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How would you have handled the slenderman case?

Discussion in 'BLS Discussion' started by ksquared, Jan 11, 2018.

  1. ksquared

    ksquared Forum Ride Along

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    You may have read up on the (attempted) Slenderman murder. The case is a tragic one. Before answering, you should look up this case if you are not familiar. However, from an EMS point of view, this scenario gets interesting, ESPECIALLY if you are attempting to provide true field medicine rather than arriving on a fully equipped ambulance.

    The trauma surgeon in this case said that "if the knife had gone the width a human hair further, she wouldn't have lived." (I believe it was the heart that was such as close call, but specific medical information seems scattered.) This suggests that you would NOT want her body moving around any more than it absolutely must because clearly, the structural integrity of blood flow mechanisms were damaged (what if it had been an artery nearly broken through, rather than the pericardial sac?). However, in cases of severe bleeding (this would have been immediately apparent) it may not always be worth the time to immobilize patients who (otherwise) have a low index of suspicion.

    I can't clearly see the patient, but to my understanding there were so many stab wounds that a higher index of suspicion for CNS injury may have been warranted because, disturbingly, there was so much blood it would have been difficult to assess all of the wounds. However, since the girl was obviously suffering massive hemorrhage this would have been a little bit of a close call for a novice such as myself.

    So my question is: Would you have taken the time to immobilize? Why or why not?

    The question gets even hairy if we are in the wilderness. In real life, she dragged herself to the side of the road and was able to summon help from a passing cyclist. If, however, you had found here there, what would you do?

    The question is two-fold: we have a real-world situation where one would have to consider the chances of oneself being attacked. If possible, I would render first aid while calling for help on a cellphone, but signal strength or describing the exact location or even the chance of being ambushed may have made this difficult. Disregarding this, would it be better to, after addressing any imminent external hemorrhage:

    1.) Declare an "emergency" move, carry her to nearest populated area or chance for aid (obviously, the assumption is that we are strong enough to maintain some sort of a pace along the distance)
    2.) Leave the victim where she is and flee for aid as quickly as possible, doing your best to remember the location.

    In this case the victim was conscious but that was for from inevitable.

    I hope I'm not wrong, but I think there may be enough factors here that it warrants some thinking through.
     
  2. Doomedtheory

    Doomedtheory Forum Probie

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    Your safety is first, then your partner, than the patient
     
  3. akflightmedic

    akflightmedic Forum Deputy Chief

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    What an amazing, insightful, well thought out reply to a very complex case presentation. Sounds like parroted rhetoric, however I could be wrong.
     
    NPO likes this.
  4. DrParasite

    DrParasite The fire extinguisher is not just for show

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    When was the last time you saw a military medic applying a board and collar to a trauma victim? and I'm sure they see more trauma than many of us will see in our career.

    I also believe the latest research says once the knife gets removed, the injury will not get any worse than what happened when the knife was initially stabbed in the victim, so immobilization is pretty must a waste of time.

    If it was me, I would try to keep her from bleeding onto the back of my car, tell her to hold pressure and drive really fast to a trauma center.
     
    cprted likes this.
  5. VFlutter

    VFlutter Flight Nurse

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    Not really a great comparison. Much of what the military does is out of necessity and to maintain combat effectiveness ( i.e Cric's ) not necessarily because it produces the best patient outcome. And if you look at the SCI data from Iraq/Afgan it isn't great, most SCI of any conflict in history.
     
  6. cprted

    cprted Forum Captain

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    Patient with multiple stab wounds, what are the immediate threats to life? Exsanguination, tension pneumo, tamponade, airway obstruction. Does a board and collar help better the outcomes of any of those pathologies? I would suggest a hard no. Thus any time spent performing a procedure that doesn't correct threats to life is delaying arrival at a trauma receiving facility where the people who are actually going to save this girl's life are waiting.
     
  7. StCEMT

    StCEMT Forum Deputy Chief

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    It sounds like the knife has long since been removed, so no. HABC and go. Watch for the problems cprted listed.
     
  8. EpiEMS

    EpiEMS Forum Deputy Chief

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    I'm not sure about the "why", but I can pretty much agree - there is no indication in the research I've seen over the past couple of years that spinal immobilization is indicated for penetrating trauma. (FWIW, NAEMSP agrees...)

    @VFlutter - any thoughts on immobilizing penetrating trauma patients?
     
  9. VFlutter

    VFlutter Flight Nurse

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    Probably not necessary for the vast majority of patients unless there are signs/symptoms of spinal cord injury i.e. paresthesia, paralysis, etc.

    Having said that I did have a GSW patient with entrance near the shoulder, bounced off the scapula, severed the spinal cord, and stopped somewhere near the pelvis. Not that Spinal precautions would have helped anything but it really is impossible to determine trajectories of objects in the body.

    Wasn't really arguing the need for spinal immobilization for the patient in the scenario but rather "The military doesn't do it and they see tons of trauma" isn't really a great argument.
     
  10. EpiEMS

    EpiEMS Forum Deputy Chief

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    Now that's a messy injury. Fair enough, I'm inclined to agree with your criticism of the reasoning. That said, sounds like we all agree that penetrating trauma doesn't (necessarily) necessitate spinal immobilization.
     
  11. Tigger

    Tigger Dodges Pucks Community Leader

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    If there are deficits then I would consider SMR. If there aren't then it's not a consideration.

    Probably worth adding that whole SMR doesn't actually do anything. Really. There is no evidence that spinal motion restriction (vac mattresses included) does anything to immobilize the spine.
     
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  12. EpiEMS

    EpiEMS Forum Deputy Chief

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    But, but, my EMT instructor said so! He said that if they fail the poke-the-spine-test, I gotta strap them down, or I'll get sued!
     
  13. Tigger

    Tigger Dodges Pucks Community Leader

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    Teaching EMTs SMR slays me.
     
    EpiEMS likes this.
  14. DrParasite

    DrParasite The fire extinguisher is not just for show

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  15. RocketMedic

    RocketMedic Fancy Book Learnin'

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    Very common misperception. The 'average' military medic sees no trauma, or such minimal trauma that a college football player or wrestler would be competitive. The training is superior, but the exposure is less. To really exceed that, you need to look at combat-arms medics in deployed units, which is a very small group of people- perhaps not more than a few thousand people in any given year.

    Honestly? If I'm carrying her out, the knife is getting pulled out and wounds are getting packed fast and tight.

    Same.
     
  16. RocketMedic

    RocketMedic Fancy Book Learnin'

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    That's also because we are surviving more catastrophic injuries than before and understand more about what SCI is. We're also wearing heavy helmets, in gigantic vehicles, and rolling them pretty frequently as compared to 'Nam or even Desert Storm.

    The military approach isn't the cleanest, but it is the most effective for field deployment by the average soldier, in combat conditions.

    To the OP, I'd bind up the core wounds and carry the patient out quickly, arrange rapid transport to somewhere with Kerlex and blood, and get them to/on that transport. Keep them warm if you can, go fast, try to keep them alive.

    As for self-defense- in this case, shouldn't be an issue. If similar, bring a gun or friend(s) with guns to pull security and help carry patient(s).
     

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