Bad situation. What would you do?

[usalsfyre]

I hate to be this guy (although it's already been mentioned) BUT....

Understand that the moment you touch blade to skin you have ended any career in medicine of any kind, no matter the outcome, in 99.99% of places. State EMS and medical boards tend to take a VERY dim view on this kind of thing. Not to mention you are probably going to have millions in legal judgements against you, again, no matter the outcome. Are you willing to accept the effect on the rest of your life?

Another thought is, has anyone actually CUT tissue and bone with a sawzall? The other day we ruined two blades cutting through rubber mats at my part time FD job. It took at least 5 minutes to cut them as well. An amputation may not be as easy as it seems.

Poetic, did they use extinguishers on the fire? This is probably a better option trying to buy time for the pump than trying to free the trapped hand. Of course this is all Monday morning quaterbacking. However, I wouldn't do the amputation. It's just....yeah.

 

[Shishkabob]

Treat is as an MCI. Black tag em and move on, help who you can and forget the rest.

You're trading one potential life saved for countless potential lives saved in you career that you'd be giving up.






It sucks and I hope to not be put in this position, but that's my view when there's plenty of time to ponder it.

 

[DesertMedic66]

So you're saying your BLS units don't have AEDs?! That's insane.

Yeah. None of our BLS units have AEDs. Our medic units are required to have monitors. But we are short 2 monitors so we are now short 2 medic units.

If we arrive on scene to a full arrest all we do it pump chest and NPA/OPA unit a medic ambulance arrives or a medic fire engine arrives.

 

[SanDiegoEmt7]

Perhaps your review of the call will result in extinguishers being placed on all your units. I guess I could understand how your truck doesn't carry water, buuuuuuut no extinguisher? ridiculous.

Ambulances, police, and FOR DAMN SURE fire carry them around here.

I have personally put out a car fire with an entrapped patient, using our ambulance extinguisher and it prevented a catastrophe until fire got on scene.

Unless I'm missing something in this story?

 

[Sasha]

I wouldnt consider amputation. It sounds cold but im not going to open myself up to criminal and civil liability.

We have 2 fire extinguishers on our trucks and we are ift. Could you have used them to try and control the fire enough before it flashed? Idk much about fire or fire extinguishers.

 

[Sasha]

Ps aeds are optional here too and half our bls trucks have them stocked with open pads.

 

[STXmedic]

Perhaps your review of the call will result in extinguishers being placed on all your units. I guess I could understand how your truck doesn't carry water, buuuuuuut no extinguisher? ridiculous.

Ambulances, police, and FOR DAMN SURE fire carry them around here.

I have personally put out a car fire with an entrapped patient, using our ambulance extinguisher and it prevented a catastrophe until fire got on scene.

Unless I'm missing something in this story?

Who ever said our units DON'T carry fire extinguishers? We carry a water, dry chem, and CO2 extinguisher. As I wasn't there, I don't know if the extinguishers were used or not; but from the sounds of it, this fire wasn't going to go out with an extinguisher. It was no small engine fire; the car and trailer of the 18 wheeler were fully involved (the car may not have been fully at first, but pretty damn close if it was hot enough to cause the interior to flash). Not little ooo look that's a little warm let's throw a bucket of water on it to save our patient fire. Again, I don't know if they were used or not, all I know is that a very good group of very well trained firefighters did everything they could at the time to save this lady. So maybe refrain from making such assumptive and accusatory statements? Thanks

 

[jjesusfreak01]

Best idea...go to med school, get an unrestricted license, and cut away!

 

[Sasha]

Who ever said our units DON'T carry fire extinguishers? We carry a water, dry chem, and CO2 extinguisher. As I wasn't there, I don't know if the extinguishers were used or not; but from the sounds of it, this fire wasn't going to go out with an extinguisher. It was no small engine fire; the car and trailer of the 18 wheeler were fully involved (the car may not have been fully at first, but pretty damn close if it was hot enough to cause the interior to flash). Not little ooo look that's a little warm let's throw a bucket of water on it to save our patient fire. Again, I don't know if they were used or not, all I know is that a very good group of very well trained firefighters did everything they could at the time to save this lady. So maybe refrain from making such assumptive and accusatory statements? Thanks

Sorry love, you posted this so you're inviting all kinds of responses... but I have to wonder if you weren't there, why are you asking others to armchair QB it? You asked for this.

 

[usalsfyre]

Again armchair QB'ing, but...

It wasn't that massive on arrival if the patient had a chance. I've extinguished a couple of fires involving semis, they're hot. D@mn hot. The idea is NOT extinguishment, it's to buy time for the pump and it's 500+ gallons of water to arrive. Which still may not be enough, but it's a heck of a lot better than the extinguishers.

Again, I'm not trying to demonize the crew. It's very easy to sit around here come up with the perfect solution through the prism of hindsight. Heck, I had a couple of minutes to think of using the truck's extinguishers to buy time, which is not something it sounds like the crew had. I'm not sure I wouldn't have gotten focused on freeing the hand as well. Without being put in that position we'll never know. Even now my response would be different because I've thought about it. I have no doubt they did the absolute best they could have with the information, experience, equipment and brain power they had available. Unfortunately the reality is it wasn't good enough that day, which isn't unusual. There may not have BEEN a mixture of the above factors that was good enough.

The one thing I'm sure of is I'm not performing an amputation I'm not credentialed, trained or insured for.

 

[mycrofft]

Fluke call, tough luck of the draw for everyone.

