you have even done to influence the health of your back, neck and head.


Thanks, as of right now we're only 20 hours from the end of shift.  I'm still a provisional status with them so I don't have a report per se to fill out but will probably write an email to the captain or personnel LT to let them know about this.

Like I said though, give what we had at the time, I'm not sure there was much more we could have done in the back with what HE was doing up front.


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## VentMedic (Jul 6, 2009)

WuLabsWuTecH said:


> Like I said though, give what we had at the time, I'm not sure there was much more we could have done in the back with what HE was doing up front.


 
I forgot to finish my post.

That was the point I was making about CPR.  If you are hanging on for your own life, you won't be caring for the patient.

Since he was an experienced Paramedic, he may also have thought that there wasn't too much experience in the back and speed might be the best option.  I sorry if that sounds insulting but sometimes if who you have in the back caring for the patient is freaking out, the hospital might seem like a million miles away when you are driving. 

This is also why our pilots and drivers for specialty teams know very little to nothing about the condition of the baby or child.  We in no way would want it to influence their driving and our safety.


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## WuLabsWuTecH (Jul 6, 2009)

VentMedic said:


> I forgot to finish my post.
> 
> That was the point I was making about CPR.  If you are hanging on for your own life, you won't be caring for the patient.
> 
> ...


There wasn't much we could do.  Aside from starting lines, keeping them wide open and squeezing the bag, and me applying as much pressure as I could, there were no interventions in the field that could help this guy.  Had there been, I'm sure the most experienced medic would have asked the other medic to drive and he would have been in the back, but I think he too understood there was nothing to be done but get to the hospital.

That being said, he overreacts and gets jumpy sometimes at scenes and I think something got into him.  unfortunately there is no way we can get dedicated drivers that know nothing about the condition of the patient, but I see how in a bird its possible to keep the pilot more in the dark.

And we in the back wern't freaking out, it was surprisingly calm except for the being tossed around everywhere!


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## marineman (Jul 6, 2009)

Maybe your area is different than mine but not all hospitals here stock whole blood products. It's hard not being able to see exactly what's going on and I don't want to armchair this and say an experienced provider that did see the whole story was wrong however the only time I have taken a major trauma patient anywhere other than a trauma center was when we picked up 3 from one incident and I wanted to allow them some time to get the others out before bringing a third in. 

Like I said I didn't see what was happening nor do I know your protocols but an uncontrolled bleed is a reason for us to call a trauma alert, not enough to divert. 

Back to the topic at hand definitely make sure something is on file that says exactly what happened, Vent as usual was right on the money about the delayed pain response and if it's not on file you're SOL


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## WuLabsWuTecH (Jul 7, 2009)

I have talked to the LT and we will be drawing up a report.  Thank for all of your guys' help.

I was wondering if anyone had pictures of other restraint systems (other than seatbelts).  I know some have overhead but I hear they are not that great so I was wondering what you guys might suggest.

Thanks!


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## scottmcleod (Jul 7, 2009)

WuLabsWuTecH said:


> That being said, he overreacts and gets jumpy sometimes at scenes and I think something got into him.



My communications teacher would call that a definite need for CISD. I actually just finished completing that section (5 pages) in my syllabus, and those are a few of the symptoms that a call may have affected him more than he's willing to admit...

Just my $0.02 (Cautiously, as I see VentMedic has entered the thread ^_^ )

h34r: *quietly goes back to lurking the shadows*


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## usafmedic45 (Jul 8, 2009)

> My communications teacher would call that a definite need for CISD.



Two things.

#1:  In what way is your communications teacher qualified to make that judgment?

#2:  When was the last time this bastion of knowledge actually looked at the research on this subject?  CISD *does not* work.  In fact, it may actually be harmful.  Please do not confuse real psychiatric care (you know....medicine?) with its _quasi modo_ illegitimate little brother.


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## WuLabsWuTecH (Jul 8, 2009)

usafmedic45 said:


> Two things.
> 
> #1:  In what way is your communications teacher qualified to make that judgment?
> 
> #2:  When was the last time this bastion of knowledge actually looked at the research on this subject?  CISD *does not* work.  In fact, it may actually be harmful.  Please do not confuse real psychiatric care (you know....medicine?) with its _quasi modo_ illegitimate little brother.


usaf:  Read http://www.ncbi.nlm.nih.gov/pubmed/15131998 .

