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From: Seng, Dave <Dave_Seng_at_health.state.ak.us>
subject: RE: [Paddlewise] accident scenario
Date: Thu, 10 Aug 2000 13:48:11 -0800
> a:  what's your first plan of action

Assuming that we're beginning this scenario with the injured paddler on
shore and it's not an arterial bleeder.

Perform quick initial visual evaluation of patient.
Get the patient down and treat for shock
Direct pressure on wound

Have someone call for help if within radio or cell range.  If this is not
possible - dispatch a _pair _ of paddlers to either get a car if your
transport is nearby or to flag down a passing car or truck.
Put someone in charge of dealing with the rest of the group - you don't need
six people hovering around watching.

Clean and bandage wound.
Check entire body for other less obvious injuries.
Assess the patient's capacity for being moved.

Have someone attend to and talk quietly to patient - keep'em calm - some
people get panicky if they're hurt.

> 
> b:  how do you decide if the person is capable of continuing 
> on, on their
> own, or if someone needs to play ambulance driver

  My take on most serious injuries is that once you start treating the wound
care for the patient should be continued until responsibility is handed off
to the next care-giver.  Don't let the patient make decisions right now.
Don't argue with the patient - just quickly and efficiently make things
happen to deal with the situation.
> 
> c:  how do you notify the "next of kin" --- ie tell them to 
> meet you at
> the hospital/ER, without adding undue stress to the callee
  
  Do not let this notification get in the way of anything else - taking care
of the patient is primary even though they might not agree with your
prioritization.  In some cases it might even be best to make that call from
the hospital.  "Hi Sue/Ted.  Ellen/John was hurt, but we're at the hospital
and he's OK - the doctors are with him right now.  Can you find someone to
bring you down here? (that's important!)  Keep your voice calm and even.
Communicate efficiently, don't go into too many details - just notify them
and get them there.

> 
> d:  what other factors should be involved/considered

  Well, we've treated the obvious wound and checked for other problems.
We've arranged transport and handled it until the handoff to the pros.
We've notified next of kin.  Maybe the next thing is a group debrief - it
depends on how tight or loose the group is - if you're all good friends you
might find it useful and beneficial to talk it through in an _informal_ way
- sometimes surprising details surface in the post-game analysis.  Do not
push this issue - it's only helpful to someone who wants to deal with it.
> 
> e:  is this discussion usefull?
  
  Yes, it is.  Sometimes stuff like this seems too far-fetched and frivolous
to even waste time on - right up until something really happens.  At that
moment you do not want to be wondering what you should be doing - you want
to be doing it!

Dave Seng
Juneau, Alaska
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From: Mark <canoeist_at_dotzen.org>
subject: RE: [Paddlewise] accident scenario
Date: Thu, 10 Aug 2000 18:21:15 -0600 (MDT)
On Thu, 10 Aug 2000, Seng, Dave wrote:

> > a:  what's your first plan of action
> 
> Assuming that we're beginning this scenario with the injured paddler on
> shore and it's not an arterial bleeder.

that's the ball we're running with!!
 
> Perform quick initial visual evaluation of patient.
> Get the patient down and treat for shock

maybe it's that bad maybe not... i'd have resisted that, unless i had a
fair amount of confidence in the examiner

> Direct pressure on wound

done

> Have someone call for help if within radio or cell range.  If this is not

a corralry to this, if you use an electronic comm device, know its: range,
or EFFECTIVE area of usage...

> possible - dispatch a _pair _ of paddlers to either get a car if your
> transport is nearby or to flag down a passing car or truck.

good call, i stood in the road, bleeding, and they didn't stop :-( had the
kayaker from heaven not been there, that would have been neccessary.

> Put someone in charge of dealing with the rest of the group - you don't need
> six people hovering around watching.

EXCELLENT... the only folks around me were the folks the coordinator had
already "deemed" appropriate [first aid kit, nurse...]
 
> Clean and bandage wound.
> Check entire body for other less obvious injuries.

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nobody EVER did this to me ... not even the ER drs ... all _my_ focus was
on my bloody leg, and what to do about it ... no other blood. ER drs
ass-u-me-d i knew the extent of my injuries ... of course, from their
side, they see me come in and calmly tell them i cut my leg!! they asked
when, and i looked at my watch, checked the stop watch, and told them to
the nearest 5 minutes, that it was 4 hours 25 minutes previously. seems
organized and coherent to me ;-)


> Assess the patient's capacity for being moved.
> 
> Have someone attend to and talk quietly to patient - keep'em calm - some
> people get panicky if they're hurt.

thank god i tend to be calm, focused, but very calm... made a few jokes,
and tried not to scream ... answered questions, and hoped nobody would
loose their weeeknd drawing the "short straw" and taking me somewhere!!
 
