Femur fractures and first aid

[riddler 0]

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the possibility of litigation arising out of well-intended medical intervention.

This is not true of every state, but Colorado has "good samaritan" laws that limit your liability for trying to help. The catch is you need to be certified in whatever procedure you are doing. You only do CPR if you have a current rating (i.e. you do certifications every year). Same with basic First Aid, except the re-cert is now every three years, IIRC. I stay current in First Aid and CPR for my diving certifications, but in most cases I would defer to someone else, because it seems like every DZ has EMTs or doctors that jump.

Hint - I also try make sure I know the distance and direction to the nearest hospital for every DZ I jump at. Gives me an idea how quickly the ambulance can get there.

Trapped on the surface of a sphere. XKCD

[firediver 0]

Sorry bro, didn't mean for it to look like I was dumping on what you had said. I was just speaking in general, knowing that most people just see a kinked leg and a lot of screaming (hopefully, cuz screaming is a good thing).

Skydiving isn't scary;...but clowns...CLOWNS are scary!

[skymedic 0]

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Hint - I also try make sure I know the distance and direction to the nearest hospital for every DZ I jump at. Gives me an idea how quickly the ambulance can get there.

The majority of EMS in the united states is NOT hospital based...so just knowing where your hospital is will tell you how long it will take for them to get you there...but not how long it will take for them to get to the scene.

Marc
otherwise known as Mr.Fallinwoman....

[riddler 0]

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The majority of EMS in the united states is NOT hospital based

I live immediately next to three hospitals - literally a half-block away, and they always seem to have ambulances right there waiting to deploy. But it is in the middle of a fairly large city, so I could see how most ambulances don't come from hospitals in rural areas.

Where do they stay when not driving? From what I've seen, they pretty much camp at the Einstein Bagels/Starbucks parking lot Is there like a building that houses them somewhere, similar to a firehouse for firetrucks? And wouldn't they put them close to hospitals?

Trapped on the surface of a sphere. XKCD

[Hazarrd 1]

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Where do they stay when not driving?

Most ambulances work as a division of the fire departments i believe.

.-.

[WeakMindedFool 0]

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Where do they stay when not driving? From what I've seen, they pretty much camp at the Einstein Bagels/Starbucks parking lot Is there like a building that houses them somewhere, similar to a firehouse for firetrucks? And wouldn't they put them close to hospitals?

Like 15% of the country is covered by a privat company called American Medical Response. The 15% however constitutes 80% of the population. They have different deployment methods for different areas. Mostly they use what's called a "Fluid systems status deployment" which means the drive around and hang out at Starbucks. They are generally spread out over a geographic area to provide good coverage to everywhere. It's the best way to do it, even if us fire department people don't like it (like my 24 hour shifts...much more time off to jump). I don't know who has more of the US but I would bet it's private companies and Third agencies that have most of the Ambulances on the streets!

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
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[rigging65 0]

Actually, since most dropzones aren't located in the hustle and bustle of a city (read: They're in the middle of no-where), you're much more likely to see private ambulance companies responding to pick up our buddies than a city box.

Generally speaking, you'll get either a Volunteer Fire Dept. or a city FD rig (if you're not that far into the sticks...) as your First Responders. After that, you'll get a posted private ambulance sometime in the next 10-30 minutes.

Having gone through this whole thing once or twice (and being on the receiving end once), the best advise I can give is to get your DZO or S&TA to get in contact with whichever First Responder units will be responding to your DZ and give them the low-down of what they'll most likely be coming across (I mean the actual Station, talk with an officer on each shift). Do all this BEFORE you actually have an incident. Fire guys love knowing what they're getting into before they role, so they'll be more than happy to speak with you. Just call them, or stop buy during business hours..they won't bite, unless you ask them to.

If you get on good terms with them, you might actually be able to get info from them about when to request helicopter support...then you can pass that info along to 911 when you call it.

