Over response

Capri

Response a bit OTT ?

http://www.independent.ie/irish-news/good-samaritan-let-a-young-crash-victim-take-shelter-in-his-car-which-was-then-cut-to-pieces-by-rescue-workers-35441745.html

Good Samaritan let a young crash victim take shelter in his car - which was then cut to pieces by rescue workers

I was rear ended at 5mph ( a tip basically !) yet the driver that hit me,despite video evidence that he was in fine fettle for 20mins after the accident , decided to go to hospital and then got a 5 figure compensation off PIAB/my insurance , I'm still out of pocket for repairs to my car..


Lesson - help nobody in an accident, and play the old soldier if your hit...:mad:

easygoing1982

Capri wrote: »

Response a bit OTT ?

http://www.independent.ie/irish-news/good-samaritan-let-a-young-crash-victim-take-shelter-in-his-car-which-was-then-cut-to-pieces-by-rescue-workers-35441745.html




I was rear ended at 5mph ( a tip basically !) yet the driver that hit me,despite video evidence that he was in fine fettle for 20mins after the accident , decided to go to hospital and then got a 5 figure compensation off PIAB/my insurance , I'm still out of pocket for repairs to my car..


Lesson - help nobody in an accident, and play the old soldier if your hit...:mad:

So have you ANY training or knowledge in emergency services protocol. Questioning the guards last week now the fire/ambulance service.

At no stage in the article does it say what speed she was travelling at, if she was wearing her seat belt etc. All factors for a neck injury. You've no idea what pain that girl was feeling after the adrenalin wore off

Personally I'd write off any car to a cost to myself than have a young girl paralysed for the rest of her life.

Anyway whose next week. The coastguard?

colm_mcm

The fund page has gone over €7000 now

Noddyholder

Thought if you rear end someone that your in the wrong ?
How can someone who crashed into you then claim from your insurance company?

Noddyholder

Noddyholder wrote: »

Thought if you rear end someone that your in the wrong ?
How can someone who crashed into you then claim from your insurance company?

They didn't say what they were doing before the other car hit. Eg reversing.

RiderOnTheStorm

Not OTT IMHO. Standard procedure is to remove the car from the person. Ask any fire brigade member. If the accident victim has a broken neck they sometimes don't even know it. Muscles & shock can compensate and allow them to think they are ok. Its better to be safe than sorry.

Capri wrote:

Lesson - help nobody in an accident, and play the old soldier if your hit...

Its always better to help than not. But you need to know how to help. It comes up regularly in first aid classes......You dont put a crash victim in your car for this exact reason. Even if the person is walking around after a crash, the ES may do a standing take-down, where they place a spinal board / long board at the (standing) persons back and they are lowered backwards to the ground. If the person is in the car, then the first ES there will stand at the front of the car and tell the casualty to stay looking at them while the 2nd ES gets in the car and holds the persons head. They have learned through experience that otherwise the casualty turns their head to look at whoever gets into the car. And you don't want the casualty to turn their head in case they have broken their neck.

Mycroft H

Standing takedowns aren't considered best practice any more, shouldn't really be done. As is routinely immobilising people "just in case". Risks are greater than the benefit.

Bang Bang

RiderOnTheStorm wrote: »

Not OTT IMHO. Standard procedure is to remove the car from the person. Ask any fire brigade member. If the accident victim has a broken neck they sometimes don't even know it. Muscles & shock can compensate and allow them to think they are ok. Its better to be safe than sorry.

It is not standard procedure, it is a procedure that is carried out way too often on the roads of Ireland based on poor decision making and lack of confidence.
The ability to 'rule out' a spinal injury is a skill set taught to Paramedics of which unfortunately, not enough are using this knowledge.

There is absolutely no need to cut up the vast majority of vehicles we see being torn apart by the decision of over zealous or unconfident Paramedics and Firefighters, and we are all paying for this each year in our motor insurance premiums.

