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Old 08-04-2002, 11:57 AM   #46
eap OP
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Re: Obligation to treat in SF -- Not!

Quote:
Originally posted by David Rivers

snip
The unfortunate fact, borne out by numerous medical literature, is that patients in blunt trauma arrests have less then a 0.1% SNIP

So, if I ever get hit by a truck while riding and Iím not breathing and have no pulse when you arrive, please donít do CPR on me either. Thanks.

SNIP
Good discussion - That's all well and good, but for me (after reviewing my CPR handout) and perhaps most of us - Joe Blow Biker/citizen with maybe basic CPR training, you are taught to: do a primary survey to determine if the victim is breathing, If NOT breathing, then give 2 slow breaths, and then determine if the victim has a pulse, If no pulse - begin CPR.

After that CPR is to continue until: 1) another trained person takes over CPR, 2) a more advanced medical person takes over, 3) you become exhausted and unable to continue, 4) the scene becomes unsafe, or 5) the victim's heart starts beating.


With the knowledge that CPR is less than 0.1% effective, a responder can mentally cope better with a situation where he/she attempted CPR and the victime still doesn't survive.

In many cases, the responder won't have the knowledge to determine if the victim is brain dead - Isn't that the fear? That a brain dead trauma victim could be revived by CPR? Well I guess there is < 0.1% chance... So why wouldn't one try to save a life rather than just assume it is hopelss?
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Old 08-04-2002, 03:03 PM   #47
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Ok so very few people who need CPR from trauma will survive. right..... The cause of their death will be greatly varied.
If they are head injured and need CPR there is no hope and the probable outcome would be a persistent vegetive state. If they don't have head trauma You may actually be prolonging their pain and suffering. Imagine a person with multi trauma but no head trauma. This trauma has caused their body not to be able to support itself. You come along and interrupt the coarse of their death with CPR. Blood is returned to their brain and for a short time they feel pain and are able to do nothing about it.

We know that the get up and go home rate is very low. even after a prolonged hospital stay. (please keep in mind that the survival rates for CPR are not go home and have a normal life. They are people who have a heart rate for some time on their own whether this is 1 hour or 1 day or 1 month. There is also no information about normal brain function after CPR. ) Just to make yourself feel better that you tried valiantly to help someone are you willing to cause more pain and suffering. PLEASE remember that the vast majority of times that CPR actually works the people will not return to normal function.

Do not forget that CPR is very messy victims often vomit and there is a lot of blood at these type scenes. Please protect yourself from blood born pathogens like HIV and HEP B,c


Every state has different requirements for stopping resuscitation. The rules for starting are fairly uriform. If the patients are dead on EMS arrival and some one has been there to state pulseless for 30 minutes prior to arrival. they may not start. If you have been doing CPR they will continue. It will be quite a while until activity is stopped.

One other thing, I have never seen pain meds given in a trauma code. If we are keeping the brain alive we are surely not making it comfortable. The doctors have cut open the chest of a dead person to attempt resuscitation without pain or anesthetic meds.
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Old 08-04-2002, 09:38 PM   #48
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Quote:
Originally posted by Sig
Even that probably isnt enough documentation for medical reponders in most states, not do CPR on you. I know in my area you would have to have a court document that is notorized.
when I wrote that, I was refering to someone working as a first responder / emt / etc..

I believe in most states the general public has no repsonsibility at all to initiate first aid. And if they do they are covered by "the good samaritian act" if they F* you up.

sorry for the confusion.
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Old 08-04-2002, 10:21 PM   #49
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Re: Re: Obligation to treat in SF -- Not!

Quote:
Originally posted by epfister
snip
With the knowledge that CPR is less than 0.1% effective..

... the responder won't have the knowledge to determine if the victim is brain dead - Isn't that the fear? That a brain dead trauma victim could be revived by CPR? Well I guess there is < 0.1% chance... So why wouldn't one try to save a life rather than just assume it is hopelss?
Please note: you must differentiate blunt trauma arrests from penetrating trauma arrests. A guy with no pulse, no respirations and a bullet hole in his heart *may* be saved by a rapid thoracotomy in the ER. This guy is not hopeless.

Conversely, a guy who hits a truck at 70 mph and is pulseless and breathless when you get there isnít going to make it. Period. This guy is a bag of bones. He may look very peaceful. He is very peaceful. He is dead. He is the hopeless one.

And BTW, you will not even be able to salvage his organs. The pt needs to have a pulse when he arrives in the ER for the harvest team to yank out what they need (except for eyeballs, thay last longer w/o circulation).

So go ahead and do CPR on the guy with a hole in his chest, as long as he will soon be in a trauma center.
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Old 08-05-2002, 04:39 AM   #50
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Re: Obligation to treat in SF -- Not!

Quote:
Originally posted by David Rivers


Sorry, no offence, but I'm gonna have to throw the Bull Shit flag on that one.

