medical scenarios

What would you do?
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Scuba
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Postby Scuba » Tue Jul 11, 2006 9:43 pm

dentedhead wrote:Excellent policy.Its true enough that most chemicals have MSDS #s and 1-800 #s plus the name so the ER can call canutec/poison control.

Dentedhead


Shouldn't you be calling them if you can? I mean....20 minute wait time - there's more than enough time to start the ball rolling....

My experience with chemical exposures they've asked what hospital and done the heads up for what's coming in before we've arrived at their door.....

Mind you - as soon as you call them and say you have a possible mass exposure....they seemed to jump a bit faster lol


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dentedhead
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Postby dentedhead » Tue Jul 11, 2006 10:43 pm

Scuba wrote:Shouldn't you be calling them if you can? I mean....20 minute wait time - there's more than enough time to start the ball rolling....

My experience with chemical exposures they've asked what hospital and done the heads up for what's coming in before we've arrived at their door.....

Mind you - as soon as you call them and say you have a possible mass exposure....they seemed to jump a bit faster lol




Not much sense in calling if you are a humble first responder.Your Tx is universal and limited,remove from area give O2 and monitor.Even at an ALS level your scope/drug list is pretty limited with what may be required for invasive Tx

I have been involved in several exposures/hazmats some which our own BillyBlazes was prolly at. I have yet to hear or experience a notification of an ER from a chemical company or agency.

I would hardly regard two kids in a tree fort a mass exposure.Be it accidental or self inflicted.

Dentedhead
Thousand a week for hide and seek on call when Im paid to be.

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Scuba
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Postby Scuba » Tue Jul 11, 2006 10:45 pm

dentedhead wrote:Not much sense in calling if you are a humble first responder.Your Tx is universal and limited,remove from area give O2 and monitor.Even at an ALS level your scope/drug list is pretty limited with what may be required for invasive Tx

I have been involved in several exposures/hazmats some which our own BillyBlazes was prolly at. I have yet to hear or experience a notification of an ER from a chemical company or agency.

I would hardly regard two kids in a tree fort a mass exposure.Be it accidental or self inflicted.

Dentedhead


I was refering to an incident I was involved in....but none the less - if you have time and are able to have the information passed on about what's showing up on their door it isn't a bad thing....needless to say if you can do something while you're waiting to help the situation to a better resolve....

ps. congrats you've heard of one now ;)
Last edited by Scuba on Tue Jul 11, 2006 10:52 pm, edited 1 time in total.


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CanuckEMT
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Postby CanuckEMT » Tue Jul 11, 2006 11:12 pm

I agree with the previous Tx's of ABC's, remove from the tree house ASAP as you need to get them to fresh air and also better to have the extrication done prior to EMS arrival and more room to manage an airway on the lawn.

The Pt who vomited, yes have suction ready and check the airway. If he is not reponsive to verbal, does he respond to pain and is he able to protect his own airway? Probably not, but prior to inserting an oral or nasal airway I would check to see if the chemical was caustic. If it was I would just open the airway via modified jaw thrust with NRB.

The same with the other Pt, the biggest thing is to manage the airway and ilicit as much information as possible from the Mother on scene and also poison control.

As far as invasive ALS procedures, it is within our scope here in Alberta to insert a nasogastric tube and evacuate the stomach contents. Of course this would be dependant on what type of chemical this was. Again being careful not to contaminate the inside of the bus, and checking with the online Doc @ the local ER prior.

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firefighter26
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Postby firefighter26 » Tue Jul 11, 2006 11:46 pm

In an ideal world it would be great if the manufacturer or poison control could fax an MSDS sheet or the treatment specs over to the ER prior to the PT arriving......

I've set this scenario up half a dozen times in my own back yard for FR practice to test new first responders....plus it gets the rest of the guys busy getting the equipment for PT removal ready (then just because I am a hard ass, they'll get toned out for a vehicle fire down the road and have to roll the engine shortly after the PTs are on the ground).... anyway, even though it is drilled into all of us to do a proper scene assessment, I would guess that 25% of the new FRs completely miss the jug of chemicals and rags in the tree fort, even though some of them will move them out of the way to work on the PT!