At our DZ, the fire station is literally right across the runway from the DZ...and we have people affiliated with both in contact on a regular basis...so when we have to call 911, the First Responders get the info they need over the dispatch to let them know if this is a helicopter worthy event or not. We're in a very fortunate situation having the FD so close...not everyone is, which makes good pre-planned communications so important.

For many skydiving incidents, a helo is put in the air during the initial dispatch, just as a precaution....those guys love to fly, and you can always turn them off. Keep in mind, it takes about 5 minutes from the time they are dispatched until they can actually lift off the pad. You can buy those 5 minutes back by having them called them early on in an incident!

We've gone so far as to have the Volunteer Dept. near our DZ come out and hold a drill each spring (right about the same time as Safety Day, usually) so that they are all re-familiarized with our landing zones, how to get to them, where the truck access points are, etc. We generally send a DZ representative to that drill to tell the Fire guys what types of injuries they can expect and where. Then the Fire guys can translate the DZ-ese into EMS-ese and then we're all speaking the same language (i.e- was the "landing injury" a "traumatic fall" or a "trip and fall"?)

Volunteer Depts. are, for the most part, hard working Depts. that are on-top-of-it, but remember this: They can have high turn over rates, and low(er) experience limits. Having them ALL refresh each year can only be a good thing for your DZ. So be pro-active and make it happen!

Good proper planning will greatly reduce the scene time, and that's what it's all about with Trauma.

"...and once you had tasted flight, you will walk the earth with your eyes turned skyward.
For there you have been, and there you long to return..."

[nacmacfeegle 0]

"you shouldn't be trying to give aid to a broken femour unless it is absolutly nessasery to move the injured (unlikly on a DZ) or if there is a large amount of blood being lost (ie their gonna die anyway unless you do something)."

I fully agree MrM2, however the last femur incident I helped at involved a swoop ditch and a low hook. The guy hit the bank and ended up in the ditch. We had to get the guy who had a compound fracture out of the water for two reasons, the water was really nasty, and I was worried about the onset of shock. So it may be more likely than you may imagine.


Now then I have a query for EMS pros who may be watching. What is the best way to get a full face helmet off someone after a hard biff / suspected back injury? Skydiving helmets tend to be a bit more snug than motorcycle full face jobs. Removing full face helmets was not part of my trauma training (Coastguards and Mountain Rescue background). Fortunately I have not had to deal with this scenario....yet.

--------------------

He who receives an idea from me, receives instruction himself without lessening mine; as he who lights his taper at mine, receives light without darkening me. Thomas Jefferson

[flighty 0]

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What is the best way to get a full face helmet off someone after a hard biff / suspected back injury?

I asked this exact question in EMT-basic class.
I am not an expert, So please correct me if nessecary. Thats why I brought this subject up in the first place.

A: Do you really, really, really need to take it off? (ie airway or lots of bleeding)

B: Maintain c-spine, have a helper hold the victim's head near the back of the jawbone.

C: Slip both hands up inside over the person's ears and push outwards and up to push the helmet off rather than pull.

D: They now make little air pumped pillow thingies that you slip in above the person's head and inflate to get a helmet off.

~Cindy~
Quantum materiae materietur marmota monax si marmota monax materiam possit materiari?
Spelling and grammar errors are left as an exercise for the reader.

[mww115 0]

As an EMT and a ER Nurse (10 years between the two) recently returned from Iraq (plenty of limb injuries there) , my $0.02...

Someone had it right before. First, cause no further injuries. If they hit hard enough to fx a femur, they laded hard enough to fx their spine. That said, if your ABCs (airway, breathing, or circulation) can not be maintained, sometimes it's necessary to move their melon, esp to get a helmet off. Some great techniques were described earlier, but it's not something you can READ. It's something that takes practice to get right, esp if you're talking cervical injury.