I will not debate it here b/c 1) we're going off topic, and 2) its entirely not certain still whether CISD helps or hurts or does neither.  There are studies that say both, but when you dismiss something so perfucntly.

Also, any restraint systems anyone has seen yet?


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## VentMedic (Jul 8, 2009)

WuLabsWuTecH said:


> usaf: Read http://www.ncbi.nlm.nih.gov/pubmed/15131998 .
> 
> I will not debate it here b/c 1) we're going off topic, and 2) its entirely not certain still whether CISD helps or hurts or does neither. There are studies that say both, but when you dismiss something so perfucntly.


 
Read the articles to the right of the abstract you linked and then read th e articles linked on each of those pages and you will find more than enough reasons why CISD can be harmful.

There will always be articles pro just like it was mentioned in another thread that advanced skills for an EMT-B are great as concluded by some researcher. Or, that MAST work. As more data is available, which has been for CISD since it has been around for a long time, the participants have been studied carefully in some areas. 




> Originally Posted by *WuLabsWuTecH*
> 
> 
> _That being said, he overreacts and gets jumpy sometimes at scenes and I think something got into him. _


CISD is not going to change someone's personality or something that has been embedded into their emotional makeup. There may also be many other issues happening with this person that they would prefer not to discuss in a room of their peers in fear of looking stupid or weak. There have been issues with CISD since the beginning and I have watched as many good people leave the job or some have ended their own life because they relied on the "buddy debriefing" provided by their peers instead of seeking true professional help. A few hours of "training" does not make one a Mental Health Professional.


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## scottmcleod (Jul 8, 2009)

usafmedic45 said:


> Two things.
> 
> #1:  In what way is your communications teacher qualified to make that judgment?
> 
> #2:  When was the last time this bastion of knowledge actually looked at the research on this subject?  CISD *does not* work.  In fact, it may actually be harmful.  Please do not confuse real psychiatric care (you know....medicine?) with its _quasi modo_ illegitimate little brother.



My comm teacher also teaches psych, but I'm not going to get into that, because arguing on the internet is like... (you can finish that sentence yourself).

I never said I was an expert on the subject, and you're right, there are situations where it can make it worse... but;

Is it acceptable for that medic to be acting the way he is? Y/N?

If N, does something need to be addressed? Why is he acting out of character lately?

That being said, I'm stepping away from this conversation before it gets out of hand, and further off topic.

... that, and VentMedic's shown up ;-)

h34r:

*poof*


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## VentMedic (Jul 8, 2009)

scottmcleod said:


> My comm teacher also teaches psych,
> ... that, and VentMedic's shown up ;-)
> 
> h34r:
> ...


 
I show up because some make comments without posting anything to back it up. 

What type of psych does your teacher teach? Is this at a votech or university? Is your teacher a mental health professional? Psych, like many areas in medicine, has many specialites. Not all "psych" instructors are qualified to practice patient care when it comes to mental illness nor are they experts in all areas. 



> If N, does something need to be addressed? Why is he acting out of character lately?


 
Yes it is something that may need to be addressed by a qualified professional.

Does he have marital or financial problems? Is he impotent? Is his wife leaving him? Does he have an alcohol and/or drug problem? That is a serious issue when in some CISD sessions others are talking/joking about just having a few beers to cope while someone is struggling to control their addiction and yet want to be "one of the guys". Does he have a true mental disorder that is now just presenting itself? Depression? None of these issues should be handled by someone with just a few hours of training. How willing are some to be truthful to themselves or others that they have other serious problems and this one trauma is just a catalyst for other emotions to arise? How many are willing to openly discuss with their peers that they are having alchohol, sex and money problems that are compounding their ability to deal with the stressors of the job? 

