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Martin
04-24-2004, 19:04
This was sent as a PM to Surgicalcric. He told me to post it here. Note addition of question at the end of my PM, regarding artery.

Surgicalcric: your reluctance for M2M, is it because of decease?

Muchas gracias!


Martin to Surgicalcric:
Casualty priority

I don't want to upset anyone, so I'll PM you in an effort to keep it low profile. This is a civilian scenario. I hope you don't mind, and will accept my apology otherwise.

It is my understanding that those in the most critical conditions should be given higher priorities. I have little knowledge and would, if needed, like to put it to the best use. So, the question is, how would one act in the scenario below? (which I choose because I think it seems likely and covers the little I can do)

Example situation:
You're alone in a motorized vehicle, any type, with only some bandages, material for wound cleaning, a knife and duct tape. Your knowledge does not extend far further than ABC (I think you use that term too; for control of and help for breathing, pulse and chock), bandaging and basic stabilization (broken legs, you don't know about hips).

You're travelling on a low traffic interstate, with nobody else but the two vehicles ahead of you.
200 meters to your front vehicle A makes a right turn onto a smaller road. Vehicle B is driving towards the interstate from that road. Vehicle A hits vehicle B in the side, slightly in front of the driver's door.

You stop and find that:
There are cracks at vehicle As driver's side wind shield.
Vehicle B is deformed inwards at the place where the driver's door connects to the body of the car. The car door is torn open.
Person A (driver) in vehicle A has pulse, but does not breathe.
Person B (front seat passsenger) in vehicle A is unconcious, but breathes and has pulse, he does not seem to have acquired body damage.
Person C (driver) in vehicle B is very bloody and has a big cut on his left arm, but the blood is not gushing out as if an artery had been cut off. Legs of person C are locked into place by the pressure of the deformation of the car. Unconcious, but has pulse and breathing.

-----
The question is: what priorities would one recommend based on this limited information that the untrained eye sees?

My thoughts:
Call 911 (112 actually, over here), telling:
name, place, number of victims, describe their states and wounds.

Wait with person B: he does not seem to be critical, or if he is, I don't know what to do.
Person C is bleeding heavily... but the effort put into trying to stop that would probably kill person A.
I start by pulling person A out of the car and trying to get him/her to breathe (mouth to mouth), thinking that both person A and C are critical, but person A is easier to fix and it will probably take untrained me a longer time to stop a bleeding than to put my mouth over person A. As soon as respiration is acknowledged, he is put into that position on the side, that I don't know the english name of.
I then go to person C.
I will not try to move person C, because of his legs being trapped. I would not consider hip fractions as reasons for not moving him because of the legs not being in weird positions, or turned awkwardly. I pour anti-inflamatory fluids over the wound - thinking that using a sponge (or what you call them...) would not do anything good with a pretty heavily bleeding wound. I then wrap the bandage around the arm, hard enough to still be able to get a finger under it. I use my hand to put pressure on it. If there would have been somebody else who needed attendance, I would have wraped it tight, to be able to have a look at the others. I would then try to remember that and tell either the paramedics that or put on an looser bandage myself.
After that I'll check that person B is still alive and haven't gone into cardical rest or something... If I can do that without person C's bandage getting screwed up without the pressure.

If person C would have been unable to breathe, I would still have gone to person A first. Both critical, but giving a higher chance of saving at least one of them.

Is this thinking correct?

If an artery is zapped, should one try to stick one's hand in (only if you have clean gloves) and try to hold it shut? Preferbly putting some clips there (any special kind?), of course.




Surgicalcric reply:
Patient A: Try to open airway. If patient starts breathing on their own maintain the airway, or direct another bystander to do so and hold C-spine as well. If patient does not begin breathing move on to Patient C. Doing mouth-to-mouth aint gonna happen unless I know the person. Move on to someone you can help.

Patient B: Nothing you can do for this person other than hold C-spine.

Pateint C: If you have a first aid kit apply a couple 4x4's to the wound and wrap with gauze. Apply pressure to the site of the wound, or have a bystander do so. If this does not stop the bleeding raise the limb above heart level. Instruct a bystander to hold c-spine. There is nothing more you can do for this patient as they will need to be extricated from the wreckage.

After this person has been treated you can go back to Patient A. If he/she still has a pulse then you can begin M2M if and only if you have a pocket mask.

Post this question in the med forum. Others can learn from it as well.

HTH.

James D

Surgicalcric
04-24-2004, 19:47
Originally posted by Martin
...Surgicalcric: your reluctance for M2M, is it because of decease?
If you meant disease, YES.

If an artery is zapped, should one try to stick one's hand in (only if you have clean gloves) and try to hold it shut? Preferbly putting some clips there (any special kind?), of course.

Muchas gracias!
NO. Not unless you are a surgeon or other medical professional with formal training in minor surgery. Pressure dressing, elevate, pressure points, quick-clot or TraumaDex, and as a last resort a tourniquet.


The treatment advice I have given is from a civilian paramedics perspective, here in the US. What you are allowed by law, in your country, will likely vary from what is done here. Before you set out on treating people at the scene of a MVA (car accident), or any other medical emergency you would be well advised to find out how the laws of your country govern any treatment you may or may not render. Also if you are that interested you may want to invest in a first-aid/CPR or EMT equivilent program there.

HTH.