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  • How Far Are You Willing To Go

    Most of us have basic aid bags. Some advanced care bags and a few minor surgical kits. Few of us, myself included, are licensed above the RN/Paramedic level.

    How far are you willing to go in providing care, assuming aid is hours away, or days, or perhaps the system is broken in such a way seeking outside aid is impractical.

    We are going to use the Good Samaritan laws as a general boundary. What would you as a reasonably intelligent person do under dire circumstances if called upon. Give me an example of a situation and what you would be prepared to do.

    RR

    ------------------
    Got sutures? http://medtech.syrene.net/
    Tricks and treachery are the practice of fools, that don't have brains enough to be honest. - Benjamin Franklin

    I have but one person on my ignore list. Can you guess who it is?

  • #2
    Would be willing to handle anything we do in the field plus, suturing, reduction of fractures/dislocations, antibiotic administration, local blocks, etc. Anything more than just superficial surgical procedures (simple amputations, removal of a projectile from an extremety, etc) would scare the heck out of me and would be very hesitant to do those. We do concious sedation in the field so if I had access to the meds I would need that would be an easy option (and a big help in reductions). Did assist on a number of reductions and did a little suturing during my clinical rotations in the ER.
    "Stand your ground. Don't fire unless fired upon, but if they mean to have a war, let it begin here."
    Captain John Parker at Lexington Green

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    • #3
      I'll bite on this one first I guess RR. It will be reasonably difficult to formulate one's own situation and response as both can be tailored to his/her own knowledge and experience.

      As does occur in my AO, a vehicle has gone off the road in a desolate are of the mountains. Lack of guard rails has allowed the vehicle to drop 60' while bouncing off of trees and rocks only to be destroyed in the process. Getting the victim to the roadway is impossible by myself and traffic rarely comes this way. Fortunately I have my gear and tools in the truck. I would extricate the victim, assess the injuries and begin aid. Getting him/her sheltered is first job then begins the staunching of blood flow. I would go as far as tying off severe bleeders, splinting what I could that was broken and dressing as many of the more severe wounds as possible. IV fluids would be begun if the blood loss was extreme enough and oral water given if the patient is conscious and can keep it down. I would stay there as long as it took for someone to find us or until the situation grew so dire that I would be forced to attempt to get additional help on my own. This action would fall under the good samaratin laws as I did all that I felt I could in attempt to aid this person with what I had available when no other more qualified aid was available. I have aligned fractures and reset dislocations before. Sutured moderate wounds and removed impaled objects. The limits of removal would be objects imbedded or impaled in the torso or head, removal of buried shrapnel, bullets, bone fragments, and of course, the treatment of evisceration.

      ------------------
      "The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld



      [This message has been edited by deerwchr (edited 21 January 2002).]

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      • #4
        I Commit totally to any course of action deemed necessary in the particular situation. Each call......each patient is gonna be situationally dictated. Total commitment is necessary. PERIOD. As a medic it may start with your first "anatomical IV stick", that stick that you do when you can't feel a vein, but you know where one SHOULD be. Trust yourself. That's where it starts..... It progresses to your first EJ or external jugular cannulation, moves on to your first IO or intraosseous. Then your first needle and then surgical cric. Then it moves to your first mass casualty where you may have to write off one or two folks because you know they have non-survivable injuries, aganol resps. From there your commited baby, you BELIEVE in yourself. Once you have completed your assessment of the patient, you have chosen the course of action, you go for it. Pure and simple. What would I do in the situation you described? That's a simple answer. I would do anything. I would pull out all the stops. I would use every trick I ever learned or had seen. Hell, I've already done that.

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        • #5
          I'll do whatever my skill level will allow me. In a total bttwshtf situation, I'd try things that I've never done should the situation arise and it's life or death. I keep a complete med kit. HMO ? We don't need no stinking HMO. We accept only precious metals namely lead, copper and brass.
          Jag

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          • #6
            RR,

            I rekon I'll go as far as need be. I look at it this way - your patient isn't going to get any deader than he would if you just stood there and did nothing.

