Mark writes: > ok, 8-10 of you paddle to an off shore island/ oil rig. when you return to > shore there are some mild [2-3ft?] breaking waves, and as one of your > members gets near the shore, they perl off the wave, and get "window > shaded" and impaled on their paddle [a leg injury ;-]. you are near a > road, and i'll make up whatever other "details" you need ;-) > > a: what's your first plan of action 1. Scene Safety Is the patient in a dangerous position to themselves or those who would help.. Can we get the patient away from the water w/o endagering ourselves or can the patient be treated 'in place'? 2. Patient Stability (ABC's: Airway, Breathing, Circulation) [simultaneous with the ABC's is the issue of spinal injury. since being windowshaded is an moi (mechanism of injury) for spinal, its reasonable to suspect this kind of injury - One of the very first things is to stabilize the patient and keep them from moving so they can be assesed for spinal injury after the ABC's are dealt with]. Is their Airway clear? (this can be simultaneous with a Level of Consciousness check), is Breathing compromised, is there loss of Circulation (we're assuming so, since there's an paddle shaft sticking out from their leg). Each of these has to be dealt with in turn, since loss of airway is more immediatly life threatening than blood loss. This could end up one of those cases where the panic in treating a trauma patient can blind the caregiver to other more life threatening problems. Lets say that the patient got a mouth full of water and sand, but once we get to them we focus on the paddle sticking out rather dramatically from their leg. We may stop the blood loss, but the patient asphyxiates. Immediate treatment of impalement - Is the impaled object stable? If so and removing it will cause a greater loss of blood then compress with clean bandages and elevate. If that doesn't stop the bleeding, add more bandages (and compress). My understanding of torniquets is that they are a last resort and will likely cause more damage than they help if left on for any length of time (perfusion is a wonderful thing and cutting it off will lead to damage). Possibly wrap the impaled object into a stable position. OTOH, if the object is unstable (which I think much more likely with a paddle), it will probaly come out either by the time you get there or soon after. In this case you likely have a mess on your hands (depending on the size of the object of course). Here's where having large bandages would come in handy. If no large bandages are available and if you have access to the patients gear - use *thier* gear to make bandages. [add in here, checking for shock, but I noticed David Seng gives a good description of how to evaluate and treat for shock, besides I'm not very good at remembering the levels and stages of shock myself 8] After that I'd do an injury check to see if the patient has other collateral injuries. Its easy (so I've heard 8) at this point to miss other damage because of the dramatic nature of the primary injury. Thats just the immediate concern. Other semi-immediate concerns: Patients Level of Consciousness. How Alert and Oriented are they? Do they know what just happened to them (short term memory), what day it is (medium term) or who they are (long term)? What are their vitals (Pulse, Skin Color/Temperature, Pupils, Breath/min)? Its also good to check SCM's (Sensation, Circulation, Mobility) - hold fingers from both hands, ask patient which fingers your holding. Have them grip your fingers - are both hands of equal strength? . And don't forget you're still stabilizing them in case of spinal injury. You can either try to clear them for spinal <which is a subject in and of itself> or keep them immobilized for evac. Later it would help if you got a patient history, esp for handing over to the emt/evac people or just later at the hospital (assuming you self transport). > b: how do you decide if the person is capable of continueing on, on their > own, or if someone needs to play ambulance driver Leg impale = non minor trauma = evac. Theres numerous factors that would go into evaluating a patients condition and their ability to 'continue on'. Given the scenario above, I would *not* try to get them to keep going and would be calling for outside assistance/evac. > 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 Calmly and simply. I wouldn't go into details, but I also wouldn't lie about the patients condition. > d: what other factors should be involved/considered > > e: is this discussion usefull? Only in the abstract. My EMT teachers *hated* to bring this kind of stuff up, since it was essentially a 'what if' scenario and usually had way to many other factors to consider to 'flesh it out', so to speak. My point of view is that if you get something out of it - then yes, its useful. Really what it comes down to is the same set of rules for any emergency scenario that then get applied using your own discretion. *************************************************************************** PaddleWise Paddling Mailing List - All postings copyright the author and not to be reproduced/forwarded outside PaddleWise without author's permission Submissions: PaddleWise_at_PaddleWise.net Subscriptions: PaddleWise-request_at_PaddleWise.net Website: http://www.paddlewise.net/ ***************************************************************************
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