Capri

Bang Bang wrote: »

It is not standard procedure, it is a procedure that is carried out way too often on the roads of Ireland based on poor decision making and lack of confidence.
The ability to 'rule out' a spinal injury is a skill set taught to Paramedics of which unfortunately, not enough are using this knowledge.

There is absolutely no need to cut up the vast majority of vehicles we see being torn apart by the decision of over zealous or unconfident Paramedics and Firefighters, and we are all paying for this each year in our motor insurance premiums.

Well said, Thanks

TallGlass

Just from another side of things, we seriously need our govemerment to put some manners on insurance companies. Why would they treat this as if he had an accident? He didn't, it's a third party liability claim. Getting seriously pissed off with insurance company they seem to get away with what ever they want.

sjb25

Bang Bang wrote: »

It is not standard procedure, it is a procedure that is carried out way too often on the roads of Ireland based on poor decision making and lack of confidence.
The ability to 'rule out' a spinal injury is a skill set taught to Paramedics of which unfortunately, not enough are using this knowledge.

There is absolutely no need to cut up the vast majority of vehicles we see being torn apart by the decision of over zealous or unconfident Paramedics and Firefighters, and we are all paying for this each year in our motor insurance premiums.

+1

Schindlers Pissed

This was total overkill to take a decision to cut up a bystanders car. She was walking around at scene.....any potential damage would be done in the milliseconds during the impact. Spinal rule out, why wasn't it done? Maybe the mechanism was there so we'll give the crew the benefit of the doubt.

If the patient was walking around at scene we can assume she was pretty stable, so why wasn't the KED used?

Cutting the car is NOT standard procedure. Neither is a standing take down. Spinal immobilisation in this country needs to be looked at, evidence based research is out there to say people move less when they extricate themselves from the vehicle.

Overkill and dogma was the cause of that car getting cut.

easygoing1982

What this post has me wondering is how many commenting here are actually ES members. For the record I'm not.

Something that you hear from most ES members is when asked what do they like about their jobs and one of the answers is no 2 calls/days are ever the same.

So to any ES member thats maybe on this thread who i would persume wasnt at the scene how does reading a news paper article make you more qualified to criticise your colleagues on scene which would consist of a minimum of 2 paramedics, 6/7 firefighters and possibly several gardai.

There's one thing I will always accept when I see blue lights at an incident is that those people are there to help any victim/patient to the best of their ability.

And capri I'd love to see your reaction if you heard your mother/father brother/sister was refused shelter in someone's car after an accident in case they cut the roof off.

Schindlers Pissed

Yep, I'm ES. Paramedic actually. What does the fact that Gardai or Fire Service being there have anything to do with it?

Do I tell the Gardai how to investigate the RTC? NO.

Do I tell firefighters how to make the scene safe? NO.

Will Gardai or firefighters tell me how to treat the casualty? NO.

easygoing1982

Schindlers Pissed wrote: »

Yep, I'm ES. Paramedic actually. What does the fact that Gardai or Fire Service being there have anything to do with it?

Do I tell the Gardai how to investigate the RTC? NO.

Do I tell firefighters how to make the scene safe? NO.

Will Gardai or firefighters tell me how to treat the casualty? NO.

So are you deliberately ignoring my main question. Were you at the scene of this incident that you knew the patients medical history ,mechanism of injury etc or are you going by a news paper article.

So are you saying when you the paramedic turn up on scene you completely ignore the other services. You don't consult with the fire service about extricating the patient from the car. They don't assist you with this process? Are you also saying the Gardai only investigate the collision and do nothing other than your words investigate the collision.

Mycroft H

easygoing1982 wrote: »

What this post has me wondering is how many commenting here are actually ES members. For the record I'm not.

Something that you hear from most ES members is when asked what do they like about their jobs and one of the answers is no 2 calls/days are ever the same.

So to any ES member thats maybe on this thread who i would persume wasnt at the scene how does reading a news paper article make you more qualified to criticise your colleagues on scene which would consist of a minimum of 2 paramedics, 6/7 firefighters and possibly several gardai.

