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Ice Skating - What would you do?
Brufen20 Offline
#23 Posted : 17 June 2010 00:00:00(UTC)
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I agree with ambulance timinings, I was on a truck last night sent to a purple call and sat nav said 53 mins to get there, poor RRV driver had lots of time to dwell over a not too good pt.
trainer2000 Offline
#24 Posted : 17 June 2010 00:00:00(UTC)
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arealhighlander wrote:
trainer2000 wrote:
arealhighlander wrote:
"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."



BRCS Trauma Management Course? And I assume St John have an equivalent.


These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger

 

 




My reply was to your statement that you knew of no qualification that aplies to use of spinal boards, that was all.

Sorry, I should have qualified that to mean training available to the general (non VAS or Ambo) public.
trainer2000 Offline
#25 Posted : 17 June 2010 00:00:00(UTC)
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OK. There may have been a crack team of highly qualified, properly trained very well practiced and extremely competent first aiders on site who were used to using the equipment supplied.

Now all of this training, qualification and practice would have been carried out at the behest of, paid for by or at least with the knowledge of, the manager.

He didn't seem too keen to let them swing into highly trained action and use all of the expensive skills and equipment that his company had paid for.

Maybe he knew somethingWink

SeaJones Offline
#26 Posted : 17 June 2010 00:00:00(UTC)
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trainer2000 wrote:

arealhighlander wrote:
trainer2000 wrote:
arealhighlander wrote:
"On your second point I would assume no such thing. I don't know of any specific qualification that applies to use of spinal board etc."



BRCS Trauma Management Course? And I assume St John have an equivalent.


These were First aiders in the workplace, no mention was made of any VAS members on scene, and even if there were, why on earth would they want to move a suspected spinal injury that is in no immediate danger

 

 




My reply was to your statement that you knew of no qualification that aplies to use of spinal boards, that was all.

Sorry, I should have qualified that to mean training available to the general (non VAS or Ambo) public.


There's loads of that too.
mph Offline
#27 Posted : 17 June 2010 00:00:00(UTC)
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the patient will become hypothermic within minutes,  the pressure sores  you are causing by  prolonging the time on a hard service will be made far worse by the cold 
mph Offline
#28 Posted : 17 June 2010 00:00:00(UTC)
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trainer2000 wrote:
 
Sorry, I should have qualified that to mean training available to the general (non VAS or Ambo) public.


this training  is available to the public, from a variety of providers, the credibility and quality of some of the training providers may be questionable - we are in ' 5 day EMT course' territory here ... but as far as I am aware SJA course regulations  do still permit PHFM to be unbundled from the ETA course and taught seperately ...  
DRM Offline
#29 Posted : 17 June 2010 00:00:00(UTC)
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trainer2000 wrote:
I am willing to stand corrected on arrival times for the ambulance. I hadn't realised that thing were so bad.

 

Things must be bad!

 

Sounds like people are getting hypothermia and pressure sores waiting for emergency ambulances these days.LOL

 

Brufen20 wrote:
staff at risk of hypothermia, frost bites etc etc.

 

My guess is they were wearing boots, scarves, gloves, parkas, goggles, pompom hats and had all completed arctic warfare courses with Inuit trainers in the frozen north.Tongue

 

This is an urban skating rink, not the chuffin North pole. 
trainer2000 Offline
#30 Posted : 17 June 2010 00:00:00(UTC)
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mph wrote:
the patient will become hypothermic within minutes,  the pressure sores  you are causing by  prolonging the time on a hard service will be made far worse by the cold 


The patient may well get cold in (quite a few) minutes but won't get dangerously hypothermic for quite a long time.
Many variables of course. Wind chill unlikely to be a factor indoors. Not talking about immersion.
Depends on what she was wearing, most people going ice skating don't do it in swimming costumes.
Also depends on her personal insulation, was she a big girl or was she skinny.
How did you decide that she would be hypothermic in minutes without any of this information?
Then of course we have the laws of physics governing heat exchange. It just doesn't happen that fast.

