Trapped pt with amputation

[Akulahawk]

Falcon, it's clear that you want us to go towards limb amputation. That is something that is highly unlikely to occur in the field. My feeling is that if you're that far out where you think the patient will die without immediate amputation and there's no chance of getting a surgeon to the patient (how are you going to evacuate the patient if you can't bring the surgeon to the patient?), the patient will likely die regardless of your amputation efforts.

You have presented us with a high risk, low reward scenario... and the patient will likely die regardless of which option we take.

That's the reality of it.

Extrication is only part of the story... evacuation is the other portion. If you can not get a surgeon (can't fly/drive in) you're not going to be able to evacuate your time-critical patient...

 

[wvditchdoc]

You have presented us with a high risk, low reward scenario... and the patient will likely die regardless of which option we take.

That's the reality of it.

Extrication is only part of the story... evacuation is the other portion. If you can not get a surgeon (can't fly/drive in) you're not going to be able to evacuate your time-critical patient...

+2, excellent point.

I think the scenario is quite a bit far fetched to begin with. Don't get me wrong, I like to think outside the box as well but the scenario(s) still have to be doable.

If this were in fact the case, you can do all the cool stuff you want but until you get the patient out to definitive care, chances are they are still gonna kick it.

Marc

 

[Mountain Res-Q]

Extrication is only part of the story... evacuation is the other portion. If you can not get a surgeon (can't fly/drive in) you're not going to be able to evacuate your time-critical patient...

In SAR we refer to this by the acronym LAST... Locate, Access, Stabilize, and Transport... Falcon is talking about the Stabilize portion of this scenerio, somehting that could take hours, much manpower, and great danger... and every other step in this scenerio is going to present us with the same issues... Heck, the act of locating and accessing the subject could take days on it's own... and trust me it has... ans transporting? Carrying anyone out of the woods is not an easy of quick process. If we NEED to chop that arm off to save a life, lets also factor in the response time, the time to locate them, the time to access them, and the time to get them out... Reality is that all that extra time is gonna kill a critical patient, a patinet that probably wasn't alive (if they were critical) when we got to him... been there done that...

Like you said, it is just unrealistic and the series events that would have to transpire would likely mean that the the subject would be dead by the time we got there or that they would be alive and we (EMT, Medics, OEC, and a Surgeon ASAP) would probably have the time to do things right and not have a First Aider grab a hack saw and go at it...

 

[EMTinNEPA]

Where are you that you can't get a field surgeon there? My county is EXTREMELY rural, and in this scenario, we could still have a field surgeon in less than half an hour and a helicopter in less than 15 minutes, to say nothing of the County's Rescue Task Force.

 

[Mountain Res-Q]

Where are you that you can't get a field surgeon there? My county is EXTREMELY rural, and in this scenario, we could still have a field surgeon in less than half an hour and a helicopter in less than 15 minutes, to say nothing of the County's Rescue Task Force.

You may find your area extremely remote, but I would venture a guess that any place you can have a helo in 15 mnutes and a surgeon in less than 30 minutes is not really remote...

http://www.emtlife.com/album.php?albumid=70&pictureid=848

http://www.emtlife.com/album.php?albumid=71&pictureid=389

And even those areas are more accessable, but would take us hours to get in to and then, worse, to access the patient. Trust me. Me thinks you overestimate your areas wilderness-ness and/or your areas Wilderness Rescue Capabilities... Best case scenerio, from injury to the time the subject could be in the OR... 6 hours... more realisticlly... 12 to 36 hours... anything else and we are not talking about real wilderness (USFS definition: COMPLETELY WILD and UNTAMED).

 

[Mountain Res-Q]

A word on the thought of "what is really remote?"

We ran a call last year where the subject had one of those new emergnecy GPS locaters, where you can push a button and send out a 911 signal. Those coordinates are given to the local SAR team as soon as possible (<2 hours). Of course, the reason he sent out the signal was becasue he was trying to beat an incoming early snow storm and got bluffed out (stuck on a cliff side). He was located in the federally designated wilderness (112,000 acres of granite and alpine forests at 5,000 to 12,000 feet only access by law is on foot or horse, http://en.wikipedia.org/wiki/Emigrant_Wilderness) The weather made helo not possible for at least 36 hours. We had his exact coordinates (or so we thought) and it took us, from the moment the call went out to the moment we (2 of us) were at those coordinates, 38 hours! Only he wasn't there (coordinates were inacurate). It took another 30 hours to locate him, deceased by now; and another 2 hours to access him with ropes...