Rant follows, not aimed at anyone in particular, but at an attitude:

What sort of logic is there in witholding action to save a life because, even though it is the only way to save the life, you might get sued or lose your ticket? There is a logic , but it smells bad. You will have to live with it.

The danger in this sort of occasion is of people taking precipitate but wrong action (unnecessary amputations or done because the responders are scared). However, if there is no other way and you do nothing despite having the means to do it, the failure due to potential sanction is pusillanimous.

Fears of infection or disability are silly.

Try these intermediate steps before the great hack job, though: cover the victim with turnouts and blankets as a thermal shield; get every extinguisher you can including the trucker's; if you have enough extra gear, cover the fuel nearest the victim with turnouts or anything to suppress vapor spread; if even a garden hose is available start washing down the fuel; use any means to absorb and divert running fuel away (so long as you don't take out a neighborhood doing it).

Cutting metal with the saw without at least a charged and misting handline would not be on my list of things to try. Neither would climbing into the vehicle nor staying in the fuel without the proper gear.

 

[Sasha]

mycrofft, so you will risk not only your livelyhood (your job, and possibly the soul source of income for your family in some people's positions) and spending time in jail for something that is out of your scope, above your education level that may not even save the patient?

You're braver than I am. I come before my patient every single time. And in a litigation crazy society it has to be that way.

 

[usalsfyre]

What sort of logic is there in witholding action to save a life because, even though it is the only way to save the life, you might get sued or lose your ticket? There is a logic , but it smells bad. You will have to live with it.

Very simply? I'm going to sound like (to quote Dr Cox) a "b@stard coated b@astard with b@stard filling" but it is in no way my responsibility to lose my livelihood and destitute my family to resolve an emergency not of my doing. It's the same reason I don't stop at wrecks. If that seems cold, callous and not of the appropriate attitude for a "lifesaver" than so be it. You don't see ED physicians in small hospitals trying to repair rupturing AAAs either, even though they're technically "allowed", unrestricted license and all. They're aware of what's over their head. I doubt if a FM or dermatologist had been immediately available they would have done the amputation either.

It sucks. There's no real "win" in this situation. But it is what it is, I've made my decision and can sleep at night.

 

[the_negro_puppy]

A very unlucky and unfortunate situation. I dont think i'd be sawing at anyone's hands in a burning wreck about to explode. As bad as it sounds, I want to go home at the end of my shift. We are not trained in rescue and I wont go into an unsafe scene. This lady is just very unlucky and would be a horrible job to go to especially with 4 children nearby.

 

[lightsandsirens5]

It sucks. There's no real "win" in this situation. But it is what it is, I've made my decision and can sleep at night.

I'm glad you have bro. Cause I have not and I hope to God I don't run across something like this before I do make my decision.

The thought has tortured me on occasion and I guess I'll only get over that once I make a choice.



Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.

 

[mycrofft]

It's personal. I said it was a rant.

The answer is that I would do it, unless I was too frightened and couldn't rally enough spit to go in due to fire hazard.

If Mom goes home to her kids and I become "Evelyn" at the Microsoft chat service center, so be it. Professionals need to know when and how to fall on their sword.

Ask military guys. If you are their "Doc", the guys/women get the good stuff for you, they look out for you, but when there's someone out front yelling "medic", your bill just came due and you MUST attend to that person, even if you get hurt or killed. Nothing's free.

PS: Ladder trucks don't carry pumps and water because they are tasked differently and would be the size of a small ocean liner, plus articulated halfway from the front. A Ladder going to a vehicle collision/fire is a bad thing unles they are just carrying the bags and the litter. Someone's going to get reamed.

 

[STXmedic]

Sorry love, you posted this so you're inviting all kinds of responses... but I have to wonder if you weren't there, why are you asking others to armchair QB it? You asked for this.

Lol oh I'm all for arm chair quarterbacking, that's why I posted it. To see others thoughts, ideas, etc. That post came off (to me at least) as fairly accusatory without attempting to find out more information. I'm here, ask away and I will share just about any piece of info I can

Some great perspectives by everyone by the way! Personally, I'm torn. I don't know if I would be able to live with myself if I know I didn't do everything I possibly could at the time. I think there'd be no problem with using the sawzall (in reference to usal). I've cut through support posts in seconds. I think it would be the act of doing it that would be the hardest. Inflict severe pain, though for a good purpose, would be Rey difficult.

Yeah, I've thought about the legal ramifications too. It's sad that we live in such a society that the best of intentions (and even with positive results) can place a person without a job or even in prison. I've seen it happen first had with some LEOs. I like to be pretty optimistic that most people are good at heart, but the sad truth is so many are out just to use, abuse, and take advantage of the system.

 

[Sasha]

Also a thought to ponder, if the car had flashed while you were in it trying to saw off her hand, you'd have two or more dead bodies and not one. Not worth it in my opinion.

 

[usalsfyre]

Professionals need to know when and how to fall on their sword.

I disagree. Knowing when your in an untenable situation and acting to the best if your education while calling for backup is one of the traits of a professional. Going cowboy with a recip saw doesn't meet that criteria.

 

[STXmedic]

Also, right or wrong, I've never bought in to the whole your life over your patients. Not fully at least. Risk-benefit analysis. Risk a little to save a little. Risk a lot to save a lot. If a fellow PD brother goes down in the hot or warm zone, I know that I will do whatever it takes to get him out. If a fellow firefighter goes down in a bad fire, I will make every attempt to get to him. If a patient is within arms reach in a fire that's threatening to flash, I'm going to exhaust all means to get her out. Again, right or wrong, that's just the way I'm wired.