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Morning Lineup – October 21

17 comments

Yesterday’s story on the head-on crash with an ambulance (Firegeezer HERE) and a pickup truck that killed a grandfather was a sad story in its own right.  But for me it raised some questions about what was going on with the patient care.  The man’s legs were crushed beneath the dashboard, trapping him in the truck.  He was conscious and seemingly alert with no other apparent injuries, yet he died a few hours later in the hospital.  I’ve got a couple of things to ask about this, so please help me out here.

First of all, this is a classic case for using the shock-trauma pants.  They were designed for just this sort of trauma care.  Naturally, the news reports didn’t mention anything about that, and I wouldn’t really expect them to.  But the outcome of the event is exactly what happens with these things.  The inflatable trousers are ideal for stabilizing extreme leg injuries as well as serving the function of returning the patient’s blood back to his heart and brain.  Like I said, a classic case to use them.

But as I’ve said before, I haven’t peeked inside an ambulance in quite a while and I’m wondering if anybody even carries them anymore?  Have they been “disallowed” and removed from ambulances?  Have they been shoved out of the units to make room for newer devices and expanded equipment inventories?  Perhaps the shock-trauma pants are just not carried on AMR units.  If that’s the case, what a shame.  Let me know if you’re allowed to use them anymore.

The other item that started me thinking is in the newspaper story that we linked to in the posting.  They are reporting that during the extrication, the patient (Hager) pulled out his cellphone and called his family to tell them what was going on, right in the middle of the evolution.  They tell:

Vickory (a relative) said Hager called his wife while he was pinned inside the truck to tell her what had happened.

Vickory and three other family members converged at the scene and watched the rescue operation.

As half a dozen Tampa Fire Rescue workers ripped the top of the truck off and finally broke Hager free, Vickory yelled “He’s out,” and they rushed to see him, following as he was taken to the ambulance.

Welcome to the Wireless Age.  This strikes me as so strange an event.  It got me to thinking of how I would have reacted if I was doing an extrication and the victim whipped out his cellphone and started calling people.  I think my own personal reaction would have been to gently discourage his actions and insist that he not do that.  My justification would be that his fiddling with the phone is a major distraction to the life-saving activities going on around him and the need to keep him in communication with US rather than someone far away.  Priorities, you know.

But having hindsight available to us now, I suspect that some people would claim that the family benefited from the call because they got to see and talk to Gramps, giving him some final moments of pleasure before he passed away.  Knowing what you know now, what do you think you’ll do if you are faced with something similar?

We had better get this equipment checked out now.  I’ve got to get  the coffee started and then in a little while we’ll get together in the day room talk over the best action to take if our patient wants to describe his last moments to the folks back home while we’re working on him.

Posted by on October 21, 2009 • Filed under: ambulances, Fire Rescue Topics, morning lineup • Tagged: , , ,
  • J. Cook

    hey geez here in north texas in a little podunk town we have the MASS trouser pants stuffed into a corner lol at some point to be used im sure they are ready but i have been a year and a half at this station and have never seen them off the truck…the cell phone situation…probably like you said gently hint that its probably not warranted here…

  • Ralph

    The shock pants question was one I raised in 06 when retaking the EMT-B class. I was a basic in the 80`s, we used them ALL the time. My understanding is that their use has “fallen out of favor”. Most of our trucks have them. In 3 years back on the job, I have yet to see them in use. That just blew my mind since we used them on just about everything. Arrests, trauma, hip/pelvis, ect. For this fella in the crash. I`m wondering if he didn`t have an artery severed and bled out after extrication. Compartment syndrome maybe? Who knows, I feel bad for him and his family. Cell use…..man, I`m on the fence there. I`ve had drunks try to use thier cells over and over again during transport, to the point I have taken them away from pt`s. For a situation that is going to have an obvious crappy outcome for the pt, if he wants to call family while he`s trapped, I say OK. As long as it doesn`t interfear with the extrication itself.

    What`s next to fall out of favor equipment wise? KED`s? traction splints? We use the KED for far more situations than extricating a sitting pt. Pelvis/hip injuries, I LOVE the KED.

  • josephschmoe

    M – medics
    A -ain't
    S – seen
    T – them

    Haven't been used in our ounty for at least 12 years.

  • topv7051

    We still carry them on the rigs, mostly because we have the room and they were free. The use of MAST for shock has been removed from our county protocols for lack of clinical data supporting their effectiveness. We have used them like a giant air splint to stabilize pelvic fractures a few times over the years.

  • mack505

    We haven't used MAST around here in years.

    As for the cell phone, I've even had a patient try to get me to talk to her family during the extrication – http://mack505.blogspot.com/2009/08/more-danger…

  • Joe

    MAST fell out of favor after a study was done that questioned there effectiveness. The study was basically junk science done in an urban/suburban area where the time to the ER was an average of 10 minutes and ALS was everywhere. Someone should look at it again

  • steve

    I remember back in the 70s, we had a crash on the beltway in DC….during the extrication the driver kept up a running commentary on his CB radio. In the end, we physically had to take the mic out of his hand to put him on the stretcher. Dumbass.