Oh well, what about the pressure sores. Am I really causing pressure sores by prolonging the time on a hard surface?
Don't spinal boards have a hard surface? Can't put her on one of those then.

Back to reality. I had a very similar accident in february last year and would like to share my experience with you.
I slipped on ice and suffered a fall onto my back causing a hyperextension injury to C6. I had pain / tingling in arms and legs and my hands didn't work.
This was in a remote area in the Highlands of Scotland. It was about 15 minutes before I could move my arms enough to reach my phone and call for help. Another 40 mins before the paramedic arrived in a rapid response vehicle. He could do nothing on his own so backup was called. This arrived 35 minutes later. It then took the three of them another 15 mins to move me onto a spinal board.
At this point I had been laying on sheet ice with my head in a snow drift for an hour and a half.
Once in the ambulance it took another 2 hours to drive the 60 miles to the nearest A&E unit in Aberdeen.
Once in A&E I remained on the spinal board whilst X ray and CT scans were performed which confirmed the diagnosis of Fracture to C6
I was finall moved off the board an hour and a half after arrival.Ever spent three and a half hours on a backboard in collar and headblocks?
So after 11/2 hours laying on ice, outside in sub zero temps I was not even close to hypothermia
After 5 hours laying still on assorted hard surfaces (ice and backboard) I didn't have a sign of a pressure sore.
Now I am a fairly feeble old man in his 60s so how could this happen?
mph Offline
#31 Posted : 17 June 2010 00:00:00(UTC)
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trainer2000 wrote:

mph wrote:
the patient will become hypothermic within minutes,  the pressure sores  you are causing by  prolonging the time on a hard service will be made far worse by the cold 


The patient may well get cold in (quite a few) minutes but won't get dangerously hypothermic for quite a long time.

 on what basis do you make that satement, and what is your evidence base 

Quote:

Many variables of course. Wind chill unlikely to be a factor indoors. Not talking about immersion.
Depends on what she was wearing, most people going ice skating don't do it in swimming costumes.

an interesting assumption ,  given that a 'skating dress'  as worn by serious female skaters is leotard type garment .... 

seen  plenty of  casual skaters in leggings or tracky bottoms and a light top -even on outdoor rinks -  same as any one expending a lot of energy you do get quite warm 

Quote:

Also depends on her personal insulation, was she a big girl or was she skinny.
How did you decide that she would be hypothermic in minutes without any of this information?
Then of course we have the laws of physics governing heat exchange. It just doesn't happen that fast.

 you have Delta T between the skin  and the ice of at least 40 k  if not 50 k 

Quote:

Oh well, what about the pressure sores. Am I really causing pressure sores by prolonging the time on a hard surface?
Don't spinal boards have a hard surface? Can't put her on one of those then.

by packaging the patient you reduce the scene time for the responding ambulance and consequently the time from injury to delivery to definitive care , consequently you have 'killed two birds with one stone'  there 

Quote:

Back to reality. I had a very similar accident in february last year and would like to share my experience with you.
I slipped on ice and suffered a fall onto my back causing a hyperextension injury to C6. I had pain / tingling in arms and legs and my hands didn't work.
This was in a remote area in the Highlands of Scotland. It was about 15 minutes before I could move my arms enough to reach my phone and call for help. Another 40 mins before the paramedic arrived in a rapid response vehicle. He could do nothing on his own so backup was called. This arrived 35 minutes later. It then took the three of them another 15 mins to move me onto a spinal board.
At this point I had been laying on sheet ice with my head in a snow drift for an hour and a half.


presumably  suitable clothed to be outdoors in such conditions 

Quote:

Once in the ambulance it took another 2 hours to drive the 60 miles to the nearest A&E unit in Aberdeen.
Once in A&E I remained on the spinal board whilst X ray and CT scans were performed which confirmed the diagnosis of Fracture to C6
I was finall moved off the board an hour and a half after arrival.Ever spent three and a half hours on a backboard in collar and headblocks?

