Roll Over MVI

[traumateam1]

Was thrown this scenario during training a little while ago.. I guess one of those "think outside the box" scenarios. So it got me thinking.. would anyone else have done what I did? Is it worth it? etc. So here is what happened:

You are either dispatched to, or are doing stand by for a speedway where a car has been hit at high speeds and flipped several times. Major vehicle damage to the only car involved. As you approach you smell gas, however there is currently no fire. You yell out at your patient not to move and ask him where he is hurt. As he's screaming he tells you it's his arm. It's stuck and he can't get it out. (Between the drivers door and the dash). As you approach to assess your patient the cars engine ignites in flames. Quickly other rescue responders get out the extinguishers and try putting out the fire. You and your partner start working as quickly as possible to get your patient out as the fire quickly spreads. After several minutes your attempts to get his arm free fail, and the attempts the extinguish the fire are also failing.. now the fire is starting to come up into the car and burn your patients feet. Also, the heat and smoke are getting unbearable for you and your partner and patient.

Decision time!

I asked what resources/equipment I had available to me to do a rapid extrication of the patient. My answer: "That axe on the ground.. oh and hurry.. his feet are on fire."

I knew what they wanted to see.. pick up the axe.. tell my patient to take a deep breath and chop his arm off. So it's either let him slowly burn to death.. or hack his arm off. I decided to hack his arm off... told my patient to look away.. take a deep breath and then I hacked as close to the crushed part as possible. The person giving me the scenario then says "great, his arm is now free.. get your patient outta there.. he's burning to death!" Got my partner to do some half a$$ C-Spine and we hauled him outta there. Laid him down, partner took C-Spine and I got someone to extinguished his feet. I then continued on my scenario as per usual. Dealt with the amputation, ABC, etc etc.

So my question for all of you is: based on this, or a similar type of situation.. would you take that axe and hack off the arm.. would you have done something else.. would you have let your patient burn to death? What would you have done differently? Is it worth the lawsuit? I am interested to see what other people would do.
Cheers!

 

[Sasha]

April Fools was Wednesday...

I'm hoping you aren't serious. You can't be serious.

 

[CAOX3]

What kind of ***-backwards race track is this? Usually when 99.99% of your calls will involve extrication, you might actually have extrication equipment on hand. (Axe isn't an extrication tool, its an entry tool.)

Also when cars crash doing 200mph there is usually a fire. So I'm hoping there is a fire truck and not just a fire extinguisher.

What would I do? First, I wouldn't be in that position without the proper extrication and fire suppression equipment.

 

[traumateam1]

Sasha.. sadly I am no serious. That's what they gave me! I know.. I was a little shocked too...

CAO.. They just said fire truck/extrication tools weren't available.. I dunno what was going thru their head when they were giving me this scenario. lol And so that's why I put that one on here.. cuz I wanted to see what others would say.

 

[Veneficus]

"Why oh why didn't I take the blue pill?'"

Is use the axe to cut off the head of the person giving the scenario an option?

 

[Hockey]

Tell the guy I guess its just not your day

 

[traumateam1]

"Why oh why didn't I take the blue pill?'"

Is use the axe to cut off the head of the person giving the scenario an option?

I guess you could try it. I honestly think that's the worst scenario I have ever been given. Then when I questioned the person giving it to me, he simply said "hey.. it could happen, just wanted to see how you'd react" So I think he was serious.. that's the scary part.

 

[amberdt03]

They just said fire truck/extrication tools weren't available..

i've worked Texas Motor Speedway and there is never an event that goes on were there aren't any fire equipment immediately available. I think that this guy must have just wanted to mess with your head.

 

[VentMedic]

This scenario is a good example that shows the difference between instructing and educating or the lack of both.

If your service is sitting coverage at a speedway or have one in your area that does not have any extrication rescue available, YOUR service should be prepared. Extrication should then be become part of your job description if you are the only service available instead of ignoring the various problem areas and waiting for a scenario such as this. If there is a potential for a problem at the speedway, the situations should be discussed with the speedway and ambulance service before the accidents happen and not have an EMT chopping off extremities as a solution. The speedway would also be liable, as would the ambulance, for not having the ability to satisfy the safety and rescue capabilites specified in most contracts between these agencies and the race car drivers.

