Confined Space Rescue

BloodNGlory02

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Male fall apprx 35 ft in a pump house pit. It's a building, but goes 35 ft underground. Dept. of Public Works confined space team immediately dispatched. Upon arrival 4 emt's race down the 4-5 flights of stairs under the 'ok' of the DPW supervisor. You find a 40 somethings male, left lateral recumbant, apprx 300cc of blood all around, some clotting. You roll your pt supine to find bilat hemorhagging from the ears, moderate amount from the nose, color- ashen/gray, pupils dilated non reactive, JVD, no trauma to any other body part. No pulse, no respirations. No shock advised.

STOP! Do you begin CPR knowing the MOI and amount of blood lost??

Ok, you insert an oral and someone begins chest compressions. Someone drops an ET tube, suction, secure pt to confined space teams' board and begin to hoist pt 4-5 storys to the exit. Resume CPR, one round of Epi, get in the squad, more suction, no changes. Helicopter overhead.

Do you REALLY do CPR or do you continue the motions?

I chose to 'do the motions' as we suctioned about 700 cc of blood from just his mouth and nose. Flight crew comes in, by this time the media is all over the squad and blankets are hung on the windows. About 10 more min of tap tap breath tap tap breath, ausciltate, no heart tones, no resps, PEA, Flight MD asks if we're all comfortable with ending. we all agree he didnt have a chance and let him go. Wait about 45 min for the ME, move him to her cot, it was like a blood river. I thought we had suctioned everything outta him, apparently not.

All in all everything went excellent and it was a good experience. The DPW guys did an incredible job and im very proud of them as this was the first time they've actually had to use the equipment outside of training, and given the looks of the patient, thats not something they're used to seeing, and it was one of 'their guys'. Im not so much 'upset' that he died. I knew he didnt have a chance, it was going back into the scene after OSHA had left and seeing the bloody finger marks 15 ft up on the wall where he tried to catch himself.
 

SafetyPro2

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Confined space accidents unfortunately rarely turn out happy. There's just too much working against you there, and by the time you take the necessary precautions for rescuer safety, whatever slim chance has usually faded.

Sounds like you did everything you could though. Regardless of the confined space issue, doesn't sound like there was much that could have been done anyway with that kind of fall.

I've never been involved in the rescue side, but I used to do a lot of confined space ENTRY training at my last job, and its good you followed all the precautions. I think the scariest statistic I took away from confined spaces is the fact that 65% of the fatalities are would-be rescuers, which means that for every "true" victim, you loose more than one rescuer.
 

Jon

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I wouldn't have worked him.... I would have been on the phone for a field pronouncement.

How long after he fell did it take for him to be found? EMS to arrive? Resuce to arrive???? anything more than 10 minutes, you are talking veggie to begin with...

Jon
 
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BloodNGlory02

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His partner witnessed him fall and called 911 immediately. The first EMT was on scene with the team enroute within 2 min. He was out of the "hole" within 15 min of his fall, the helicopter was there within 25 min of his fall. He definitely would've made the golden hour had he had a chance
 

Jon

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He was down for 15 minutes before he was out. Golden hour is out the window in an arrest. He was vegatable material at that point.

And blunt trauma codes, by mechanism, are usually not worked. They never survive.

Jon
 

joeyjoejoe

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For some reason I couldn't edit, bit this was my thing...

EDIT - Before anyone comments...You are risking more lives by having a helicopter attend and having the world attend. This is a simple and obvious blunt trauma arrest. You should have put the leads on him and called a doc. Blunt trauma arrests should be some of the easiest arrests a medic works. People don't survive, witnessed or not. It is an unfortunate accident. Expalin to the peeps and move on...
 

ffemt8978

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Originally posted by joeyjoejoe@Oct 26 2005, 01:52 PM
For some reason I couldn't edit, bit this was my thing...

EDIT - Before anyone comments...You are risking more lives by having a helicopter attend and having the world attend. This is a simple and obvious blunt trauma arrest. You should have put the leads on him and called a doc. Blunt trauma arrests should be some of the easiest arrests a medic works. People don't survive, witnessed or not. It is an unfortunate accident. Expalin to the peeps and move on...
We had a problem a while back with editing of posts, so we changed our policy. If you have less than 10 posts, you only have 5 minutes to go back and edit your post. If you have more than 10 posts, you have 3 hours to go back and edit your post. Anything beyond three hours requires a moderator/admin to edit.
 
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BloodNGlory02

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wow i didnt know I was here to be criticized. Thanks guys, now I know where NOT to bring my 'difficult calls' to be discussed.
 

Jon

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Originally posted by BloodNGlory02@Oct 28 2005, 05:09 PM
wow i didnt know I was here to be criticized. Thanks guys, now I know where NOT to bring my 'difficult calls' to be discussed.
Steph,

I'm not trying to critisize, just provide some "constructive comments." I don't think any of us had a malicious intent, we were just sharing our experiences.

Jon
 

Firechic

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BloodNGlory02,
If you take a situation and ask 10 people their opinion on what they would do - you'll get 10 different ways on how to handle the scenerio.
You decided to handle it a certain way. Personally, I would have done it differently based on the information you gave us. There is no right or wrong here.
I think it's good to share tough calls here. Everyone has different levels of experience and different protocols. It's interesting to see what the others may say.
Please continue to share your experiences!! :)
 
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