I was doing a ride along a while back when we got a call for a suicide attempt at the fire station where we have our quarters. Apparently his father had found him and driven him to the fire station because he refused to go to the hospital. Upon our arrival firefighters were extricating a 40 year old male with a self inflicted gun shot wound to the chest from a truck. The pt. had an exit wound in line with the entrance wound to just below the left nipple. He still had CMS cause he was fighting with us as we tried to help. Long story short the guy ends up dieing. I was speaking with another medic just recently. Her take on it is that he was sitting up and blood was filling his abdominal cavity, when we back boarded him it began to fill up in his chest and caused his heart to stop. To her credit she admitted that she wasn't there so who knows. I would like to know what you think? Has anyone transferred a pt. to air care sitting up? Would it have delayed the pt. crashing? Your thoughts?
Backboard or not?
- Thread starter Paulie_G
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Shishkabob
Forum Chief
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Why would you backboard for an moi inconsistant with spinal cord trauma?
1.) The medic you talked to was 100% correct: we weren't there, so as the saying goes, "don't judge an operation from an armchair." That said,
2.) I personally don't see a reason to board this patient, except potentially to make extrication from the vehicle easier.* Can you give some more information? I don't think there's really enough here to determine anything.
3.) The fact that the man's father did not immediately call 9-1-1 is reprehensible. If the son didn't want to go to the hospital, what did the father think going to the station would do?! Furthermore, he just shot himself... clearly the father's interests and the son's are misaligned. Ergo, 9-1-1. Personally, if I were responding to that 9-1-1 call, I'd make sure LEOs beat me there to secure the scene, since it sounds potentially lethal to the responding crew.
*I have zero experience with this situation, and I haven't been in the field for very long, so take this with a grain of salt.
EDIT: Linuss beat me to it.
2.) I personally don't see a reason to board this patient, except potentially to make extrication from the vehicle easier.* Can you give some more information? I don't think there's really enough here to determine anything.
3.) The fact that the man's father did not immediately call 9-1-1 is reprehensible. If the son didn't want to go to the hospital, what did the father think going to the station would do?! Furthermore, he just shot himself... clearly the father's interests and the son's are misaligned. Ergo, 9-1-1. Personally, if I were responding to that 9-1-1 call, I'd make sure LEOs beat me there to secure the scene, since it sounds potentially lethal to the responding crew.
*I have zero experience with this situation, and I haven't been in the field for very long, so take this with a grain of salt.
EDIT: Linuss beat me to it.
A little more info
Well I suppose the fire crew used the backboard to extricate because it was a invasive injury to the torso and that's how they are trained to remove pts. from vehicles anyway. They were doing it while we were arriving so the medic didn't get a chance to assess inside the vehicle. Not that any of us have an issue with them great first responders. Pt. was conscious, alert and oriented X3 on our arrival. Pt. had a Hx of ETOH and drug abuse but we couldn't say either way if there was any use prior to shooting. No head or neck problems that were visible. Pt. was combative and just kept telling us to let me die. Pt. cooperation was non existent. But CMS was intact.
Well I suppose the fire crew used the backboard to extricate because it was a invasive injury to the torso and that's how they are trained to remove pts. from vehicles anyway. They were doing it while we were arriving so the medic didn't get a chance to assess inside the vehicle. Not that any of us have an issue with them great first responders. Pt. was conscious, alert and oriented X3 on our arrival. Pt. had a Hx of ETOH and drug abuse but we couldn't say either way if there was any use prior to shooting. No head or neck problems that were visible. Pt. was combative and just kept telling us to let me die. Pt. cooperation was non existent. But CMS was intact.
911
As for the dad not calling 911 right away. he lived a block down from the station. He had found the pt. some time after incident. Pt. still had the gun. I don't know about you but I'd be afraid to screw with someone holding a gun even if pt. wouldn't shoot you they could still turn the gun on themselves if you aggravate them more.
As for the dad not calling 911 right away. he lived a block down from the station. He had found the pt. some time after incident. Pt. still had the gun. I don't know about you but I'd be afraid to screw with someone holding a gun even if pt. wouldn't shoot you they could still turn the gun on themselves if you aggravate them more.
medichopeful
Flight RN/Paramedic
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If a patient or anybody on scene (besides LE) has a gun, EMS/FD shouldn't be going in in the first place. Very easy way for somebody to get shot or killed.
Did the patient have the gun AT the FD? If he did, the firefighters screwed up royally, and are lucky they lived.
Ditto that.
Also, that was exactly the reason I said if I were dispatched to that I would wait for LE to arrive and clear the scene.
Scene Safety
And you're right scene safety is the most important thing. As far as I am aware the gun was left at the pts. parents home. PD was on scene for the duration of the call. I would also wait in the truck and let PD secure any scene with a weapon present. So as far as scene safety goes it was run by the numbers. It certainly makes it interesting though when a patient shows up at your front door rather than the other way around.
And you're right scene safety is the most important thing. As far as I am aware the gun was left at the pts. parents home. PD was on scene for the duration of the call. I would also wait in the truck and let PD secure any scene with a weapon present. So as far as scene safety goes it was run by the numbers. It certainly makes it interesting though when a patient shows up at your front door rather than the other way around.
JPINFV
Gadfly
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What if you're treating someone with a valid CCW? Do CCW holders lose the ability to seek emergency care?
medichopeful
Flight RN/Paramedic
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If they have a weapon on them? Yes. I am not treating somebody until they are weapon free, unless they are a police officer, soldier, etc.. There is just too much danger. Let them give their weapon to a police officer, or leave it in a different room, or unload it.
The scene could just change too quickly. Yes, they may have honorable intentions, but if they have a gun, they are just too much of a danger to my safety. Once they are cleared, though, I will be more than happy to treat them.
medichopeful
Flight RN/Paramedic
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Ditto that.