> > 
> > b:  how do you decide if the person is capable of continuing 
> > on, on their
> > own, or if someone needs to play ambulance driver
> 
>   My take on most serious injuries is that once you start treating the wound
> care for the patient should be continued until responsibility is handed off
> to the next care-giver.  Don't let the patient make decisions right now.

i agree, and feel this is the deciding factor ... was my injury serious...

> Don't argue with the patient - just quickly and efficiently make things
> happen to deal with the situation.

here's the key... to _ME_ ... there were people on the trip i trusted,
others i barely knew. had more than one of the folks i knew tried to
"stop" me from going on my own, i probably would have followed their
direction, but maybe not. the person who was least in favor of me going
alone, was the nurse, obviously there were enough other positive
circumstances that allowed me to go on with her consent [cell phone &
knowledge of the coverage from 2 years experience] 

> > c:  how do you notify the "next of kin" --- ie tell them to 
> > meet you at
> > the hospital/ER, without adding undue stress to the callee
>   
>   Do not let this notification get in the way of anything else - taking care
> of the patient is primary even though they might not agree with your
> prioritization.  In some cases it might even be best to make that call from
> the hospital.  "Hi Sue/Ted.  Ellen/John was hurt, but we're at the hospital
> and he's OK - the doctors are with him right now.  Can you find someone to
> bring you down here? (that's important!)  Keep your voice calm and even.
> Communicate efficiently, don't go into too many details - just notify them
> and get them there.

yes, and m y wife agonized for 3 1/2 hours waiting for me [it was an hour
from the time of the accident, until i got to cell range] 35 minutes to
get me off the river completely [i was pulled out to the closest bank,
where the group was, but the road was on the other side of the river] 15
minutes to my car and then 10 minutes to coverage.

> > d:  what other factors should be involved/considered
> 
>   Well, we've treated the obvious wound and checked for other problems.
> We've arranged transport and handled it until the handoff to the pros.
> We've notified next of kin.  Maybe the next thing is a group debrief - it
> depends on how tight or loose the group is - if you're all good friends you
> might find it useful and beneficial to talk it through in an _informal_ way
> - sometimes surprising details surface in the post-game analysis.  Do not
> push this issue - it's only helpful to someone who wants to deal with it.

correct. i was never able to "debrief" and don't know about the rest of
the group. i hope that some of the "attendees" will contribute also.
that's why i'm going through the exersize here, and make something very
positive come out of this...

> > e:  is this discussion usefull?
>   
>   Yes, it is.  Sometimes stuff like this seems too far-fetched and frivolous
> to even waste time on - right up until something really happens.  At that
> moment you do not want to be wondering what you should be doing - you want
> to be doing it!

well said!!

> 
> Dave Seng

the RMCC holds a "safety fair" annually, aimed to teach basic safety &
rescue techniques, usually consiting of a potluck dinner/w safety videos &
actual footage of classes taught by the club's instructors, accompanied by
lecture/Q&A session, followed the next day by a pool session. this way
folks can have a "warm water session" with throw rope practice [and folks
taking turns rescueing & being rescued]. all anyone has to pay is the
admittance to the pool... pretty cheap. we get 25-30 or so attendees, plus
10+ "instructors" works out well. that's about 5-10% of the club ...
our former president started this 5 or so years ago, and drives 4-5 hours
each way for the weekend to continue making it happen!!

mark
-- 
#-canoeist[at]dotzen[dot]org-------------------------------------------
mark zen                      o,    o__              o_/|   o_.
po box 474                   </     [\/              [__|   [__\
ft. lupton, co 80621-0474 (`-/-------/----')      (`----|-------\-')
#~~~~~~~~~~~~~~~~~~~~~~~~~~~_at_~~~~~~~_at_~~~~~~~~~~~~~~~~~~~_at_~~~~~~~~_at_~~~~~
http://www.dotzen.org/paddler     [index to club websites i administer]
---- A smooth sea never made a skillful mariner.  --  English Proverb

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