You, or any other citizen, have no legal obligation what so ever in the state of California to do CPR or provide any other aid to anybody whether they are dying or not.

Whether you have a moral obligation is another matter. :)):

Now, if you were *on duty* as a working EMT or paramedic and you on-viewed or were called to the scene of a patient collapse then you would have an obligation to render aid. ..
Yes Dave, you are right. I checked the "legal and ethical issues" of my EMT - A textbook, and it does stated that "While on duty, the first responder has an obligation to respond to an emergency and provide care at the scene. This oblibation is called "duty to act". This duty is governed either by case law, statute, or job description." Bla bla, bla. Thanks for the clarification. As I read the remainder of the text, is very specificaly stated that , "failure to adhear to these agreements could result in legal action." It's the old damed if you do and damed if you don't! So I guess I error on the side of providing emergency medical care and as a CSAR medic, I could have been shot (by frendly or enemy fire) so somhow the threat of civil lawyers pales in compairson.

All this was only to point out that even medical DNR ID would not necessary provide the "no action" responcibility unless I was clearly told by a supervisor or primary care taker with legal court official documentation (hospital situation, hospic etc.) not to do so. I had the unfortunate first hand experiance of this with a long-time firend who provided both me and my friend (Doctor) with court witnessed DNR under the supervision of a hospice director.

If you collaspe in front of me, I WILL try to revive you. Perriod. If, once you are revived, wish to sue me, go right a head. It would be a very humorous day in court. It just does not happen. However, it DOES happen the other way. So use your best judgement. I think we managed to get a bit away from the thread, but I hope it helps everyone understand the importance of training, and regular update certification. Without this, you could be doing the right thing, but (as statisticly pointed out earlier) in a situation where the client can not be revived, you might be the next person to "blame". So... simple problem, GET SOME TRAINING.

As for me, I consider my self "onduty" any time I am needed and am safe to engage. I have stopped for EVERY motorcycle accident (unless other preofessionals were already providing necessary aid). I would hope you would do the same for each other.

In the time you read all this.. you could have enrolled in a first aid class. Please do it. According to something I read on BMW demographics, "we" are aprox. 47-52 years old! (damm "old farts club") so statisticaly we are likely to be arround people (if not ourselves) that may need emergancy criticle care. Now add the " adventure" risk quality... oh ya. I bet I have to restock my kits from some of you guys! (Glady do so.)

One last thing, NO Doctor, EMT, Paramedic, GOD, etc. can provide assistance to a person who is competent to make a NON-Consent statement. There are specific conditions that of "expresses consent" that overrule this, so if you are some "I got to die fool", please remember to remain in a competent status so we responders can be legaly dismissed. Ya, right. I bet these will be the people screaming the loudest!

Also a person can withdraw concent from care at any time. I hope that clears up all this part of the topic.
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Old 08-05-2002, 10:25 AM   #51
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Wink Re: Obligation to treat in SF -- Not!

Quote:
Originally posted by Red Bull who is a Combat Search & Rescue Medic
Ö I error on the side of providing emergency medical care and as a CSAR medic, I could have been shot (by frendly or enemy fire) so somhow the threat of civil lawyers pales in compairson.

If you collaspe in front of me, I WILL try to revive you. Perriod...

As for me, I consider my self "onduty" any time I am needed and am safe to engage. I have stopped for EVERY motorcycle accident (unless other preofessionals were already providing necessary aid). I would hope you would do the same for each otherÖ
Mr. Bull,

My original post was just to clarify that little legal obligation thing. I wasnít trying to dis you in any way. I know several former military medics and have nothing but respect for them and those like them.

I appreciate your willingness to step into harms way to help your fellow man. Iím right there wit cha, bro. As far as you helping me if I drop in front of you, thanks for that too.

As far as the lawyer thing, my policy, whether on duty or off, is to do the right thing for the patient no matter what. IOW, be the patientís advocate no matter the law, policy, or whatever. This is my shield against lawsuits brought by assholes. It has worked for me for 11 years right here in the law suit happy Bay Area. The other important shield that medical people should use is being *Nice* To The Patient, His Family and The Bystanders. Nice people in medicine tend not to get sued even when they deserve it by being totally incompetent/negligent. Where as not-nice people get sued right and left even when they are technically competent.

I also stop when on-viewing TCs and whip out my Ricky Rescue kit if it looks like help is needed and not immediately forthcoming. With moto peeps I stop even if professional help is on scene so I may assist the moto peep with logistical concerns (like the bike/gear/communications/whatever).

Later.
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Old 08-05-2002, 10:46 AM   #52
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Good Samaritan Act

Until this last legistalive session here in VA. the GS Act did not apply to Ski Patrollers. I was reluctant to provide care any where other than the Mt. where I worked and was protected by their liability insurance. Doing so would have exposed me to serious personal liability. Since the act has been amended to cover us just as it does EMT's and the like, I have no issue provideing care.