Also, that was exactly the reason I said if I were dispatched to that I would wait for LE to arrive and clear the scene.
Oops, didn't catch that. Well, it deserves repeating.
You raise an extremely good point that I think merits discussion - but not in this thread. We've already gotten off-topic from the OP.
I am hesitant to agree, solely because with a CCW permit holder, you probably will NOT know about the weapon until you are already on-scene. But again, we digress.
Summit
Critical Crazy
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Backboard if you have time since the bullet theoretically could have fragmented internally unseen and a fragment then shattered a vertebrae leaving compromise with articulation a possibility.
However, with no s/s of spinal compromise, one should focus first on what is killing the patient now and how to solve it. If your patient has a bleeding issue in the chest, especially one headed towards a hemothorax, then that is gonna kill your patient and you can only treat that by getting them to an OR.
OK, maybe I misunderstood, but I think you need to thwack the medic on the head. She is suggesting a tension hemothorax killed the patient, but blood doesn't magically drain into the abdomen while sitting then into the thoracic cavity while laying down unless you blew one hell of a hole through the diaphragm and peritoneum.
Of course, as your medic friend said, I wasn't there.
Why don't you ask the hospital what killed your patient? Exsanguination? Tension hemo/pneumo?
However, with no s/s of spinal compromise, one should focus first on what is killing the patient now and how to solve it. If your patient has a bleeding issue in the chest, especially one headed towards a hemothorax, then that is gonna kill your patient and you can only treat that by getting them to an OR.
OK, maybe I misunderstood, but I think you need to thwack the medic on the head. She is suggesting a tension hemothorax killed the patient, but blood doesn't magically drain into the abdomen while sitting then into the thoracic cavity while laying down unless you blew one hell of a hole through the diaphragm and peritoneum.
Of course, as your medic friend said, I wasn't there.
Why don't you ask the hospital what killed your patient? Exsanguination? Tension hemo/pneumo?
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medichopeful said:
It's never become an issue, but I work in one of those areas where guns are really common. There's no real way of knowing who has one because everyone carries concealed, so we don't usually worry about bystanders with guns unless there's some reason to suspect the scene might turn ugly. If we found one on a patient, though, we'd remove it.
We get those pretty often. They don't want the cost of an ambulance, or to bother us (!), and they hope we can treat them there. Sometimes they really do have minor things that we actually can treat and release, although we always advise them to go to the hospital. More often, it's something that makes us wonder how the hell they managed to drive there, and then we have to argue with them about whether they should attempt to drive themselves to the ED.
medichopeful
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Noted and started in EMSTalk
mycrofft
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Left nipple area. Look up the anatomy of that area when sitting upright.
Lots of vasculature as well as the lungs. Our active duty military medic members could shed more light, but I'm thinking O2, airway maintenance, IV large bore but only TKO until needed, be prepared to decompress enroute, and get thee to an OR.
I've seen my share of people crump as soon as they are placed supine, and long boards are pretty supine all right. Every treatment has it's negative effects and being unable to keep your airway clear versus potential for spinal injury in this scenario is a bad ratio. One field tx for penetrating wound to chest is place the pt on the affected side.
Lots of vasculature as well as the lungs. Our active duty military medic members could shed more light, but I'm thinking O2, airway maintenance, IV large bore but only TKO until needed, be prepared to decompress enroute, and get thee to an OR.
I've seen my share of people crump as soon as they are placed supine, and long boards are pretty supine all right. Every treatment has it's negative effects and being unable to keep your airway clear versus potential for spinal injury in this scenario is a bad ratio. One field tx for penetrating wound to chest is place the pt on the affected side.
Lvillemedic
Forum Ride Along
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Yes..LSB the Pt.
Yes the pt should be placed on a LSB due to possible spinal compromise for one and two it will make restraining the pt easier, But remember to restrain to the LSB and not to the stretcher. Also you could stuff pillows, blankets, sheets or what ever under the one side of the LSB to try and keep the injuried side down and hopefully keep one lung somewhat usefull. Good BLS before ALS...Don't get tunnel vision thinking there's only the one GSW. You gotta look for other GSW's....
Yes the pt should be placed on a LSB due to possible spinal compromise for one and two it will make restraining the pt easier, But remember to restrain to the LSB and not to the stretcher. Also you could stuff pillows, blankets, sheets or what ever under the one side of the LSB to try and keep the injuried side down and hopefully keep one lung somewhat usefull. Good BLS before ALS...Don't get tunnel vision thinking there's only the one GSW. You gotta look for other GSW's....
thatJeffguy
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People legally carry guns where you live? My god! You must have millions of murders! You should follow the lead of such peaceful places as New York, New Jersey and Los Angles and ban those darn murder-sticks!
The backboard is a great device to restrain a combative patient, roll patient for exam, position patient for injury and with a GSW to the chest, CPR may be only minutes away. Log rolling a patient is also a nice way to place the patient on a board then to the stretcher and maneuver them where the patient doesn't get the providers all bloody. As well, if one was not certain of the path of the bullet, the spinal cord is in the chest. Several of our para and quadriplegics in LTC and Rehab were GSWs to the chest.
Without vital signs, breath sounds, and heart sounds it is difficult to know what all happened but the patient probably had a pneumothorax, hemothorax and maybe a cardiac tamponade. The heart or one of the pulmonary vessels may have been severed.
What the Paramedic could have meant is the patient lost his BP (hypotensive) by sitting him up which diverted the blood toward the lower body instead of the head and chest. Remember the MAST days of autotransfusion or the principles of what trendelenburg is supposed do?
If the blood "bubbled" there was air mixed in there.
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