It is usually those with the deep seated problems that don't outwardly display serious "psych" issues to the untrained and uneducated eye. Ever wonder why some are so shocked when a co-worker, adult or child they know commits suicide? Most don't know what to look for and a person with serious problems may not be that obvious. We have lost too many in this profession relying on "we take care of our own" and lead them to believe a good "b***S### session with the guys lead by someone who has attended a few hours of training is sufficient. That doesn't just apply to suicide but also to addiction to alcohol and drugs as well as burn out.


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## mycrofft (Jul 8, 2009)

*Helmets versus vehicle design.*

Nice big boxy units allow more acceleration space when things start to fly and slide. Vehicles nearly always decelerate back-to-front (stern to bow, posterior-anterior) much more strongly than any other direction. As in the driver compartment of cars, padding, avoidance of ninety-degree angle angles of attack form decelerating objects, etc., will help cut down on the impact damage helmets protect from. I'd be comfortable working in a helmet, but a helmet is only part of the issue.

Provider cervical spine damage, shoulder injuries, etc. are harder to prevent because to immobilize them renders you ineffective. Try top find ways to be up against something betwen you and the front so when deceleration happens, you have less acceleration space.

By the way, Wu, very gentlemanly of you to let the lady by...


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## VentMedic (Jul 8, 2009)

The device should prevent collision with other people in the patient compartment as well as the interior.


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## mycrofft (Jul 8, 2009)

*I know...*

Sumo Suits.

Yeah, that sound of a parietal bone hitting a TMJ is sort of less than comforting.


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## scottmcleod (Jul 8, 2009)

VentMedic said:


> I show up because some make comments without posting anything to back it up.
> 
> What type of psych does your teacher teach? Is this at a votech or university? Is your teacher a mental health professional? Psych, like many areas in medicine, has many specialites. Not all "psych" instructors are qualified to practice patient care when it comes to mental illness nor are they experts in all areas.
> 
> ...



I agree wholeheartedly.


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## WuLabsWuTecH (Jul 8, 2009)

scottmcleod said:


> I agree wholeheartedly.


Scott and vent?  Agreeing?  WHAT?

Anyways, i was probably semi tired when I read the above!

mycrofft, that's why I was suggessting helmets.  I was holding pressure on the carotid and jugular and I was as close to the cabinet as I could get.  The impact for me was not as hard as for the medic and student who traveled 4 or 5 times the distance I did.   Further I had my ankle dug in right next to the cabinet which is how I twisted myself to let my bulletproof vest take the full brunt of the impact.  I thought helmets might help incase I also hit my head, but from the previous posters, some think that halmets can actually be detrimental.

I guess my new question is, in addtional to using those restraints that everyone has mentioned but no one has provided an example of, why would helmets be detrimental?


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## scottmcleod (Jul 9, 2009)

WuLabsWuTecH said:


> Scott and vent?  Agreeing?  WHAT?
> 
> Anyways, i was probably semi tired when I read the above!
> 
> ...



I'm not going to bother getting into the physics of it (again, arguing over the internet is like... ), but there's a reason that racedrivers use the HANS device ( http://en.wikipedia.org/wiki/Hans_device )

A helmet adds the equivalent of "unsprung weight" to your body. The back of the ambulance should be better designed to have less protrusions into the path of a possible moving head. Have you seen the videos on youtube? They're scary as hell. ( http://www.youtube.com/user/ParamedicSafety )

... again, I'm not here to argue against anyone else's points, just post things and let people make their own conclusions, so don't bother arguing with me, because I won't argue back.

h34r:

*holding smokebomb, anticipating VentMedic*


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## VentMedic (Jul 9, 2009)

And the helmet turns your body into a great battering ram to use on the others in the patient compartment as you are soaring through the air.  It will also do little for the position that your body will land with great force.


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## scottmcleod (Jul 9, 2009)

VentMedic said:


> And the helmet turns your body into a great battering ram to use on the others in the patient compartment as you are soaring through the air.  It will also do little for the position that your body will land with great force.