 

[Veneficus]

let's dissect this a bit

Vent,

While I agree with your statement, especially about education and addressing this before hand, picking up an axe and in a single moment swinging it down to amputate and effect a rescue boarders on outrageous. Such a scenario has incredible complications and nobody should be suggesting this as a potential "out of the box" course of action.

You are either dispatched to, or are doing stand by for a speedway where a car has been hit at high speeds and flipped several times. Major vehicle damage to the only car involved. As you approach you smell gas, however there is currently no fire.!

Gloves on scene safe? If you are not equipped to handle this situation with protective gear, the ability to neutralize the threat of a fire from the standard flammable soup from a motor vehicle, those who can need to be summoned. Otherwise, you may find yourself standing in a flash fire, which is not going to slowly creep towards you. One breath of superheated gas from this flash, and the next responders will be calling you on scene.

You yell out at your patient not to move and ask him where he is hurt. As he's screaming he tells you it's his arm. It's stuck and he can't get it out. (Between the drivers door and the dash). As you approach to assess your patient the cars engine ignites in flames

For the benefit of the doubt, let's assume the car is stable with the proper side up and not laying on the roof or side. What exactly is the cause of the fire? an electrical system that should have been cut? The heat from the block? This will be a flash fire, and if all you got is an extinguisher it is only going to be enough to maybe get you out. If the fire has enough fuel and heat to continue after a suppression attempt, what is burning in the floorboards? The metal? The extra durable floor mats? (note the sarcasm) The nomex or other flame resistant material the driver should be wearing? Hopefully you are not standing there with your o2 tank.

Quickly other rescue responders get out the extinguishers and try putting out the fire. You and your partner start working as quickly as possible to get your patient out as the fire quickly spreads.

What exactly are you using to free his arm? The proper extrication equipment you don't have? That fire spread is not going to be slow. Go and light a pool of flammable liquid on the ground and see how fast it "quickly spreads" (better yet don't try this at home)

After several minutes your attempts to get his arm free fail, and the attempts the extinguish the fire are also failing.. now the fire is starting to come up into the car and burn your patients feet. Also, the heat and smoke are getting unbearable for you and your partner and patient..

Several minutes huh? in those several minutes where is the cavalry? Smoke and heat unbearable. That will be an understatement, fortunately you can see the axe on the ground and pick it up. So what will you do for your inhalation injuries and other burns?

Decision time!

I asked what resources/equipment I had available to me to do a rapid extrication of the patient. My answer: "That axe on the ground.. oh and hurry.. his feet are on fire."

It just keeps getting better... So you couldn't use said axe to use as a lever to get just enough space to free the arm prior standing in the unbearable smoke and heat. You're now thinking... Maybe in the excitement of the moment I can just cut his arm off and drag his burning body out of the vehicle?

I knew what they wanted to see.. pick up the axe.. tell my patient to take a deep breath and chop his arm off. So it's either let him slowly burn to death.. or hack his arm off.."

Without a moment to lose you are going to use an axe to chop off the arm of somebody trapped in a burning car while standing in smoke that obscures your vision and inhibits your breathing, in heat that is unbearable, you will overcome your instinct to flee, and you will stand there and make small chops to hack is arm off, which will take several more minutes? Or were you planning on standing outside the vehicle and in one fell swoop bringing the axe down and severing the limb. In the heat and smoke, I hope you took the time to aim, otherwise you may bring the axe down into his head. I am sure he was calmly sitting there for the event and not squirming out of control as he burned.

I decided to hack his arm off... told my patient to look away.. take a deep breath and then I hacked as close to the crushed part as possible. The person giving me the scenario then says "great, his arm is now free.. get your patient outta there.. he's burning to death!"

I in no way lay any fault on the OP for this outrageousness, he had to give the answer the preceptor wanted to hear.

Got my partner to do some half a$$ C-Spine and we hauled him outta there. Laid him down, partner took C-Spine and I got someone to extinguished his feet.

I would not in anyway be concerned with c-spine while dragging a person on fire. as for extinguishing his feet, might have been a good idea to try that when he was still in the car. But I doubt it would have changed the outcome the (i'll be kind) senior provider giving the scenario was driving towards.

I then continued on my scenario as per usual. Dealt with the amputation, ABC, etc etc.