            Dan

            ------------------
            Go Get 'em Gear

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            • #7
              I guess my answer depends on the exact situation. If I am in a hours/days away thing then I would do anything reasonable. If I was in a TSHTF then anything I felt I was either directly trained or knew enough about I would do. Many things I have observed and read about being a paramedic aren't in my normal job descritpion but I can do. One tidbit to offer everyone is that there is a limit to "Good Samaritan" laws.I am talking about a non TSHTF time. If you regulary carry "stuff" that you aren't supposed to outside of your regular practice then you are responsible for that. I.E. you can be sued for that. The clause is called "intent to practice". It affects us all be it EMT or MD. In doing some research online for remote/expedition medicine I came across this issue in a forum for M.D.s who are away from there hospital/office/clinic. If they bring along meds/instruments then they are "intending to practice" in the eyes of the court. This puts them outside of Good Samaritan laws and many Malpractice insurance coverages. No I am not saying don't do anything,,,,,,,just think about what you are doing,what is your chance of success,do I know enough about it and does it really need to be done. My interest lies in living in Alaska and frequently traveling the very remote backcountry. This is a long ways from any help. So what should I carry and what can I do if one of my party gets hurt? I have answered that in my own mind but I feel everybody needs to know there limits to your coverage and be aware of it. As I said before this is for a non-SHTF situation. Good luck akraven

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              • #8
                Well I'm currently working on my EMT certification, so anything covered in the EMT-B (NYS/NYC EMT-D) scope of practice I'm totally willing to do. Things not covered I'm most interested in learning are intubation, more pharmacology and IV administration (also that nasty little F.A.S.T. mutha that Dan has =-) Dan I have an idea for them BTW: T shirts with the pic you took of the end of it) As for things I'm willing to do? I'll tell you when I've come to something I wasn't willing to do. I haven't heard of anything yet that I'm opposed to, but I don't know that that streak will keep up, but I don't see why it wouldn't. It's like the whole mouth to mouth (full of junkie puke) discussion in bringing out the dead (background noise to my studying last night as it was the least horrible thing on cable) what do you do. I carry a pocket mask in my backpack that goes almost everywhere with me (and have been dragging it along for excursions i normally wouldnt have it just cause it's in there.
                -bill

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                • #9
                  I've thought about this before, most specifically in the context of a tracheotomy [sp?]. In other words, you're in the woods, somebody's choking on something, can't breath, they're dying, I can't get the object out, and time has just about run out.

                  Understand, I don't have a clue if a tracheotomy would work under those circumstances, and I sure don't know how to do one. My first aid training ended when I was about 13. But the question was "how far would you go?"

                  I decided (on one of those nights when you can't sleep, and you're thinking about all kinds of weird stuff) that if it was a stranger, I probably wouldn't do one. I don't feel especially good about that, and who knows, maybe I would. But if it was my wife or kids, I'd try it in a heartbeat. The result would probably be the same, but I would have to try.

                  It's an interesting question.

                  Brad1

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                  • #10
                    In that case Brad you want to try a cricothyrotomy rather than a true trach. Much simpler and less likely to go bad.

                    Basically the notch below the Adam's Apple on men (woman have it too, just not as prominent) is not nearly so tough, not as vascular and about right for that ball point pen stem you were going to shove in there.

                    Very simplified explanation please do NOT try this on your dog OR your hunting buddy.

                    RR

                    ------------------
                    Got sutures? http://medtech.syrene.net/
                    Tricks and treachery are the practice of fools, that don't have brains enough to be honest. - Benjamin Franklin

                    I have but one person on my ignore list. Can you guess who it is?