DZ's and medical personnel carrying traction splints open themselves wide up for litigation (preceived impropper use, NOT using it, etc). When applied it will cause pain as the two separate parts of the femur scrape against each other. With enough traction, they separate, relieving the majority of the pain. But it is the bleeding that is a concern.

Bone marrow produces RBCs, and the bone marrow of the longest and thickest bone in the body (most peoples) has been busted like R Kelly. There is excessive bleeding. If there is heavy bleeding at the site of an open fx, consider a dressing and pressure. IF THERE IS EXCESSIVE BLEEDING where you think they will die.

When I respond to these things, it's imperative to note that this is no substitute for BECOMING a EMT or RN. This isn't a block of instruction, just my two cents. The EMT course is 110- 120 hours; take one and run with the local rescue squad. It opened my eyes enough that I changed my major to Nursing (enough with the Gaylord Fauker jokes already).
And remember to always wear gloves...

Mike

Until you've stepped out at 800' in the dead of night with 100 lbs of chute and equipment.. you haven't jumped. AIRBORNE !

[Cacophony 0]

I don't really have any background in emergency situations but I feel that it would be appropriate for me to emphasize just how important it is to not move someone with a femur/back/hip injury. I smashed my femur into a bunch of pieces, cracked my pelvis in 2 places, and slammed my face into the ground last August. It certainly knocked me out. The next thing I knew my camera helmet was off as well as my rig and the top of my jump suit. However, all of that stuff wasn't removed by an EMT. It was removed by some people that had no idea what they were doing.

There needs to be some kind of stronger emphasis in skydiving towards this kind of thing. I was very lucky that I had no back injury because I feel pretty confident by everything that I was told by the people who were there, that if I did have a back injury I would certainly be paralized by how much I was moved.

On my DZ we do have several people that are either a nurse, or have professional training in medical treatment, however, in an emergency situation, sometimes people choose to take matters into their own hands rather than listen to the people that matter.

I guess what I'm getting at is that a more global training for emergency situations might prevent the untrained person from acting irrationally before anyone else gets there. People shouldn't be trained necessarily in what to do, but what not to do.

[billvon 2,991]

> What is the best way to get a full face helmet off someone after a
> hard biff / suspected back injury?

Amy went over this at the last first aid meeting we had at Otay. Basically don't unless they're not breathing. If they're not breathing, do whatever you have to to get it off. We put a cable saw in the trauma box so the chin could (potentially) be cut away while stabilizing the neck, but until someone has an old helmet they want to donate for the experiment we can't test that procedure.

[Clownburner 0]

***If you are Identified in any way as a Paramedic/Emt you have to act.

[Billy 0]

My 0.2 cents..
I think someone mentioned, twice actually, the only time you apply traction to a femur is when you know it's a closed, isolated, mid shaft break. In DZ type shit, that ain't gonna happen, and if they hit with enough force to break a femur you have to assume they broke a bunch of other shit too.. I liked that care list also, just keep it simple...

Natural Born FlyerZ.com

[WeakMindedFool 0]

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I don't know if this changed in the last few years or what, but my paramedic instructor was very clear on this point: In CA, you are only REQUIRED to act as an EMT/Paramedic if you are 1) Attached to the local EMS agency AND 2) On-Duty. If you CHOOSE to act you are limited to Basic procedures only (because of H&S code section 1797.178) and will be expected to perform according to the 'reasonable' standards of care associated with the level of certification you hold.

You are correct...up to a point. Once you become Identified as such, even after the fact, you WILL NOT be covered by good sam laws in this state. You will be covered by standard of care. What this means is that they will go find 3 like trained EMT's put them on the stand and ask what they would have done (remember, you don't get to pick the EMT's)...As long as you limit your care to BLS in it's full scope your cool. In my particular county, we can act as Paramedics. Gross negligence can be by omission or commission. If you are down there holding c-spine...you are already engaged with the patient, you will be held to your certification level. I'm not saying we should all be Ricky Rescue out there, I am saying that given the choice, if someone is in need, I will act!

Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
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