As goes for anything that's unrestrained, as big as your monitor (if not strapped down properly), or as small as your shears if you've put them down somewhere and not back in your holster/pants.

h34r:

*poof*


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## mycrofft (Jul 9, 2009)

*OK, no prob. Get the physics straight though.*

(I'm smiling here, don't get mad). In real life, a pair of unsecured Tetrasnips isn't going to go zanging across the ambulance interior with nearly enough force to go stick into the wall. Otherwise, there would be a lot of scissor, pen, spring-loaded centerpunch, handheld radio, and other injuries to EMT's every year, including the poor driver (whenever he or she slams on the brakes and all that kipple comes flying in the pass-through!)

Physics-wise, the only occupant of an ambulance eqiuvalent to a race driver (hopefully) is the driver, and she/he is mostly in their dreams.

The answer is to drive more safely, make basic safety design changes in the interiors, drive more safely, and drive more safely.

PS: How about taking lights and sirens off ambulances? Just give them flashing yellow lights like a tow truck, paint them Barney purple, hook up FD-style traffic light control devices, and cameras to provide evidence for stiff punishment of people impeding the operation of the ambulance? No more "Mario Andretti" syndrome, and maybe cut down response times.


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## VentMedic (Jul 9, 2009)

mycrofft said:


> No more "Mario Andretti" syndrome, and maybe cut down response times.


 
Nice guy and makes great wine.  
Infineon Raceway is pretty incredible also.  You can learn alot about restraining devices and Mario would  be a good source of information.   I may have to make a trip just for the purpose of this thread. 

Just a tidbit for those in California.


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## WolfmanHarris (Jul 10, 2009)

mycrofft said:


> PS: How about taking lights and sirens off ambulances? Just give them flashing yellow lights like a tow truck, paint them Barney purple, hook up FD-style traffic light control devices, and cameras to provide evidence for stiff punishment of people impeding the operation of the ambulance? No more "Mario Andretti" syndrome, and maybe cut down response times.[/FONT]



I bet no matter how much you could back this up with solid arguments, evidence that L&S doesn't save time and the increased risks you would still find tonnes of people up in arms throwing as many arguments, no matter how contrived, against it. I mean, I agree with you that the necessity of L&S is just not supported beyond public expectation and even I have to fight that irrational twinge about removing them.

With regards to helmets, they are only going to be of use ion conjunction with being properly restrained in order to prevent injuries from head strikes. As we redesign Ambulances to remove things from the head strike zone and make sure that providers can work while belted at all times the necessity of helmets goes down. They're a stop-gap for extremely poor vehicle design.


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## CAOX3 (Jul 10, 2009)

Sasha said:


> Not to be nitpicky, but why are you running l/s for a dead person?



I can see a jackpot in your future.

You will be one who ends up leaving a viable patient in the street.


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## WolfmanHarris (Jul 10, 2009)

CAOX3 said:


> I can see a jackpot in your future.
> 
> You will be one who ends up leaving a viable patient in the street.



Umm... field pronouncement? ALS almost never transports VSA's in this province and BLS already does TOR for trauma and is trialing medical TOR in some areas (which will likely be expanding).

It's been awhile since I've reviewed the criteria for the medical TOR (since my service isn't in the trial), but I believe it's unwitnessed adult arrest, no shockable rhythm and no ALS available allows the PCP to patch for pronouncement.

Stats do not support the transport of VSA patients.


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## WuLabsWuTecH (Jul 10, 2009)

CAOX3 said:


> I can see a jackpot in your future.
> 
> You will be one who ends up leaving a viable patient in the street.


Possibly even this one.

We thought he might not make it with all the blood loss but with some luck they were able to fix his artery and vein and get whole blood in him quickly.


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## Pudge40 (Jul 11, 2009)

The service that I run with got a new rig within the last year. They redesigned the rear to provide for safety for the providers during transport. The first way they did this was to remove the bench seat and replace it with two captains chairs. The second way they did this was for the CPR seat they got a 5 point safety harness installed. And yes the captains chairs do fold down to make transport of a second patient possible. Here are pics. I like the new rig because of the fact that you can remain restrained even while providing care.




Captain chairs




CPR seat


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## Ridryder911 (Jul 11, 2009)

Nice rig, but here is my point. 

Why do manufactures are still determine to place sharp corners with aluminum edges? I don't know how many times myself and partners have gouged and cut ourselves on them. As well, why not recess the buttons, suction containers, oxygen meters? Seriously, they protrude out of the wall awaiting impalement by a passing medic. 

