Bad situation. What would you do?

[STXmedic]

Alright, quick background. My station (different shift) made an 18-wheeler v sedan on the highway. Sedan ended up under the trailer of the 18-wheeler, dragged for ~800', then caught fire. 5 passengers in the sedan, mom and 4 kids. All 4 kids were able to make it out when they came to a stop. The mom, however, had her hand trapped and was unable to get out.

The ladder truck was the first on scene. Next engine was 4-5min out (ladder truck happened to already be on the highway). When they arrived, fire was just starting to impinge inside the vehicle. Mom was still awake, the guys on the ladder had hand on her trying to get her out (still no engine/water on scene). After 3min, the vehicle flashed and mom didn't make it.

So the question was posed: Having the opportunity to do it again, how far would you go, and what would you be willing to do to help save this mothers life.

One option proposed by one of the guys was to take a sawzall and amputate at the wrist. While that sounds very extreme, what else would be a viable option for this patient? Would you be able to (mentally & emotionally) very crudely amputate a patient's arm in a patient's life or death situation?

 

[Shishkabob]

Would I be able to? Sure, I think I could. Would I? Probably not. Hate to say it, but opens me up to WAY too much liability, even if the life is saved, and it sucks that we live in a country like that today, that values certain 'legalities' over a life, but it is what it is.


However, I don't know if the exigent circumstances defense could defend it, either.




Look at the 2 NJ Paramedics who did a Caesarean 14 years ago.

 

[MrBrown]

Brown's condolences first of all, what a tragically unfortunate situation

Brown is a bit worried that a fire truck does not carry something to fight you know, fire .... all our ladder trucks carry standard pumping equipment and at least one high pressure delivery. By ladder truck Brown means usually a Skylift CTL or what American's know as a "turntable" ladder, we have about three aerial trucks or elevating platforms (cherry pickers) in the country.

Now, if if were Brown sure, just cut the thing off and let the orthopaedic registrar fix it up.

 

[shfd739]

Thats way worse than I thought based on the news reports. How are the ladder truck guys doing in the aftermath?

I'm not sure what the answer is. My first thought is try to fend off the flames with cans or fire extinguishers but I know that won't work for long. How bad was the hand trapped? The idea of a tourniquet and sawzall is doable and if the hand is trapped that bad it probably wouldn't be useful once freed anyway.

Sent from my electronic overbearing life controller

 

[abckidsmom]

I don't think this is a question that can reasonably be answered from the comfort of the internet. I have looked down the barrel of "do something right now or this person is going to go from living to dead right in front of you" and it is an ugly, ugly place to second guess yourself from.

Even making the decision and getting the sawzall out takes time, and once you see that the fire is getting away, it's already gone, isn't it? My gut says that if an experienced group of guys were on scene and didn't think of the sawzall until it was too late, there wasn't time anyway.

Brown: It's standard practice in this country for a ladder truck to have no pump and no water at all. For some reason, it's a point of pride for "real" truckies that they don't *do* hoses. :/

 

[afro]

What a :censored::censored::censored::censored:ty situation. But, I don't think in-field amputation is the correct answer. Sounds like it sucked but with nothing you can really do. Amputation opens up: liability, infection, potential shock, and death, without the proper resources to control the procedure. Remember, we try to save life and limb.

 

[MrBrown]

Brown: It's standard practice in this country for a ladder truck to have no pump and no water at all. For some reason, it's a point of pride for "real" truckies that they don't *do* hoses. :/

That is very disturbing, that's like an ambulance not carrying a defibrillator, seriously :unsure:

Oh look at us Mr. Mayor, our fifty thousand pound gargantioun piece of machinery can charge through the streets and deliver loser cookbook idiot firemedics to lil Johnny and his stubbed toe effectively saving the day and doing such awesome good we deserve more funding to send all our firefighters to loser cookbook idiot firemedic class but God forbit we be able to put out a vehicle fire and actually save a life, because we're too awesome to that putting out fire stuff, that is for the engine company ....

*Brown throws up a little

 

[STXmedic]

That is very disturbing, that's like an ambulance not carrying a defibrillator, seriously :unsure:

99 times out of 100 a motor will beat the ladder truck in. They're much faster and outnumber ladder trucks 3:1. Some departments have quints, which is exactly what you described y'all having. Those are usually much more expensive though, and in a big city where the lowest bidder wins, that's usually not an option

 

[wadford]

That's a horrible position to be in. I sort of agree with Linuss. Just a bad situation all around.