<I miss setting up training nights!>

Great responses from everyone so far. Remember, you are working within the scope of your training with the equipment you would normally have (even if it means you are EHS and not the FD)
"No one ever called the fire department for doing something smart"
- Unknown

"If you don't like what you see, Why don't you fight it?
If you know there's something wrong, Why don't you right it?"
- Trooper

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firefighter26
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Postby firefighter26 » Tue Jul 25, 2006 1:02 pm

NEW SCENARIO

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

You an your crew are at a grocery store picking up supplies to make your world famous firehouse chili when you hear over the PA "Code Adam, aisle 5." A few moments later a store clerk runs up to you and says, "We need your help. A little boy over in aisle 5 pulled out a can of soup from the bottom of a stack and the hole thing fell onto him."

Running over the aisle 5, you see a crowd of people clearing away cans of soup reveling a 4 year old male child, unresponsive. Your initial visual assessment finds that the child's breathing is weak and shallow and in-effective and his chest doesn't raise and lower uniformly. His skin is pale, cool, clammy and grey. He has what appears to be multiple bruising points already starting to show on the exposed skin on his arms and head.

Once again, EHS is 10 minutes. You have what you would normally respond with (equipment/manpower).

GO!
"No one ever called the fire department for doing something smart"
- Unknown

"If you don't like what you see, Why don't you fight it?
If you know there's something wrong, Why don't you right it?"
- Trooper

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colin911
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Postby colin911 » Tue Jul 25, 2006 2:30 pm

Well .... first of all, depending on the soup cans, how high and how many ... consider C-spine control ... as for the breathing, it's obvious that he probably has flail chest ... you would have to expose the chest and verify by looking for symettrical chest rise .... looks like you would have to assist with breathing (apprx. 20 breaths/min) with an oral airway, a BVM and 100% oxygen ... treat for shock, warm blanket, feet elevated .... if you had time you could tape a large bandage to the flail chest (if that's what it is). Be prepared to provide suction in case of vomitting ... find relative for medical history.
I'm running a fever and the only cure is more cowbell.

Dynamite
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Postby Dynamite » Tue Jul 25, 2006 11:58 pm

Great senarios!

Agree with colin911, just for emphasis though my first move would be get C-spine control IMMEDIATELY (after ensuring scene safety of course).

Amy

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firefighter26
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Postby firefighter26 » Wed Jul 26, 2006 8:17 pm

NEW SCENARIO

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

You and your crew are returning from a mid-day false alarm run. You are at a red light waiting for it too change. On the sidewalk, sitting at a bus bench, is an elderly female sitting slightly slumped over. As you start to pay more attention she slumps further and falls from the bench, hitting her head rather hard on the sidewalk.

When you get to her, she is unresponsive and pale.You notice only small movements when she breaths. There is a large cut on ther forehead where she hit the ground and she is bleeding heavily.

No one in the area knows her.

GO!!
"No one ever called the fire department for doing something smart"
- Unknown

"If you don't like what you see, Why don't you fight it?
If you know there's something wrong, Why don't you right it?"
- Trooper

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North_of_60
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Postby North_of_60 » Wed Jul 26, 2006 8:54 pm

Scene is safe...
"Control this is Pumper 1, witnessed an elederly female collapse at the corner of Mackenzie and Distributor Street. Patient is unresposive and pale. Alert EMS and put out a page to roll Rescue. Fire 9 in command."

I would gain C-Spine control right away. I will also assume that she is in a 3/4 prone position as she slumped forward. Once I do my primary assesment (ABC's), if I don't need to roll her supine, I won't. Wait untill a spine board is availible (EMS or Rescue) so that we only roll her once. Apply O2 at 15 lpm with a non rebreather mask. If the Primary survey doesn't indicate any interventions (AR, CPR, etc) I would continue to a secondary survey and put something to cover the gash on her forhead. Throughout both assesments, things that I am going to pay particularly be aware of are:
Medical Alert (Bracelets, neclaces, anklets, etc)
Injection marks (Insulin Dependant Diabetic possibly)
Pacemaker, Internal Defibrilator scars
Ensure good oscultation of the chest - equal breath sounds, pnumonia, etc.

Continued monitoring of the patients Airway, Breathing and Circulation. Cover in a blanket to maintain body temperature. Handoff to EMS if they arrive before Rescue. If not place patient on a spine board and continue to monitor until EMS arrives.
Handoff and clear the scene.

"Control Pumper 1, We have handed off the patient to EMS and are no longer neaded. Pumper 1 back in service and returning to the hall"
They drop the ball....We get the call

DFCSmash - "THAT, North_of_60, is the best damned response yet to this thread."


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