 this is unacceptably  dangerous practice and would not be tolerated in England 

Quote:

So after 11/2 hours laying on ice, outside in sub zero temps I was not even close to hypothermia

 do you have any objective documentation of that fact,  bearing in mind any  temperature recording taken at the hospital is after a substantial period of rewarming 

[quote]
After 5 hours laying still on assorted hard surfaces
trainer2000 Offline
#32 Posted : 17 June 2010 00:00:00(UTC)
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No, I just imagined all of it.No photos.

For many years I trained the rescue services in the North Sea. Hypothermia was a very important feature of the training.
Almost every one I trained had been told at some stage that if you fell in the North Sea you would be dead in a matter of minutes from hypothermia. Total nonsense, just as the idea of someone becoming hypothermic in a matter of minutes from laying on ice is total nonsense.
We will have to disagree but if you ever come across me in similar circumstances and want to load me onto a stretcher, please just walk awayWink

mph Offline
#33 Posted : 17 June 2010 00:00:00(UTC)
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trainer2000 wrote:
No, I just imagined all of it.No photos.

For many years I trained the rescue services in the North Sea. Hypothermia was a very important feature of the training.
Almost every one I trained had been told at some stage that if you fell in the North Sea you would be dead in a matter of minutes from hypothermia. Total nonsense, just as the idea of someone becoming hypothermic in a matter of minutes from laying on ice is total nonsense.
We will have to disagree but if you ever come across me in similar circumstances and want to load me onto a stretcher, please just walk awayWink



 do you normally  tell experienced specialist Registered  Nurses to go away ?

I think I've looked after enough patients with (potentially) unstable bony spinal injuries  and spinal cord injuries in the Emergency Department and on a Regional Spinal Injuries Unit , not to mention my 15 years of adult VAS service, 9 of which as Emergency Ambulance crew  including a wide variety of events including motorsport  and other high risk activities, including interestingly a being part of the cover for an outdoor ice rink in a large City, this is before considering  any of the Ambulance Support or alternatives to 999  Work ... 
DRM Offline
#34 Posted : 17 June 2010 00:00:00(UTC)
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mph wrote:
by packaging the patient

 

What a horrible way to describe a casualtys treatment.  Are you in admin?


 

mph wrote:
i presume you have a fully documented , including  clinical standard photographs , skin assessment  to evidence that statement

 

Ridiculous!

Even though T2000s brain has probably rotted to some extent through drinking copious amounts of bonded North sea rum,  he's probably still got enough cells left to tell him that he's got a pressure sore.

 

mph wrote:
do you normally  tell experienced specialist Registered  Nurses to go away ?

 

I wouldn't think that's his normal practice but he seems a good judge of characterTongue
mph Offline
#35 Posted : 17 June 2010 00:00:00(UTC)
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DRM wrote:
mph wrote:
by packaging the patient

 

What a horrible way to describe a casualtys treatment.  Are you in admin?


 

perfectly standard term among pre-hospital care Professionals 

Quote:

mph wrote:
i presume you have a fully documented , including  clinical standard photographs , skin assessment  to evidence that statement

 

Ridiculous!

Even though T2000s brain has probably rotted to some extent through drinking copious amounts of bonded North sea rum,  he's probably still got enough cells left to tell him that he's got a pressure sore.

odd then that people  routinely have grade 1 pressure sores and do not  identify this tissue damage as tissue damage,  i have seen this in clinical practice on a number of occasions




trainer2000 Offline
#36 Posted : 17 June 2010 00:00:00(UTC)
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mph wrote:

trainer2000 wrote:
No, I just imagined all of it.No photos.

