What would you do?

[Bluffer]

I've been involved in some ethically difficult situations, one example being handing over a casualty to the host nation hospital in the full knowledge that he would be brown bread within minutes because the hospital had no power, no resus kit and no ITU.

So, my first thought is always 'eligibility' closely followed by 'practicable' i.e. I may want to save a life, but not have the kit or evacuation chain (vehicle).

I'm not in the slightest bit scared of getting my hands dirty or of being sued.

 

[ganstey]

[coming in after sitrep update]
As casualty's conditions have changed, get back on to 999/911/etc. and ask them what to do - I only have basic first aid training. I could probably carry out any simply procedures they recommended and could continue to monitor. Start mentally preparing for the fact that I may be doing CPR soon if breathing continues to deteriorate. Get one of my mates to scan locality for possible sources of assistance (police/fire/ambulance travelling on local road etc).

 

[Joe tahkahikew]

Has anyone ever been sued in the Uk or Canada for giving 1st aid do you know?

 

[Wayne]

Good responses thus far.

No one has been successfully sued in the UK for performing first aid as long as your acting within your training and remit. Trying to perform a chest drain with a rusty nail and a bit of hose after watching a YouTube clip might get you into trouble.

With the scenario I suggested above the casualty had fallen from a tree and taken a blow to the bang of the head. He was complaining of chest pain and altered sensation in the leg.

Rightly the first responses was to make him comfortable and monitor whilst waiting for an ambulance. With time the casualty has become a bit cooler and the pulse has increased and his level of response has decreased. We don't like change.

It's been suggested that he is going into shock and we may need to perform CPR.

Seems like sound thinking to me. If you could examine the casualty you would find a egg sized lump at the base of the head and increased bruising on the chest. Breathing is increasingly difficult. And the patient is looking proper ill.

Time for life over limb. Carefully the casualty needs to be moved to a safe location as quickly as possible and the spine must be kept stable.

Chest compressions on a casualty with fractured ribs is that a good idea?

What's the alternative?

 

[Bluffer]

Alternative to chest compressions, is do not do chest compressions.

Casualty is breathing, so CPR is not needed.

Why move the casualty? He is already in a safe place?

I've had a group on the ground arrange a pick-up, then they moved their deteriorating casualty, which resulted in the pick-up being delayed by 30 mins. Not good.

 

[mr dazzler]

Its a LONG time since I did first aid......Well he is awake and speaking, so no need to check "bweevin" (my scout instructor Alf was a hard cockney who was a first aider during the London blitz) Next check if there is any "bweedin", its not alweays obvious, improvise a way to slow it if there is serious loss of blood as that reduces effects of inevitable shock. KEEP AIRWAY open, monitor to make sure he doent vomit and choke, cant say wether he should be put in recovery [position as he isnt unconscious....
Pinch his toes, if he can feel it, likely not spinal. He would likely have NO feeling in any leg or toe's if it was. Sounds like cracked or broken ribs. CPR could cause internal bweedin, which he almost certainly has any way...Holger neilsen instead? Call for emergency services, meanwhile make the patient as comfortable as possible, keep him warm and dry as he will likely start to suffer shock. His pulse will be very weak and "thready". If his pulse and/or breathing DOES stop then you will have to ignore the fact he has other injuries and perform CPR OK if you decide he MUST be moved, improvise splints to make his legs and back as rigid as possible, branches strapped between legs, wrapped with anything t shirt, paracord, belt's, even see if their is a gate to use as a stretcher spinal board. At a pinch you could use the canoe paddle/s as splints/boards.

 

[Graveworm]

Alternative to chest compressions, is do not do chest compressions.

Casualty is breathing, so CPR is not needed.

Why move the casualty? He is already in a safe place?

I've had a group on the ground arrange a pick-up, then they moved their deteriorating casualty, which resulted in the pick-up being delayed by 30 mins. Not good.

I like this kind of exercise but they do have problems in as much as everyone is right as they need to go with what they have been taught.