  • Dalmatian90

    We began our ambulance service in either '89 or '90.

    At the time MAST was a device only allowed, with prior permission of medical control, to be carried by ambulances in Connecticut, not first responders so it previously wasn't an issue for us.

    Our medical director (and head of the local ER) at the time refused to grant us permission to carry them as even then he didn't believe in their value.

    Dalmatian90

  • Ralph

    Steve, Let me guess……He drove an 18? Or just a wanna be truck driver? That one goes along the line of the drunk drivers in crashes we`ve had to take the cell away from. Kept calling friends and saying “how cool it is to be in the back of an ambulance” and giving play by play on his treatment.

  • Capt. Bob

    No MAST in our County for many years now. Used to use them a lot though.

  • http://www.iaff3499.com/ Nate Q.

    Never personally used the MAST trousers. They were being written out of curriculum and protocol (Central FL) when I first started about 12 years ago, so I can't really comment on them. I do think , however, that this patient could have been a victime of reflow syndrome or compartment syndrome like someone else mentioned. MAST might not've helped if you had to get the pt. out before getting them on. I'd be curious to hear about the treatment given during the extrication, up to and including charging his cell phone for him.

  • Jim

    Not permitted here in Maine under state ems protocols. Reason i heard was the study showed no signifigant increase in blood flow to the organs. With the improvement in air and vacum splints, maybe the need for ortho use is diminished also, plus we use helicopters alot and not permitted in the choppers.

  • Tony

    MAST as already stated fell out of favor for many reasons. I believe they maybe indicated here, but for a different reason. There was a study back in the 80's that showed MAST were effective in controlling leaking Abdominal Aortic Aneurysms. This was due to reducing the circumference of the aneurysm, the other reason was the direct pressure.= to the Aorta. never saw any replicated or similar studies. ! of the problems with this theory if the bleed is above the diaphragm, MAST will speed up bleeding. This is where other diagnostic tools might be helpful like Ultrasound. But this sounds, like the typical steering wheel pressing on the aorta against the spine and tamponading the bleeding, you release the steering wheel, you open up the leaking garden hose. Only thing gonna cure this is immediate surgery. In theory the mast pants could buy time, based on my aforementioned rationale. Get Dr. Blesdoe to comment, he always has a good perspective.

  • north98

    Sounds like he may have died from crush syndrome, where the damaged muscle cells release what are essentially poisons. These poisons then get circulated when the pressure is released. If the body can't keep up, (compensate) organ failure results. I'd have encouraged him to make the phone call. To me it's part of caring rather than just treating.

  • chief603

    I am in full agreement on the need for us to return to the use of Military Anti Shock Trousers (MAST)/Pneumatic Anti Shock Garment (PASG.) It has become kind of a joke on my department during medical trainings, because my response to most questions is “Apply the MAST!” I am not sure if this case would have specifically called for them, (it is always hard to second guess,) but I am convinced I have seen them save lives. I recognize that medical science has advanced and that the contraindications today are greater than they were back 20 years ago when we used them successfully, on several occasions. Still, like “da Geezer” I see the need for them still today, particularly for fracture stabilization and at least in part for certain types of hypovolemic shock. The PHTLS book still refers to them, so why aren't we carrying/using them? I am interested in others thoughts. Am I a “Geezer” too??

  • chief603

    I am in full agreement on the need for us to return to the use of Military Anti Shock Trousers (MAST)/Pneumatic Anti Shock Garment (PASG.) It has become kind of a joke on my department during medical trainings, because my response to most questions is “Apply the MAST!” I am not sure if this case would have specifically called for them, (it is always hard to second guess,) but I am convinced I have seen them save lives. I recognize that medical science has advanced and that the contraindications today are greater than they were back 20 years ago when we used them successfully, on several occasions. Still, like “da Geezer” I see the need for them still today, particularly for fracture stabilization and at least in part for certain types of hypovolemic shock. The PHTLS book still refers to them, so why aren't we carrying/using them? I am interested in others thoughts. Am I a “Geezer” too??

  • chief603

    I am in full agreement on the need for us to return to the use of Military Anti Shock Trousers (MAST)/Pneumatic Anti Shock Garment (PASG.) It has become kind of a joke on my department during medical trainings, because my response to most questions is “Apply the MAST!” I am not sure if this case would have specifically called for them, (it is always hard to second guess,) but I am convinced I have seen them save lives. I recognize that medical science has advanced and that the contraindications today are greater than they were back 20 years ago when we used them successfully, on several occasions. Still, like “da Geezer” I see the need for them still today, particularly for fracture stabilization and at least in part for certain types of hypovolemic shock. The PHTLS book still refers to them, so why aren't we carrying/using them? I am interested in others thoughts. Am I a “Geezer” too??