Used my firearm in an emergency scenario today

[jw34]

Your instructor was full of crap.

I'd tend to disagree. They're still teaching and instructing to not yank someone out unless there's a greater threat by leaving them where they're at.
A quick google-fo of "first aid for crash victims" or "should you move the victim of a car cash" still confirms that mindset.

Who exactly is training you to yank everyone out of their cars? Cite?
Sometimes the safest place at a crash scene is to remain seated in that safety cocoon that the engineers have been perfecting for decades.

If there's something different or new we should be doing, I'd like to know about it

[PAMedic=F|A=]

I'd tend to disagree. They're still teaching and instructing to not yank someone out unless there's a greater threat by leaving them where they're at.
A quick google-fo of "first aid for crash victims" or "should you move the victim of a car cash" still confirms that mindset.

Who exactly is training you to yank everyone out of their cars? Cite?
Sometimes the safest place at a crash scene is to remain seated in that safety cocoon that the engineers have been perfecting for decades.

If there's something different or new we should be doing, I'd like to know about it

Personally I'd say it is best to get out of a travel lane, if possible, as secondary accidents are always pretty likely, because people are awful drivers. There are lots of things we've always done or that are common sense, that are complete crap, but the masses believe are the truth. Nonsense like finger prints being unique, ballistic matching, stopping power, damage from "hydro-static shock" or someone who falls or is in a crash not being allowed to move "because it is going to make them worse". Of course, when you should get out is a judgement call, and most likely if a person had good judgement they wouldn't be debating when to get out of the cocoon of safety. In this case, the Fire Fighter on scene (OP) judge the smoke to be serious (not steam).


One of those nonsensical things is that a person can "suddenly be paralyzed" after an accident because they or someone else moved them. There is absolutely no evidence to support this, and the things EMS has always done (long spine board, c-collar, head blocks), or that the public does (letting people lay on the cold ground for however damned long it takes EMS to arrive) has actually been shown to cause physical pain, & harm, restricting the airway, causes bed sores (15 minutes is all it takes), increasing intracranial pressure, worsening injuries (putting a GSW on a backboard doubles the chance they'll die), and increasing chance of aspiration. It would be interesting to find out who has done more damage to peoples lives: LEOS with pseudo-science forensic, or medical providers with pseudo-science "medicine".


Ideally they should get their own fat butts out of the car & off the road. Ambulate Before Carry, but there is no reason to not move, or for any person to tell them not to move. IT's been years since backboarding was authorized by the protocol for anything other than an emergency carry. I won't say that some poorly trained EMS providers don't do it, in the same way that some poorly trained State Troopers disarm someone who happens to be open carrying because he was rather helpfully using his shirt as a dressing upon the rather impressively bleeding head of a motorist he had happened upon.

[jw34]

Personally I'd say it is best to get out of a travel lane, if possible, as secondary accidents are always pretty likely, because people are awful drivers. There are lots of things we've always done or that are common sense, that are complete crap, but the masses believe are the truth. Nonsense like finger prints being unique, ballistic matching, stopping power, damage from "hydro-static shock" or someone who falls or is in a crash not being allowed to move "because it is going to make them worse". Of course, when you should get out is a judgement call, and most likely if a person had good judgement they wouldn't be debating when to get out of the cocoon of safety. In this case, the Fire Fighter on scene (OP) judge the smoke to be serious (not steam).


One of those nonsensical things is that a person can "suddenly be paralyzed" after an accident because they or someone else moved them. There is absolutely no evidence to support this, and the things EMS has always done (long spine board, c-collar, head blocks), or that the public does (letting people lay on the cold ground for however damned long it takes EMS to arrive) has actually been shown to cause physical pain, & harm, restricting the airway, causes bed sores (15 minutes is all it takes), increasing intracranial pressure, worsening injuries (putting a GSW on a backboard doubles the chance they'll die), and increasing chance of aspiration. It would be interesting to find out who has done more damage to peoples lives: LEOS with pseudo-science forensic, or medical providers with pseudo-science "medicine".