Breathing of under 10 breaths or over 30 in a minute should not be counted as breathing and they need help (CPR). Vitals seldom stabilise from a downward trend without any intervention so our casualty is on his way to one of them. If help is 40 mins away they will need more than basic CPR. You might need to move them to perform that CPR or to fix whatever is stopping them breathing before they reach that tipping point so you avoid having to perform CPR.

If they need CPR then broken ribs will not change things other than you will be damaging them and you will not have to press as hard to get to the correct depth..

 

[Bluffer]

Yeah, if I was carrying trauma kit and oxygen I know what I would do.

But I wouldn't be carrying that kit.

As I said earlier, this is a question of logistics not of clinical protocol.

 

[Stevie777]

Perform an emergency Tracheotomy then stop the bleeding from the wound by tying a tourniquet around the guys neck just below the incision..

 

[Graveworm]

Yeah, if I was carrying trauma kit and oxygen I know what I would do.

But I wouldn't be carrying that kit.

As I said earlier, this is a question of logistics not of clinical protocol.

Oxygen would definitely be great to have, but if it is a tension pneumothorax (It's possible to get a pretty good steer without any kit) causing breathing difficulties then just rolling them onto the injured side would make a big difference and needs no kit at all, the earlier this is done the more efficacious it would be. A pretty lightweight kit would add in some other options.

 

[Joe tahkahikew]

I understand that you only give chest compressions/CPR if the guy is unconscious and not breathing. So not giving chest compressions will in that case simply allow him to die. So doesn't matter if he has bust ribs - but then you don't know that either.

As for moving him - if this was in England a rescue team would be there in minutes and remove him properly as no where in England is more than a few miles from road. Moving him won't get him evacuated any faster, but might just kill him.

 

[rik_uk3]

I understand that you only give chest compressions/CPR if the guy is unconscious and not breathing. So not giving chest compressions will in that case simply allow him to die. So doesn't matter if he has bust ribs - but then you don't know that either.

As for moving him - if this was in England a rescue team would be there in minutes and remove him properly as no where in England is more than a few miles from road. Moving him won't get him evacuated any faster, but might just kill him.

Very satisfying to know, although not really true

 

[Joe tahkahikew]

Which bit isn't true? You have air ambulance I was told and these are normally quick to respond I guess?

Perhaps you could suggest what to do in the situation and we could learn from you?

 

[OurAmericanCousin]

First, what kind of tree is it? If its an apple, maybe the farmer has a phone.

Over here we just get up and walk it off.

I'm not ruining yet another canoe trip because another clown fell out of a tree, has right side chest pains and a numb left leg. Not two years in a row, I'm not.

 

[rik_uk3]

Which bit isn't true? You have air ambulance I was told and these are normally quick to respond I guess?

Perhaps you could suggest what to do in the situation and we could learn from you?

We do have air ambulance and the UK is small but they will need more than a few minutes to get there.

I'm a retired nurse, worked several area's of acute nursing but really could not say what I'd do unless I was on the scene (in reality); way too many variables in the scenario for one answer.

 

[Joe tahkahikew]

Rik, thank you for replying. I guess by a few minutes I was comparing in my head how long it would take to get to somewhere in my land,compared with yours. I agree with you too. Very difficult to know unless you are there on the ground.

Anyways, he's spoilt my day and I'd guess he's spoilt yours too. Maybe we just do what is suggested in post 71.

 

[WoodGnome]

I think the procedure could possibly change depending on what is happening with the guy. With the info we have so far I would probably not move him too much because I find the loss of sensation in the leg very suspicious for anything spinal. On the other hand, the pain on the right side of the chest combined with the fall and the shallow rapid breath suggest inner bleedings - probably in the lung area because of a broken rib...
Further info needed: Is he sweating? What colour is the skin?

As I said with the info given, I'd guess some spinal issue combined with a beginning shock. So I'd probably place his legs on top of my rucksack or similar without moving the torso so much and get the ambulance in asap.