By the way, the GS Act only provides coverage if you provide only the care that you have been trained to provide. So I won't be out there doing trach.s or stitching you guys up if you go down hard.
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Old 08-05-2002, 11:21 AM   #53
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Re: Re: Obligation to treat in SF -- Not!

Quote:
Originally posted by David Rivers

Mr. Bull,

My original post was just to clarify that little legal obligation thing. I wasnít trying to dis you in any way. I know several former military medics and have nothing but respect for them and those like them.
... Later.
Thanks Dave, et all. I did not take any personal offence (heck in this group I'd be toast of I took everthing personally.) Thanks for the positive responce. It was an important thread that may help others (non trained) understand the delema that (n. Americian) society has doen on providing aid. My father is a vetern doctor, both militaty and several years of practice, including running some very established hospitals, no longer feels compelled to stop at road-side accidents... and it is all due to these law suits. (Ironoicaly, because of his extensive medical experiance and capabilities, the areas of law suite INCREASE! :eek: )

So, I'm really glad to other trained riders would help another in need. I also hope that if even just ONE person takes first aid, than all this discussion could be worth it.

BTW- it's still a good idea to have a (current) first aid kit. Too many times I needed one, asked a Mercedes owner (who forgot they even had it with the car) and it was old and not maintained so most materials were questionable. I think I will go check my kit now, order a few soft splints (to replace the ones I used and went witht he client). Yep, It's the actions that matter, not the good intentions.

Thank you all for making the personal commitments to providing aid when needed. After all didn't we all see just how quickly our "safe" N American world can change!

See ya on the dusty trail!
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Old 08-06-2002, 05:17 PM   #54
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First aid

Good god! I've been reading this thread and seeing all the gear you guys carry and the training and such. I realize now that I'm totally unprepared. I've been carrying a fresh can of Skoal and a red bandanna for twenty years and thought that was my first aid kit! It never occured to me that I might find a biker with cardiac tampenade or a tension pneumothorax that might require a pericardial centisis on the spot. Hmmm, better call up the medical suppliers....what did I do with my scalpel?? Nurse Ratchet!
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Old 08-06-2002, 07:29 PM   #55
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Re: First aid

Quote:
Originally posted by TheBronze
SNIP...I've been carrying a fresh can of Skoal and a red bandanna for twenty years and thought that was my first aid kit! SNIP
and wellcome to the ward Dr. TheBronze.....
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Old 08-06-2002, 08:37 PM   #56
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Re: First aid

Quote:
Originally posted by TheBronze
Hmmm, better call up the medical suppliers....what did I do with my scalpel?? Nurse Ratchet!
Welcome to the Asylum, TheBronze!
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Old 08-06-2002, 11:33 PM   #57
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Eh? Jus the facts, ma'am...

Quote:
Originally posted by TheBronze, an LEO
...Hmmm, better call up the medical suppliers....what did I do with my scalpel?? Nurse Ratchet!
Hey guys, be cool, Five-O is here! :eek:
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Old 09-03-2003, 07:18 PM   #58
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Thread resurrection: doc's First Aid Kit

Okay kids, here is my Ricky Rescue Cage First Aid Kit: Iron Duck Bag


Car kit: open:


Overall view:


diagnostic: BP cuff, ears:


airway: V-Vac suction, bag valve mask (BVM), oral pharyngeal air ways (OPAs), water soluble lubricant, and nasal pharyngeal airways (NPAs). How many NPAs have you inserted?


Wound care: Trauma dressing (dsg), burn towel, non-sterile 4X4s, sterile 4X4s, triangular bandages, elastic bandage, cold pak, hypothermia blanket, Scrubb Brush (inundated with Provodone Iodine anti-infection stuff for field wound debridement, IOW road rash), hydrogen peroxide and trauma shears (these cut pennies in half, they are big-ass scissors that cut off any body covering). Medics use trauma shears to make you naked. Much easier to find injuries:


PPE (personal protective equipment): AIDS shades, latex gloves and water-less anti-cootie hand wash. Cooties are bad! Patient Info: pen and index cards, Communications: cell phone, Ring cutter: Fat finger? Cut off the ring:


In keeping with stringing you along Natchflug style I'll be posting my motorcycle first aid kit soon.
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Old 09-03-2003, 07:23 PM   #59
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I can tell you a few things I added to my kit. I fell in baja and ruined my shoulder during the trip. Now I carry the squishy freeze packs that get cold from a chemical reaction, the other is a bottle of ibuprofen. If I would have had those 2 the injury would have played out totally different.
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Old 09-03-2003, 07:26 PM   #60
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I have cold packs, as I mentioned. Vicodin kicks Motrin's ass.

doc riverz screwed with this post 09-03-2003 at 07:35 PM
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