For many years I trained the rescue services in the North Sea. Hypothermia was a very important feature of the training.
Almost every one I trained had been told at some stage that if you fell in the North Sea you would be dead in a matter of minutes from hypothermia. Total nonsense, just as the idea of someone becoming hypothermic in a matter of minutes from laying on ice is total nonsense.
We will have to disagree but if you ever come across me in similar circumstances and want to load me onto a stretcher, please just walk awayWink



 do you normally  tell experienced specialist Registered  Nurses to go away ?

I think I've looked after enough patients with (potentially) unstable bony spinal injuries  and spinal cord injuries in the Emergency Department and on a Regional Spinal Injuries Unit , not to mention my 15 years of adult VAS service, 9 of which as Emergency Ambulance crew  including a wide variety of events including motorsport  and other high risk activities, including interestingly a being part of the cover for an outdoor ice rink in a large City, this is before considering  any of the Ambulance Support or alternatives to 999  Work ... 


I think most people would lead a longer and happier life if they told registered nurses to go away, and I say that as a registered nurse of over 40 years experience.Wink
Most of that experience was as an occupational health nurse / offshore rig medic in the North Sea/Africa/Sahara desert/Middle East almost always single handed looking after up to 300 workers in some of the most inhospitable and dangerous environments in the world, and doing some of the most dangerous jobs in the world. This was followed by 15 years training seafarers and standby ships crews to rescue people from the water and treat their hypothermia as well as training mountain rescue teams in casualty recovery and rescue in the Scottish highlands where hypothermia is also a distinct possibility, so-if you want to get into a pi**ing contest I reckon I could get further up the wall than you.
You make bald unsupported statements like "she would be hypothermic in minutes" and then when I disagree you expect me to show photographic evidence that I didn't have a pressure sore.
I'm not actuall sure that you know what acute hypothermia is and would be interested to know how many times you have seen or treated it.

DRM Offline
#37 Posted : 17 June 2010 00:00:00(UTC)
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mph wrote:
perfectly standard term among pre-hospital care Professionals 


 

Strange. I found it was the amateurs that used that sort of tosh.

 

mph wrote:
odd then that people  routinely have grade 1 pressure sores and do not  identify this tissue damage as tissue damage

 

Maybe but T2000 is an RN. I think he'd know if he had a pressure sore or not.

 

 

trainer2000 wrote:
  I say that as a registered nurse of over 40 years experience.

 

I was sticking up for you, but now you've fessed up, you're on your ownBig smile
trainer2000 Offline
#38 Posted : 17 June 2010 00:00:00(UTC)
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I was sticking up for you, but now you've fessed up, you're on your own

I wouldn't normally have told anyone, but he started it and I just sort of got carried awayEmbarrassed
DRM Offline
#39 Posted : 17 June 2010 00:00:00(UTC)
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trainer2000 wrote:
I wouldn't normally have told anyone

 

Never mind, it was fun watching you RN girlies having a spat.Ouch

 

 
trainer2000 Offline
#40 Posted : 17 June 2010 00:00:00(UTC)
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DRM wrote:
trainer2000 wrote:
I wouldn't normally have told anyone

 

Never mind, it was fun watching you RN girlies having a spat.Ouch

 

 


Watch it, those handbags can hurtShocked
mph Offline
#41 Posted : 17 June 2010 00:00:00(UTC)
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how many times i have seen hypothermia ? - sufficient to know that it can have a rapid onset ...
trainer2000 Offline
#42 Posted : 17 June 2010 00:00:00(UTC)
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mph wrote:
how many times i have seen hypothermia ? - sufficient to know that it can have a rapid onset ...


The question was how many times have you seen and treated acute hypothermia.
Acute hypothermia, by definition, has a rapid onset, but not as rapid as you are suggesting in the circumstances under discussion.
The risk of allowing a team of first aiders to use equipment that they may well never have used in real life before on a potentially spinal injured casualty vastly outweighs any potential risk of hypothermia or pressure sores.
IMO when first aiders are faced with a potential spinal injury the rule is "do not move unless it is to save their life"
This girls life was not in danger, at least not until someone decides to move her.Wink
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