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                    • #11
                      Weird isn't it. We can walk around with all this medical knowledge packed in our brain pans but we better not intend to use it. So, in the current universe we can give first aid but if we pack the gear to practice advanced life support, we can be sued for "intent to practice medicine". Arggghhh! Seems to me that if we don't charge the victim for our care and they survive an otherwise unsurvivable injury, whatcha got to bitch about boy. Intelligence has it's limits but stupidity knows no bounds.
                      Jag

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                      • #12
                        RR, Just to play devils advocate:

                        If you are "going to use the Good Samaritan laws as a general boundary" (assuming that the world has not gone to hell in a handbasket) and there is hope for advanced hospital care in the reasonable future(several hours), wouldn't that limit all care to BLS only as one would be (assumed off duty/independent of the system) administering personaly owned med and performing advanced techniques without medical direction?

                        With that said I completed the EMT-B course in Dec and go to take my state test tomarrow (yah yah I should be studing not hacking at the keyboard here-I'm taking a break). I have been going thru Grays Anatomy a little at a time, have all but memorized Ditch Medicine, will be taking a venipuncture course in the near future and possibily the paramedic course in the fall.

                        I would do what I felt comfortable and competent to do to keep them from dying.

                        I don't know about the rest of the country but several of the counties where I am now allow EMT-B's to start lines and intubation(combitube).

                        ------------------
                        Swamp Rat

                        A government is like fire: a handy servent, but a dangerous master.
                        George Washington


                        DEO VINDICE

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                        • #13
                          <BLOCKQUOTE>quote:</font><HR>Originally posted by murphquake:
                          Dan I have an idea for them BTW: T shirts with the pic you took of the end of it) -bill<HR></BLOCKQUOTE>


                          Bill, check out these T-shirts They make some excellent software for med personnel also. All you aspiring paramedics and docs should check 'em out.

                          Have fun!

                          Dan


                          ------------------
                          Go Get 'em Gear

                          [This message has been edited by Javahed (edited 24 January 2002).]

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                          • #14
                            <BLOCKQUOTE>quote:</font><HR>Originally posted by Swamp Rat:
                            RR, Just to play devils advocate:

                            If you are "going to use the Good Samaritan laws as a general boundary" (assuming that the world has not gone to hell in a handbasket) and there is hope for advanced hospital care in the reasonable future (several hours), wouldn't that limit all care to BLS only as one would be (assumed off duty/independent of the system) administering personaly owned med and performing advanced techniques without medical direction?
                            <HR></BLOCKQUOTE>

                            In our increasingly liabelous world this might well be the case. It also depends what state you are in, as western states tend to be more tolerant because of the distances there and a more independant attitude.

                            The question might be better looked at from the aspect that you may have some legal protection under the Good Sam statutes but not fully, especially depending on what you do for the patient. So how far are you willing to go before saying the risk to me outweighs what I perceive as benefits.

                            RR



                            ------------------
                            Got sutures? http://medtech.syrene.net/
                            Tricks and treachery are the practice of fools, that don't have brains enough to be honest. - Benjamin Franklin

                            I have but one person on my ignore list. Can you guess who it is?

                            Comment


                            • #15
                              <BLOCKQUOTE>quote:</font><HR>Originally posted by Reasonable Rascal:
                              In our increasingly liabelous world this might well be the case. It also depends what state you are in, as western states tend to be more tolerant because of the distances there and a more independant attitude.

                              The question might be better looked at from the aspect that you may have some legal protection under the Good Sam statutes but not fully, especially depending on what you do for the patient. So how far are you willing to go before saying the risk to me outweighs what I perceive as benefits.

                              RR

                              <HR></BLOCKQUOTE>

                              What you say is very true. Sounds like I need to leave Florida, here just about everyone is "out to hit the lottery" (truly sad, but soberingly true). For me and mine as well as close frinds and fellow patriots I will do whatever it takes. At a min I will have the book knowlage in my head and a refrence libirary to fall back on, as well as working on the supplies to do the deed when required.

                              For others how far I am willing to go is more difficult to predict, it would have alot to do with the way the world is at that time and the severity of there injuries. But I most certianly would not just leave them there to die as I go on my merry way.
                              ------------------
                              Swamp Rat

                              A government is like fire: a handy servent, but a dangerous master.
                              George Washington


                              DEO VINDICE

                              [This message has been edited by Swamp Rat (edited 25 January 2002).]

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