Another pet peeve is diamond steel plates. Why? What in the back of the unit has to be armored? Brushed steel... yeah, looks great the first thirty minutes after purchasing, then looks like crap the rest of the units career. 

Manufactures refuse to listen to those within the industry. Unfortunate EMS administrators will not take a stand and demand them to be work friendly. We work in them and they should be designed for our working needs to deliver patient care, safety and comfort! 

Look at England at their lift on the back of the units. Why is it the U.S. cannot have the same? Look at how many work related injuries would be reduced, needless stretcher incidents would be eliminated. 

A part of the industry, that is well controlled and ignores those within it. 

R/r 911


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## WuLabsWuTecH (Jul 11, 2009)

Ever since the first day I was in an ambulance, I hated those edges and corners on the cabinets.  Cannot we atleast apd them or something if we refuse to get rid of them?


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## scottmcleod (Jul 12, 2009)

WuLabsWuTecH said:


> Ever since the first day I was in an ambulance, I hated those edges and corners on the cabinets.  Cannot we atleast apd them or something if we refuse to get rid of them?



... or a late night ninja-stealth attack with bubble wrap and duct-tape?

(I'm surprised more corners haven't been covered by the "2-3 inch thick corner bumpers" that that ambulance above even has a few of...)


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## Pudge40 (Jul 12, 2009)

I have never been injured by any corners on any ambulance, however I have only been running for about a year and a half.


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## DV_EMT (Jul 12, 2009)

Ok... this was a GREAT THREAD to read. Lots of good discussion and its awesome!

My opinion... helmets are only good for SAR, Medivac, and professionals who are on bikes, atvs, etc...

Wearing it in an ambulance is impractical.... and would look wierd. I say throw the helmet idea out the window and (like someone else stated) invest in a harness (either a 5 point or the jumpseat flight attendant type).

but then again thats just me..... and everyone in nascar


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## WuLabsWuTecH (Jul 12, 2009)

DV_EMT said:


> Ok... this was a GREAT THREAD to read. Lots of good discussion and its awesome!
> 
> My opinion... helmets are only good for SAR, Medivac, and professionals who are on bikes, atvs, etc...
> 
> ...


I agree, much good discussion.

If it doesn't work, that's one thing, but i'd be ok with looking a bit weird if it's going to keep me safer.  If it's not and might hurt me, then that's another issue.  I assume that you guys have to wear those bright yellow (/safety green) vests on a scene of an MVA?  Does it make me look rediculous?  Yes, but I'll do it if it keeps me safer (I know i'm about to take some flak for this, so I will state that whether or not it keeps me safer is another discussion!)


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## DV_EMT (Jul 12, 2009)

Our's are baby blue......


But i light up like the fourth of July!!!!


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## WuLabsWuTecH (Jul 12, 2009)

baby blue road vests?  I thought national DOT had said they had to be those obnoxious yellows?

And by lightup do you men reflective or do you guys have lights mounted on them?  I've seen vests with lights on them but they're mostly for the bike guys.


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## DV_EMT (Jul 12, 2009)

well we're a disaster relief... so for us we dont have to meet DOT requirments (I think.... someone check me please). But they just have a crap ton of the super reflective tape. Hence why we light up!


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## Pudge40 (Jul 12, 2009)

WuLabsWuTecH said:


> I agree, much good discussion.
> 
> If it doesn't work, that's one thing, but i'd be ok with looking a bit weird if it's going to keep me safer.  If it's not and might hurt me, then that's another issue.  I assume that you guys have to wear those bright yellow (/safety green) vests on a scene of an MVA?  Does it make me look rediculous?  Yes, but I'll do it if it keeps me safer (I know i'm about to take some flak for this, so I will state that whether or not it keeps me safer is another discussion!)



It is not a requirement of the DOT it is a requirement of congress. They are the ones that passed the FEDERAL requirement that says ANYONE working along a FEDERALLY FUNDED roadway MUST wear either a class 2 or 3 saftey reflective vest. They are even supposed to be the 5 point break away. There are exceptions to the rule such as:

Working at an incident that involves fire - for firefighters.
Working at an incident that involves hazardous materials
Police upon initial contact with a driver during a traffic stop (the state police around here never wear the vests)
And also if the roadway is shut down you are not required to wear them.