There's one thing I will always accept when I see blue lights at an incident is that those people are there to help any victim/patient to the best of their ability.

And capri I'd love to see your reaction if you heard your mother/father brother/sister was refused shelter in someone's car after an accident in case they cut the roof off.

There's also differences in ability between paramedics; experiences, confidence or education. Some may be very up to speed on current research attending lots of CPD opportunities whilst others may just play through the motions. Some may be more risk averse than others too. Yes, there is a minimum standard but there is differences in abilities.

Spinal immobilisation is something that was ingrained into practitioners minds for many many years until it became dogma. Thankfully, evidence based practice is moving us towards selectively immobilising with better clinical tools (canadian c-spine, NEXUS etc) and better hardware; combi-boards, vac-mats. Won't be long before the hard collar is put in the bin too, evidence is mounting against it.

For what it's worth; former EMT here, training as a Paramedic in the UK.

easygoing1982 wrote: »

So are you deliberately ignoring my main question. Were you at the scene of this incident that you knew the patients medical history ,mechanism of injury etc or are you going by a news paper article.

So are you saying when you the paramedic turn up on scene you completely ignore the other services. You don't consult with the fire service about extricating the patient from the car. They don't assist you with this process? Are you also saying the Gardai only investigate the collision and do nothing other than your words investigate the collision.

Immobilisation is a clinical decision; fire, whilst input is appreciated, may not be up to speed on current practice or be trained much beyond first responder.

sjb25

Mycroft H wrote: »

There's also differences in ability between paramedics; experiences, confidence or education. Some may be very up to speed on current research attending lots of CPD opportunities whilst others may just play through the motions. Some may be more risk averse than others too. Yes, there is a minimum standard but there is differences in abilities.

Spinal immobilisation is something that was ingrained into practitioners minds for many many years until it became dogma. Thankfully, evidence based practice is moving us towards selectively immobilising with better clinical tools (canadian c-spine, NEXUS etc) and better hardware; combi-boards, vac-mats. Won't be long before the hard collar is put in the bin too, evidence is mounting against it.

For what it's worth; former EMT here, training as a Paramedic in the UK.



Immobilisation is a clinical decision; fire, whilst input is appreciated, may not be up to speed on current practice or be trained much beyond first responder.

What he said not typing it all again
As you said I wasn't on scene but a lot of other options open to paramedics seems strange to rip the roof of a car for a stable patient who had self extricated in the first place and even if the patient had become unstable that quickly dunno if I'd be waiting for a roof to be cut of as I say I wasn't there but seems strange not wrong but bit OTT on the face of it
And what it's worth also Im a paramedic

sjb25

easygoing1982 wrote: »

So are you deliberately ignoring my main question. Were you at the scene of this incident that you knew the patients medical history ,mechanism of injury etc or are you going by a news paper article.

So are you saying when you the paramedic turn up on scene you completely ignore the other services. You don't consult with the fire service about extricating the patient from the car. They don't assist you with this process? Are you also saying the Gardai only investigate the collision and do nothing other than your words investigate the collision.

You don't completely ignore anybody you work as a team but as regards clinical patient care the paramedics will have the final say on what the want the fire service will facilitate that in however the deam safe the gardais role at a collision is investigation and traffic control they will help out if asked but again it's not the role they are on scene for

Schindlers Pissed

easygoing1982 wrote: »

So are you deliberately ignoring my main question. Were you at the scene of this incident that you knew the patients medical history ,mechanism of injury etc or are you going by a news paper article.

So are you saying when you the paramedic turn up on scene you completely ignore the other services. You don't consult with the fire service about extricating the patient from the car. They don't assist you with this process? Are you also saying the Gardai only investigate the collision and do nothing other than your words investigate the collision.

Thanks to the other posters for the common sense approach.