In light of the nonsense that preceeded keeping a clear head through all of ths should get you an award, promotion, and pay raise.

So my question for all of you is: based on this, or a similar type of situation.. would you take that axe and hack off the arm..!

I seriously dobt the feasability of this course of action given the scenario. The best realistic scenario you might have to accept is the only dead person is the driver. (a horrific death at that) Because your partner's and your own life could have been ended at any moment in this rescue attempt.

would you have done something else.. would you have let your patient burn to death?

To a trained, experienced, and properly equipped firefighter and/or extrication expert, there are many alternatives. Like having prevented the fire to begin with. ( i will spare the tactics because I don't want somebody trying it because they read my description here and think they know how to handle it, plus i am too lazy to type it all out)

What would you have done differently? Is it worth the lawsuit? I am interested to see what other people would do.
Cheers!

Forget the lawsuit, is it worth your life to make such an attempt? I agree with Vent totally, the safety and response measures need to be discussed and in place before this scenario.

Offering such "ideas" during "training" is how people get killed.

 

[Veneficus]

P.s.

I hope the ammo from your concealed weapon didn't start cooking off in all of this.

 

[ffemt8978]

While this scenario was definitely unrealistic, and designed for you to fail here's a couple of points to consider.

An ax is just laying in the middle of the speedway?

The fire suppression equipment doesn't have a set of jaws, a hack saw, or good ol' sparky to cut the steering wheel off?

The fire suppression unit has fire extinguishers but no water supply? What about flooding the passenger compartment with a couple of inches of water. That should buy you enough time to pry or cut the steering wheel. And while I have seen vehicles fires that were very difficult to put out, I have yet to see one involving a passenger car that couldn't at least be stopped from spreading with the water available on one structure engine long enough for extrication to be accomplished.

How the hell are you going to swing an ax with enough force and accuracy, inside the confines of the passenger compartment, to amputate an arm?

Seriously, this evaluator/instructor needs to be taken aside and re-educated on realistic scenarios before one of his students takes this "outside the box" mentality and actually puts it to use.

 

[amberdt03]

An ax is just laying in the middle of the speedway?

you mean thats not common?

 

[Hockey]

Break his arm/hand whatever. Once you do that, you got all the freedom to do whatever!

 

[Sasha]

The person who did your training sounds like one of those idiots who pride themselves on "thinking outside of the box" when they're all the way in left field.

Did he seriously think it would be acceptable for you to , even in a scenario, not only do something completely out of your scope, but something that has the potential to kill the patient? Sure, he wont burn to death, just die later on a vent and lots of fun drips from sepsis secondary to hacking his arm off.

I'd want to raise concerns with your supervisor regarding this provider. Maybe he really wants to be a surgeon instead of an EMT or Paramedic.

 

[reaper]

Grab some marshmallows and watch the carnage!

They have no fire suppression, with heavy smell of fuel! I am sitting about 100 yards away and watching the fire. He is not your pt, till you assess him. You should be no where close enough to assess him, in the first place!

 

[VentMedic]

Maybe he really wants to be a surgeon instead of an EMT or Paramedic.

To be a surgeon he would have to have an education.

This type of instructor will usually not have enough of an education to know what to teach and will often rely of war stories or "out of the box" scenarios to fill a class. This scenario probably wasted an entire class period on how to chop off an arm with an axe instead of teaching basic scene safety and extrication.

Since the OP is an EMR, which is slightly higher than an EMT-B, the instructor is probably trying to show a heroic side of the job to instill enthusiasm for the profession. This is where many students get an elated view of being an EMT or Paramedic without learning the basic realisms of the job as it pertains to medicine. Thus, they are disappointed when they get out into the working world.

 

[Veneficus]

Grab some marshmallows and watch the carnage!

They have no fire suppression, with heavy smell of fuel! I am sitting about 100 yards away and watching the fire. He is not your pt, till you assess him. You should be no where close enough to assess him, in the first place!

extremely well said.

 

[mycrofft]

I refer you to my earlier scenario comments

That was total whack.
Were you the last one one a Friday?<_<

 

[AaronMRT]

After accessing scene safety you would not want to go into that situation, but seening that did I would rather have tried applying cervical collar quickly and getting the aid of a couple more people to help pull his arm free and try to have it repaired in surgery over hacking it off and having no chance of saving it.