What would you do?

[Wayne]

I thought I would suggest a number of first aid scenarios to see if we as a group could come up with some effective rescues.

Having run a number of outdoor first aid courses and as an expedition medic I have my ideas of what's best practice but I am sure there are people on here with differing approaches and skills that are equally valid.

Our first victim is a male that he has fallen out of a tree and is complaining of chest pains on his right side and a loss of sensation in left leg.

He can answer simple questions but is not fully coherent.



You arrive on scene with a couple of mates by canoe. What would you do you only have your normal kit?

 

[Toddy]

Worry about his spine, make him comfortable and see how quickly I could get medical help with a proper back board and brace, etc.,

On t'other hand; if he 'had' to be moved…..think hard about how and do it without moving his hips and spine out of line, while still keeping him reassured and breathing.

You don't pick easy ones, do you Wayne ?

Just my 2p worth.

Good idea for a thread

M

 

[cranmere]

The loss of feeling in his leg would indicate a possible spinal injury, or maybe just that he's been lying on his leg for some time. First thing therefore is don't move him, make observations if possible to see if you can get any more info about his injuries or the mode of the fall. Examine him if you're trained to do so, ditto. Unless I was really sure that there was no spinal injury I'd use that other piece of common equipment, the mobile phone, and call for professional help.

 

[santaman2000]

Just a bit more info please; exactly where are you canoeing when you find him? In other words; is a cell phone a realistic possibility, or are you somewhere out of range?

 

[MT606]

If he was my former neighbour, I'd keep on paddling.

 

[SGL70]

If he was my former neighbour, I'd keep on paddling.

hahahahaha....

 

[Dave Budd]

knock him on the head and save him for dinner later?

 

[Bishop]

Asses the situation, can you render first aid at the scene without endagering yourself or others.

Try to find out if the symptoms described by the patient are the cause of falling from the tree or as a result of falling.
From what height have they fallen and in what position have they landed, where exactly does it hurt...
It could be just a mild concussion, a cracked rib and a thigh contusion (aka 'Dead-Leg') caused by bruising or limb position

 

[bearbait]

In addition to what's been said try and keep the patient warm and calm and out of the weather with blanket/sleeping bag/tarp/spare clothing/cag, minimising movement due to leg injury (possible back injury) until professional help can be obtained.

 

[swotty]

Chest pains suggest heart problems so perhaps a heart attack or angina has caused him to fall? Something in the back of my mind makes me the think of a connection with loss of feeling in limbs and heart problems but I would treat as a spinal injury obviously after calling/phoning for help (assuming there's a signal)
As he's conscious I would ask what happened and of any history of heart problems.

 

[Wayne]

All good responses thus far. His temperature is stable but his pulse is now 120bmp and his respiration is rapid and shallow?

Ambulance is 30-40 minutes away.

 

[lannyman8]

Possible spinal and or concussion, the shallow rapid breath and increased pulse could be a sign of internal bleeding, possible trauma from broken ribs.

any bruising around the ribs?? what does his leg look like on inspection?? any marks on his head??? did he land in a funny position or on a log/rock???

details dude?????

PS. keep him warm and calm, wait for help. do not give food or drink, do not give him pain killers. cover him with sleeping bag put tarp up to protect from wind and possible rain.

 

[Graveworm]

He's has a viable airway. But breathing is becoming a problem. So that's my priority, 40-50 mins might be too long. He needs HEMS so back to 999.
He is of course showing SOME possible signs of hypovolaemic shock but my suspicion for right side chest pain is also ribs rather than cardio add in tachycardia and the tachypnea in the absence of temperature changes etc. and you have probable tension pneumothorax. Expose, check rise and fall and auscultate to confirm, latter stages will have deviated trachea and distended veins. Treatment if indicated would be to support any obvious flail Rib, deal with open wounds with a flutter valve and log roll onto injured side, as disability can wait and unilateral leg numbness alone is not a big Red flag for spine, more likely nerves or circulation. I will make a mental note or tell my buddy that it could indicate or mask other trauma and that trouser leg does not have much of a future once we sort this breathing out.
Consider letting him take Ibruprofen or similar if he has it, as this will hurt, 45 mins is a long time and they won't be giving him any Entonox.
Check to make sure no obvious external bleed I have missed as I do this, and watch for signs and symptoms especially his reaction. Re-evaluate stats, that breathing needs watching and if necessary consider needle decompression, if you have the training and kit. Keep going through the acronym bingo ABCDE twelve flaps, AVPU SAMPLE etc until they say endex.