If I am wrong with any information posted please correct me as this is what i got from the requirement, although I can't find the document online right now.


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## usafmedic45 (Jul 12, 2009)

> Medivac



There are some- myself included- who believe there is growing evidence to indicate that the use of helmets among unrestrained aeromedical personnel may be one reason for a high rate of cervical spine and basilar skull fractures.  I agree that helmets have their limitations and that the better practice is greater use of seat based restraints and application of injury prevention ergonomics to the layout of ambulance compartments rather than helmets or those inertial reel Peter Pan harnesses that have been developed and recommended by some.



> but then again thats just me..... and everyone in nascar



Care to clarify the NASCAR statement?  They still mandate helmets and have actually increased the safety of them through the application of the HANS head and neck support device.  It is the added weight of the helmet that makes them hazardous in an unrestrained person or someone solely with their torso restrained.  If anything- and I know the safety guys for several teams (NASCAR, IRL and Formula One) and a couple who contract to do research for NASCAR as a whole- they are probably the staunchest supporters of the use of helmets as part of a protective system in motor vehicle crashes.  The problem is that people hear "helmet" and fail to realize that using one alone will not always save you and sometimes will do more harm than good.  I liken it to going into a medieval sword fight wearing solely a steel codpiece and expect that to save you.  It's not the use of helmets that's a problem it is the _inappropriate_ use of helmets or misguided beliefs about their impact (no pun intended) that is the source of issues.


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## Pudge40 (Jul 12, 2009)

Disregard my first post about the safety cests. It is the DOT and the Federal Highway Administration that made the requirement. I believe that everything else is up to par but I will review the document and post changes as nesseccary (sp?).


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## WuLabsWuTecH (Jul 12, 2009)

DV_EMT said:


> well we're a disaster relief... so for us we dont have to meet DOT requirments (I think.... someone check me please). But they just have a crap ton of the super reflective tape. Hence why we light up!





Pudge40 said:


> Disregard my first post about the safety cests. It is the DOT and the Federal Highway Administration that made the requirement. I believe that everything else is up to par but I will review the document and post changes as nesseccary (sp?).



Since EMS in under the DOT, i thought that no matter what you work fo ryou had to follow those rules.

Pudge, are you still sure of those 4 rules though?  B/c even when we have the intersection completely shutdown, we still wear the vests.


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## DV_EMT (Jul 12, 2009)

Nascar.... the harness, not the helmet

...im sure we all remember earnhardt before the neck supports were enstated...


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## Pudge40 (Jul 12, 2009)

WuLabsWuTecH said:


> Since EMS in under the DOT, i thought that no matter what you work fo ryou had to follow those rules.
> 
> Pudge, are you still sure of those 4 rules though?  B/c even when we have the intersection completely shutdown, we still wear the vests.



After I reviewed the document It does not speciffically say that however it does say: "_All workers within the right-of-way of a Federal-aid highway *who are exposed either to traffic (vehicles using the highway for purposes of travel) or to construction equipment within the work area shall wear high-visibility safety apparel.* Firefighters or other emergency responders working within the right-of-way of a Federal-aid highway and engaged in emergency operations that directly expose them to flame, fire, heat, and/or hazardous materials may wear retroreflective turn-out gear that is specified and regulated by other organizations, such as the National Fire Protection Association. Firefighters or other emergency responders working within the right-of-way of a Federal-aid highway and engaged in any other types of operations shall wear high-visibility safety apparel._"

It does however specifically state if you are directing traffic it is still required. The way I see it is if one lane on both sides of the lane you are working on are closed while you are working there they are not required but it is still possible that they are. Also no one will say anything to you if you wear it where it is not required big deal if you do. But if you don't wear it where required they may say something to you.


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## usafmedic45 (Jul 12, 2009)

> Nascar.... the harness, not the helmet
> 
> ...im sure we all remember earnhardt before the neck supports were enstated...