 

[lightsandsirens5]

What a :censored::censored::censored::censored:ty situation. But, I don't think in-field amputation is the correct answer. Sounds like it sucked but with nothing you can really do. Amputation opens up: liability, infection, potential shock, and death, without the proper resources to control the procedure. Remember, we try to save life and limb.

I agree with the first sentence 110%. I also concede that in field amputation is also a :censored::censored::censored::censored:ty option.

However, let's just say this. If any of you ever run across me in that situation, you better be cutting my hand off, either that or giving me the sawzall and I'll do it myself.

I also think you use an interesting argument. You say we try to save life and limb. I think there is a reason life comes first in the sequence. What freaking good have you done if you save her hand, but loose the whole pt? I am not telling people to haul around and start hacking off people's body parts, I am just serving up a helping of food for thought. Additionally, you mention amputation opening up the potential for "infection, potential shock and death." I guarantee you however, death is certain without amputation. Don't you agree?

Like I said, don't go out and start chopping your patients up like some medieval butcher, just think about my argument.

 

[abckidsmom]

That is very disturbing, that's like an ambulance not carrying a defibrillator, seriously :unsure:

Oh look at us Mr. Mayor, our fifty thousand pound gargantioun piece of machinery can charge through the streets and deliver loser cookbook idiot firemedics to lil Johnny and his stubbed toe effectively saving the day and doing such awesome good we deserve more funding to send all our firefighters to loser cookbook idiot firemedic class but God forbit we be able to put out a vehicle fire and actually save a life, because we're too awesome to that putting out fire stuff, that is for the engine company ....

*Brown throws up a little

Yeah, I know. I didn't say it was good, just that it's a not-unheard-of phenomenon.

 

[DesertMedic66]

That is very disturbing, that's like an ambulance not carrying a defibrillator, seriously :unsure:

None of our BLS ambulances carry any kind of defibrillator. And we are often used as the first in on 911 calls.


Hmmmmm. I wonder if calling MD for advice would be good in this call. For us it takes less then 1min to call MD. And well cutting off a wrist wouldn't be too hard and take that much time. At least that's what I would do.

 

[abckidsmom]

None of our BLS ambulances carry any kind of defibrillator. And we are often used as the first in on 911 calls.


Hmmmmm. I wonder if calling MD for advice would be good in this call. For us it takes less then 1min to call MD. And well cutting off a wrist wouldn't be too hard and take that much time. At least that's what I would do.

Absolutely no excuse for that, on a system level. If the YMCA has a defibrillator, every. single. ambulance. in the country should have one.

What's the point, otherwise?

 

[Epi-do]

It is required that every ambulance here has one on it.

To the OP, that is a horrible call to catch. Not sure what I would do in that situation. Honestly, I hope I never have to find out.

 

[MrBrown]

Unfortunately, it was foretold in Mobile Intensive Care Officer training way back during early 1992 that "by the end of [1992] every ambulance will have a defibrillator and somebody trained to use it ... and that will leave the Yanks for dead"

... and the same rings true 20 years later? :unsure:

 

[DesertMedic66]

Absolutely no excuse for that, on a system level. If the YMCA has a defibrillator, every. single. ambulance. in the country should have one.

What's the point, otherwise?

Per county policy it is not a required peice of equipment for BLS ambulances. It's only optional.

 

[MassEMT-B]

Per county policy it is not a required peice of equipment for BLS ambulances. It's only optional.

Are you serious? That is the stupidest thing I have ever seen in my life. Only in California. That really does not seem like a good idea at all..

 

[LucidResq]

Sorry to hear about this rough call. We're all here for you with internet shoulders to lean on, as you can tell.

Murphy's Law would probably dictate that seconds after amputating her hand, the fire would fizzle out as the engine pulls up, and you'd be standing there with a bloody saw and they'd be standing there with a charged line wondering what the heck happened.

 

[STXmedic]

Per county policy it is not a required peice of equipment for BLS ambulances. It's only optional.

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

 

[MrBrown]

Brown feels like Brown is going to get blamed for derailing this thread into an agry bargy about defibrillators on ambulances