Real Life Scenerio

[sofmed]

I am going to post a recent situational problem and how I handled it, then am going to sit back and soak up any information thrown my way.

As a medic in support of OIF, Detainee Ops at present, I am faced with running daily operations for our EVAC crew out of the TIF ER.

This is what happened recently...

Assault victim from detainee on detainee violence. Arrive at scene, have to enter actual caravan/living quarters as he's too beat up to carry to sally port. Guards clear area except for injured detainee.

Medic's worst nightmare...mulitiple injuries...lacerations about the head/face, arms, abdomen and legs, front and back, broken arms, bilaterally, humerous L arm, radial and ulnar fx's R arm. Legs...Left leg Femur and Fibula Fx, fibula was open fx; R leg only Tib/Fib closed fx's. Guy's been beaten about the head and shoulders with tent pole, so on top of lacs he has massive contusions and hematomas forming, seemingly everywhere.

Airway patent as he's screaming, start head to toe, C-spine control by one of the guards to start, then pressure and bandages on profuse bleeding, no flail chest or crepitous, abdomen sports a deep lac which requires bandaging immediately; pelvis stable, neg priopism, distal pulses intact all extremeties; once initial head to toe ocmplete, log roll carefully, back same as front...bruising, contusions, only minor lacs, nothing life threatening seen there.

Roll back down...begin secondary eval...Eyeballs intact (that's an issue here), PERRLA, airway still good, neg JVD/trach. deviation, lungs clear to auscultation and tympany, abdomen difficult to check at this point, but bleeding controlled to this point.

Skipping through some of the secondary to...lower extremeties...could do an anatomical splint, but for the multiple fx's the guy has. Would use the traction splint in my FLA but with a Femur AND open Fib fx on the same leg, and posing that he has present and strong distal pulses I nix on taking that route. Arms are sam splinted and wrapped with ace wraps...back to legs...now I'm out of splints...so here's where it gets tricky...the only thing I had within reach was three fruit boxes they carry daily supplies of fruit in with during meal times...very heavy corregated paper board boxes, very difficult to cut...I had no other materials to work with so I pulled out my J cutter and cut out a large rectangular section of the side of one box long enough to fit 2/3 of the L leg, scored it about 2 inches in from one end to the other on opposing sides and folded it to form a channel which I then slid under the affected leg...again ace wraps and kerlix saved the day. Performed the same steps with the right leg, while the other medic made a third check on other interventions, then we spine boarded him, litter loaded and truck loaded and transported. O2 enroute with only one vitals check available as ride to ER w/in 7 minutes. Unfortunately we're not authorized to EJ on the wire regardless of the situation or I'd have done one. Docs took care of that w/in first 5 mins on the gourney at ER.

I left out some of the interventions and such only to save space here. I am simply asking some of the QP medics to evaluate and suggest alternative tx angles I could have approached from, as I'm always about improving my skills. SurgicalCric is a dear friend and has seen me work. I'm simply asking for greater insight.

Thanks ahead of time for any advice. I'll be standing by.

Mick

[sofmed]

Gads! I misspelled scenario. Sorry guys. Very long day and night.

[swatsurgeon]

buddy tie the legs with padding (if available) between to maintain present angulation since you had distal pulses....evac as stated.
Wouldn't have done anything else different......good neurovascular exam for report to ED since compartment syndrome, primary arterial injury or nerve injury are real issues.
Good job.....want to work here?

ss

[adal]

Sounds like you did a great job to me. Nothing like a trauma scenario and having to use boxes as splints. Good use of resources and sounds like you did a VERY good assessment. Just out of curiousity, how long did it take to do all this? I'm not sharp shootin', just a question.
adal

[sofmed]

Originally Posted by adal

Sounds like you did a great job to me. Nothing like a trauma scenario and having to use boxes as splints. Good use of resources and sounds like you did a VERY good assessment. Just out of curiousity, how long did it take to do all this? I'm not sharp shootin', just a question.
adal

Thanks guys. Keep any advice coming. That's why I posted.

Once we arrived on scene, with both of us working, I think we took 5 to 7 minutes to get the guard online for c-spine, intial survey, major bleeding stopped, secondary survey started. And then the splints, spineboard, then litter and load...say 12 mics tops. Total time from touching boots on ground to handing off in ER around 17-20 mics at most. The hospital is centralized and very close. Also, the corpsman I was working with was great, considering she was an HM and not a field medic. I give credit where it's due.

After a break in service, coming back on doing this deal for 15 months I've fallen in love with trauma all over again. What can I say...it's in my blood.

And I don't mind someone 'sharpshootin' as long as I'm getting good advice with it on how to improve my skills. In that sense, shoot away. I do plan on making an appearance and finishing SFAS this time (barring another hip dislocation) and, after much smart work, becoming an 18D.

[sofmed]

Originally Posted by swatsurgeon

buddy tie the legs with padding (if available) between to maintain present angulation since you had distal pulses....evac as stated.
Wouldn't have done anything else different......good neurovascular exam for report to ED since compartment syndrome, primary arterial injury or nerve injury are real issues.
Good job.....want to work here?

ss

Once again I'm greatly humbled. Thank you, Sir. I look forward to receiving any advice you can pour into my cup.

Mick

[x SF med]

Good job.

I've had to use boxes before - on DZs when we 'contracted out' DZMO to the non Airborne ambulance medics. they got a chance to open the box on a Thomas, and they were ready... I nearly knocked two out as I came up the hill to see a buddy down, aksed what was going on, and was told that his leg was broken. The kid had a sh-t eating grin on his face as he said "...and it's a dropzone injury, we get to use a traction splint!" I did a quick assessment, asked T what was up and he said, "stop them, they're idiots" - they were, ther was a low tib fib fx, with ankle involvement - and they wanted to traction splint it, because "everything on a DZ gets traction". I threw them out of the area, got the boxes, collected belts and got transport... No M5 bag, late call for the jump had to borrow a ruck and helmet on the way out.

[sofmed]

Originally Posted by x SF med

Good job.

The kid had a sh-t eating grin on his face as he said "...and it's a dropzone injury, we get to use a traction splint!" because "everything on a DZ gets traction".

Whoa! What Knucklepucks! I can only hope someone has come along and shown them the error of their ways and made proper medics out of them by this point.

M