And I am in California, the most populated state... and we have that kind of remote area (and that wasn't as remote as it could have been, infact it was on the edge of the wilderness boundry). Of course, by the end, we had the helo available and good weather and transport out took 30 minutes from the wilderness to the helibase, but it gets a lot worse when you are talking about "remote", especailly when you are talking about Northern Cananda, Alaska, the Andes, etc... Even our neighbors in Yosemite, with a fully staffed expert SAR Team and a Helo on standby would take hours, if not days, to get a surgeon to the remote areas of the park (weather dependant).

 

[VentMedic]

please, let us talk in this subject. we have one coutry it is EMS country we discuss in it. did you see what Mountain Res-Q said you can go back and see it.

A tourniquet not stopping the bleeding?

sure it is. did you think it is stop bleeding in brain. that is what I mean.

Brain? No, a tourniquet is for the extremity. As I already said if you have no other meds other than the IV fluids there may be little you can do for a TBI.

Even a Paramedic in this country would be addressing all the issues before considering amputation. also in my country

So post your protocols.

thanks VentMedic . I know my job.

You may know your job but you do NOT know the levels of the U.S. or the training. You were asking about an EMT and not a Paramedic which is the reason a clarification was needed.

Why don't you post your protocols or the scope of practice for a Paramedic where you are at.

And again, what are a student of? Are you a Paramedic or are you just starting your Paramedic training?

quote by Akulahawk
That is something that is highly unlikely to occur in the field. My feeling is that if you're that far out where you think the patient will die without immediate amputation and there's no chance of getting a surgeon to the patient (how are you going to evacuate the patient if you can't bring the surgeon to the patient?), the patient will likely die regardless of your amputation efforts.

Yet, other than length of time, he has provided no information about the assessment of a patient.

Sometimes people get fixated on one gross point and can not see the logic or reasoning beyond that. Some become so overwhelmed by that one point that they fail to properly assess and treat or alleviate the other factors.

It is not unheard of for a Paramedic in the U.S. to finish amputating an extremity that requires very little effort or equipment such as just tissue is all that is holding the parts together in the entrapment. But, there is a difference between EMT and Paramedic in the U.S.

 

[Akulahawk]

Yet, other than length of time, he has provided no information about the assessment of a patient.

Sometimes people get fixated on one gross point and can not see the logic or reasoning beyond that. Some become so overwhelmed by that one point that they fail to properly assess and treat or alleviate the other factors.

It is not unheard of for a Paramedic in the U.S. to finish amputating an extremity that requires very little effort or equipment such as just tissue is all that is holding the parts together in the entrapment. But, there is a difference between EMT and Paramedic in the U.S.

Indeed, there is precious little info about this patient other than basically being a critically entrapped, limb crushed patient in some remote place where you can't get a surgeon to the patient... and if you don't immediately amputate, the patient will die...

Completing an amputation, to me, is something far different than initiating one... which is what I gather (from scant info) Falcon-18 wants to jump right into...

 

[Mountain Res-Q]

Completing an amputation, to me, is something far different than initiating one... which is what I gather (from scant info) Falcon-18 wants to jump right into...

For the record, amputating a limb is easy... having your patient survive is another story... especially when we tlk about transport time wihtout the helo (which must not exist if we couldn't get a Surgeon in to us)... which is why I will say again, if the patient is alive by the time we get there, then the patient is not critical, so why would I potentially change that by whacking off a limb?

Baed on the "scenerio" presented, I would be lead to believe that I should be ready to take off a limb at some point in the near future (hear that LucidResq and WarDance... clean up your hack saws ), and somehow I believe that the circumstances tht would present themselves in order to warrent this action are not likely or realistic, for many reasons expressed here. But again, I say that if the stars alligned and there was no choice... I would order a subordinate to start hacking away... :unsure: LOL