Ideally they should get their own fat butts out of the car & off the road. Ambulate Before Carry, but there is no reason to not move, or for any person to tell them not to move. IT's been years since backboarding was authorized by the protocol for anything other than an emergency carry. I won't say that some poorly trained EMS providers don't do it, in the same way that some poorly trained State Troopers disarm someone who happens to be open carrying because he was rather helpfully using his shirt as a dressing upon the rather impressively bleeding head of a motorist he had happened upon.

Well, until our training reflects those new ideas, I'll still continue to do as the First Aid/CPR instructors from the Fire Co and EMS teach me each year.

Dale Earnhardt and Kenny Irwin make me think there is still cause for concern with rapid deceleration spinal injury.

[Carson]

Personally I'd say it is best to get out of a travel lane, if possible, as secondary accidents are always pretty likely, because people are awful drivers. There are lots of things we've always done or that are common sense, that are complete crap, but the masses believe are the truth. Nonsense like finger prints being unique, ballistic matching, stopping power, damage from "hydro-static shock" or someone who falls or is in a crash not being allowed to move "because it is going to make them worse". Of course, when you should get out is a judgement call, and most likely if a person had good judgement they wouldn't be debating when to get out of the cocoon of safety. In this case, the Fire Fighter on scene (OP) judge the smoke to be serious (not steam).


One of those nonsensical things is that a person can "suddenly be paralyzed" after an accident because they or someone else moved them. There is absolutely no evidence to support this, and the things EMS has always done (long spine board, c-collar, head blocks), or that the public does (letting people lay on the cold ground for however damned long it takes EMS to arrive) has actually been shown to cause physical pain, & harm, restricting the airway, causes bed sores (15 minutes is all it takes), increasing intracranial pressure, worsening injuries (putting a GSW on a backboard doubles the chance they'll die), and increasing chance of aspiration. It would be interesting to find out who has done more damage to peoples lives: LEOS with pseudo-science forensic, or medical providers with pseudo-science "medicine".


Ideally they should get their own fat butts out of the car & off the road. Ambulate Before Carry, but there is no reason to not move, or for any person to tell them not to move. IT's been years since backboarding was authorized by the protocol for anything other than an emergency carry. I won't say that some poorly trained EMS providers don't do it, in the same way that some poorly trained State Troopers disarm someone who happens to be open carrying because he was rather helpfully using his shirt as a dressing upon the rather impressively bleeding head of a motorist he had happened upon.

Last month a couple of Philly cops accidentally backed over a female who fell behind their car. They are videoed carrying her like a shot deer and putting her into the backseat and rushing her to the hospital. Would you recommend this method or suggest waiting for rescue to transport?

[RockIsland]

Indeed, an excellent tool for those with an amateur interest in geology. And if it -just happens- to get used for another purpose... how fortunate.

I have a 1 1/4" combination wrench in my car.

Good thing I'm a mechanic.

[PAMedic=F|A=]

Well, until our training reflects those new ideas, I'll still continue to do as the First Aid/CPR instructors from the Fire Co and EMS teach me each year.

Dale Earnhardt and Kenny Irwin make me think there is still cause for concern with rapid deceleration spinal injury.

You sever your spine or you don't. There isn't really an in between, and all the research shows that. It isn't a new idea, it has been out for decades, it has just been getting people to accept the facts have been hard. Your training for the last 2 or 3 years should have reflected the statewide EMS protocol that says to put a c-collar on them (at most) and have them sit (or lift them carefully to) the stretcher.

Last month a couple of Philly cops accidentally backed over a female who fell behind their car. They are videoed carrying her like a shot deer and putting her into the backseat and rushing her to the hospital. Would you recommend this method or suggest waiting for rescue to transport?

Wow that really sucks.