 

[Bishop]

Don't Panic!
Maintain supportive care, keep them warm, dry and talking if able, inspect for any other physical injuries: swelling, bleeding, stings.
If subject not entirely commicative check clothing & gear for identification and personal medication eg: Asthma inhalers, Epipen, Insulin and Nitro sprays.
Finding one of these will give you a clue what's wrong... otherwise keep an eye on that pulse and watch out for trembling limbs.

Prepare for ambulance by getting somebody to where it's going to arrive. It may not be practical for a wheeled vehicle to get close, so somebody needs to tell them that before they get bogged down and they can lend a hand carrying some of the emergency kit. Helicopters don't like soft ground or slopes and it helps the pilot tremendously to have an indication of wind direction (T-shirt on a pole, flare,smoke grenade etc) plus a good 15 metre clearance all around the desired landing spot.

 

[david1]

Helicopter

 

[Joe tahkahikew]

How much money does he have on him?

It would have to be white Canadian as we have no need to climb trees! Thats for bears.

Difficult for us. If he's found a day or two travel days from our village, then it is likely that we'd make him warm and comfortable. We'd make a shelter for him by traditional means if we only had our hunting equipment with us. (Cut down and peel bark of trees to make waterproof shelter/small house if weather no too good.) We would look also to see what equipment he had on him we could use. He must have arrived by canoe or possibly has a shelter of his own nearby. We would look for this and see whether there was a radio as some Canadians carry them. If nothing then,

Two paddlers can go way faster than one, so we'd leave enough food for our one companion who'll stay with him. Then we'd simply paddle back to our village and raise help without pausing. One of us would guide the rescuers to him.

If it was several days travelling away, maybe we'd just wait a couple of days and see whether he was going to die before we went for help.

 

[Miniwhisk]

I would immediately look for a medical tag or bracelet (some medical conditions require immediate administered medication if they suffer shock or trauma) its wise to make sure they are otherwise in good health! We need to know why he fell out of the tree! He might have passed out up there... Keep him warm, keep talking to him, keep him awake Shine torch into eyes and note any pupil dilation. Ask him to wriggle his toes. Note the colour of his lips. All this can be done relatively quickly After that, I'd have to let medical experts take over the decision to move or splint him etc.

 

[Seabeggar]

Got to assume with those stats that he is dying, possible tension pneumothorax / internal bleed. Unless you know the helicopter or ambulance is going to be with you very soon need to consider trying to shorten the extraction time. While accepting the possibility of neck / spine /pelvic injury from the mechanism of injury ( the numb leg is less likely a spine issue) its his airway breathing circulation issue that are going to kill him possibly very soon. Could you stick him in the canoe and shorten the evacuation ? If he is going to need a significant carry to the ambulance anyway take you saw and cut a rigid carry stretcher / spine board out of your canoe hull. Use the paddles to stiffen it up & ropes to secure him, pad and immobilise his neck and RLF to the road head ???

 

[Bluffer]

Firstly, an acknowledgement that I would be in no way legally responsible to treat the casualty (assuming that I have no established relationship to him other than that of 'bystander').

Secondly, I would only consider any sort of movement in extremis (assuming that there is no urgent need to move him, falling trees, bushfire, etc) - and if I elected to move him I would be unable to do so safely and would be unable to meet his clinical needs during the move. To this end, I would consider actively preventing others moving him.

Thirdly, I would be very limited in any treatment options and if he needed 'needle decompression' or other similar intervention, I would be forced to relegate myself to 'witness' and provide a detailed statement of my observations to the coroner.

The whole scenario is a nod towards carrying VHF or Sat comms as a back-up to mobile phone.

Essentially, there is no clinical solution, the problem question is one of logistics.

With the current Bristow SAR contract, it is fair to say that a casualty in this condition in a remote area in bad weather may have a rather gloomy prognosis?

 

[Graveworm]

Firstly, an acknowledgement that I would be in no way legally responsible to treat the casualty (assuming that I have no established relationship to him other than that of 'bystander').

Well it doesn't say what country this happened in. 😈
It always saddens me when I read stuff like this. At conferences I always used to point out to French and German colleagues that we didn't need legislation like theirs because in the UK no one would just stand and watch. More and more I can't justify that.

Incidentally there are some really narrow circumstances, not like these, where you can be liable for neglect under common law, even now, if the aid to be rendered is trivial and without risk in relation to the consequences but it hasn't been used in decades. That involved a publican who refused water or to call for help for a dying tramp at his kitchen door.