Right...but they still will argue that the helmets do a lot of good.  They simply learned that they should be used in concert with proper restraints.  I believe I just misunderstood what you were trying to say initially .


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## DV_EMT (Jul 12, 2009)

usafmedic45 said:


> Right...but they still will argue that the helmets do a lot of good.  They simply learned that they should be used in concert with proper restraints.  I believe I just misunderstood what you were trying to say initially .




correct... misunderstandings happen.


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## WuLabsWuTecH (Jul 12, 2009)

What about this, you are strapped in, but your head is next to a cabinet.  Would the helmet help or hurt you should your head and the cabinet interface?  Especially if you hit a corner?


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## usafmedic45 (Jul 12, 2009)

> What about this, you are strapped in, but your head is next to a cabinet. Would the helmet help or hurt you should your head and the cabinet interface? Especially if you hit a corner?



Depends upon the amount of force involved. Most likely in that situation, it would help.  The problem is when you exceed the limits of G that the neck muscles can withstand while the chest is tightly restrained but the head is not.  Usually this is more of a problem with neck flexion/extension than with lateral motion of the head. There is some evidence to support that the added weight of the helmet contributes to injury in this situation (not the hitting your head issue, but the deceleration situation I mentioned) by both adding weight to the head and causing fatigue of the neck muscles.


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## WuLabsWuTecH (Jul 13, 2009)

usafmedic45 said:


> Depends upon the amount of force involved. Most likely in that situation, it would help.  The problem is when you exceed the limits of G that the neck muscles can withstand while the chest is tightly restrained but the head is not.  Usually this is more of a problem with neck flexion/extension than with lateral motion of the head. There is some evidence to support that the added weight of the helmet contributes to injury in this situation (not the hitting your head issue, but the deceleration situation I mentioned) by both adding weight to the head and causing fatigue of the neck muscles.


Well, we've finally come full circle.  That was the original question I posed (or was trying to pose) before we took a tangent (and a nice, educational, beneficial one I might add).  But I'm thinking that helmets in that situation can help too.

Also we have a padded ceiling, and I know this because my head has hit the ceiling before due to driver going over speedbump.  I was new to that rig (all the others I can stand comfortably while this one requires a bit of bending) and never have I made that mistake again.  Luckily it was barely a tap but it was a wake up call.  I now crouch much lower in the rig and keep a lower center of gravity.


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## usafmedic45 (Jul 13, 2009)

> Also we have a padded ceiling, and I know this because my head has hit the ceiling before due to driver going over speedbump.



I've always argued that padding as we see in ambulances and cars probably does very little in any sequence serious enough to inflict serious or lethal injury.  If one really wanted to do that, the thickness of the padding would have to be such that it would be prohibitive or you would have to find a material that would be much more effective at absorbing a given amount of energy for a given unit of deformation while remaining strong enough that ordinary "impacts" from day to day contact would not damage them or degrade their ability to fail as designed when and if the time comes that they should be needed to protect occupants. The other option is to eliminate corners altogether replacing them with rounded surfaces so as to spread any impact forces over a greater area. Ideally, you would apply both of these options together for maximum benefit.


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## WuLabsWuTecH (Jul 13, 2009)

Well, when I know what my senior design project is now for my Biomed Engineering Degree!  :-D

Yeah, the padding is pretty thick, about 2-2.5 inches, but not enough that if I had hit it harder it would have prevented me from a world of hurt.  But for a light bump I didn't feel any pain at all...


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## usafmedic45 (Jul 13, 2009)

> Well, when I know what my senior design project is now for my Biomed Engineering Degree!



:lol:  All I ask is that the source of the idea be listed in the writeup of it.  Heck, I'll even help you with your project if you want.  I'll trade that for co-authorship on one of my papers on injury patterns.  Feel free to PM me if you need anything.


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## WuLabsWuTecH (Aug 10, 2009)

So I just wanted to update you guys on this.  After submitting reports and such, I just got a CQI form to fill out in my inbox.  I assume CQI is just about patient care right?  Should I even mention something about the whole being thrown around thing or is it time to let that go?  (This call seems to STILL be following me around!)


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