In most of the Commonwealth I'd say wait, or meet EMS en route. It is roughly an hour and a half by ground to a trauma center here, which means EMS interventions may actually matter or be needed (for example, no one needs a need chest decompression 5 minutes after injury). In Philly you're not really that far from several major hospitals, and until you call your dispatcher, he talks to the EMS dispatcher, the ambulance crew goes pee and gets in the truck, the PT could already be at a Trauma center, without even considering EMS travel time, which given chronic EMS staffing shortfalls, might be extended.

So as long as the cops knew "this is where bad GSWs, crashes, burns go" (I'd expect most cops do know that), and went to the right hospital they made the right call. A trauma patient needs imaging (CT/MRI/ultrasound) to determine the extent of injury & to guide treatment (medications, surgical interventions), EMS can't do that, at best we can only get you to the right location & prolong how long you can live til you get there.

The research on Philly cops transporting GSWs vs waiting on EMS shows that you're more likely to die if EMS is called. Obviously I think every cop should know how to pack a GSW, apply a chest seal (Bolins or Hyfins are best) & tourniquet, both because those skills are stupidly easy and because it could save their own life. This link has most of the data and a good analysis of the original study, for those of us who don't have pubmed accounts.


Temple is now doing a study of the topic (the previous study was retrospective).

I find temple's study concerning on several levels. 1. If Philly EMS is giving GSW/stabbing PT's IV fluids this goes against nearly 20 years of accepted practice, hell, even starting IV's on scene hasn't been acceptable since Advanced Trauma list support was published in 1978.
2. Trauma patients should still be receiving pain management (which does not require IVs).

[jw34]

You sever your spine or you don't. There isn't really an in between, and all the research shows that. It isn't a new idea, it has been out for decades, it has just been getting people to accept the facts have been hard. Your training for the last 2 or 3 years should have reflected the statewide EMS protocol that says to put a c-collar on them (at most) and have them sit (or lift them carefully to) the stretcher.

Still trying to figure out if we are agreeing or disagreeing....

Are we yanking everyone out of non-burning cars, or are we evaluating injury extent and if spinal injury is suspected, keeping them where they're at until rescue & EMS take over?

[PAMedic=F|A=]

Still trying to figure out if we are agreeing or disagreeing....

Are we yanking everyone out of non-burning cars, or are we evaluating injury extent and if spinal injury is suspected, keeping them where they're at until rescue & EMS take over?

We don't need to "yank" people out of non-dangerous situations, but there is no medical reason for them to stay in the car. A person received a spinal injury when they were shot/crashed/hit-their-head, or they did not. If they did, they'll have symptoms (say, not being able to move their legs) but you are not going to make that injury worse by moving them, unless you do something ridiculous (like dragging them by their head in a half nelson, or folding them into a yoga pose). There is zero evidence to suggest moving in any reasonable manner worsens injury. If they are did not receive a neurological injury, they're not suddenly going to get one by turning their head or walking to the other side of the guide rail.

[jw34]

We don't need to "yank" people out of non-dangerous situations, but there is no medical reason for them to stay in the car. .

So we agree then.

There is zero evidence to suggest moving in any reasonable manner worsens injury. If they are did not receive a neurological injury, .

Then why the heck are you guys still slapping c-collars on everyone?

[PAMedic=F|A=]

So we agree then.




Then why the heck are you guys still slapping c-collars on everyone?

That is a damned good question that I can't answer other than to say, although C-collars have been proven harmful, they have not been proven AS harmful as full backboards & everything else. In fact PT with collars on actually have more spinal movement. I suspect it was due to push back by people who just can't accept facts, the same people who honestly believe the world is flat & islam is peaceful, fire fighters should use smooth bore nozzles & leather helmets.

http://www.emdocs.net/cervical-colla...uma-the-facts/

This study also says C-collars should be removed, but did not consider if backboards should be used (we know they should not) and still advocated their use).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949434/

A UK Study, which again says Collars & backboards are dangerous.

http://www.ncbi.nlm.nih.gov/pubmed/24232011

And here is a study that says putting a C-collar on basically ensures you won't be able to manage a patient's airway effectively.

http://www.ncbi.nlm.nih.gov/pubmed/24906900