To answer your question, of course I will consult with the fire service about how to extricate but you're missing the point......I will consult if they NEED extrication. I will request, they will do. I don't tell them how to put fires out. That's where the boundaries are, I'm a paramedic, not a firefighter. I'm not a Guard either, but yes, they investigate the collision. The have NOTHING to do with my decision making process.

As previous posters have said, this car was taken apart due to dogma, "it's the way we always did it". The spinal rule out tool isn't just an AP skill, but lots of paramedics seem to think it is. We need to move away from all this spinal thing......vast amounts of research is now out there to back up a move away from boarding everyone.

A patient that gets out of the RTC herself, is ambulatory on scene, has no neurological pathology, but gets a car cut up?

Also, to answer your question.....I wasn't on scene but I have many years experience in this field, many more years than you I suspect. But sure if you're still on your soap box, go onto twitter and look for this story.....emergency medical phycicians the world over are laughing at this.

p.s., if I was to go by the newspaper article I would also believe that a helicopter winched her out of the car. I am relying on experience and common sense.

easygoing1982

Schindlers Pissed wrote: »

Also, to answer your question.....I wasn't on scene

Thanks for finally answering my question so to me your opinion on this matter means F all.

BTW you may have mentioned your a paramedic but I've never mentioned my occupation. So please don't try and insult me with your soapbox comments

sjb25

easygoing1982 wrote: »

Thanks for finally answering my question so to me your opinion on this matter means F all.

So you only care about the opinion who was at the incident yet you come here to an open forum to ask!

Paramedic are not well shouldn't be robots as in "oh car crash I must spinal"
"To immobilise I must take the roof of"

What we are all saying is A paramedic uses clinical judgement to asses the patient to decide if the need to be immobilised which includes a spinal rule out if you think the patient does not require immobilisation
if on the other hand you decide right we will immobilise this person you have several choices to remove somebody from a car yes cutting the car apart is one but a few ways don't require the hole roof or any damage to be done to a car as you said we were not at this incident but from the history it sounds OTT to be cutting the car apart
Nobody is saying what they did was wrong the made that choice and that's fine it just sounds OTT we are just discussing it from our experience

derossi

Bang Bang wrote: »

It is not standard procedure, it is a procedure that is carried out way too often on the roads of Ireland based on poor decision making and lack of confidence.
The ability to 'rule out' a spinal injury is a skill set taught to Paramedics of which unfortunately, not enough are using this knowledge.

There is absolutely no need to cut up the vast majority of vehicles we see being torn apart by the decision of over zealous or unconfident Paramedics and Firefighters, and we are all paying for this each year in our motor insurance premiums.

The procedure you are referring to, as in roof removal. As a Firefighter maybe I can add my two cents. When you go to an RTC, both ourselves and the paramedics have a discussion and decide the best response. As you can imagine, we are there to assist yourselves but operationally we are in charge of the scene below the Gardai. So we have a responsibility in that regard. Rightly yourselves advise on what you want and if possible we deliver. We do ask I hope, do we have a bit of time?, if we do we try and provide a scenario where the casualty is removed as easily as possible.

Bearing in mind we can slipe someone out the side door no problem but we all have to take in to account their injuries and comfort. Being realistic and being present on many scenes as well as many HSE employees, the car is a wreck and is gonna be a write off anyway, our concern isn't about saving that company money but getting that person out of the car the easiest way possible. They may have many fractures as yous will advise and we will say look, lets take the roof off and take them out inline, why not. The whole spinal thing is mute because if yous say there is a spinal then lets take them out without the least movement as possible. If they have multiple fractures, in my opinion lets take them out with the least pain as possible. If that means remove the roof then why not? The airbags are gone, there is a massive dent in the car! and if we have to remove a door for example the car is gone anyway.

derossi

derossi wrote: »

The procedure you are referring to, as in roof removal. As a Firefighter maybe I can add my two cents. When you go to an RTC, both ourselves and the paramedics have a discussion and decide the best response. As you can imagine, we are there to assist yourselves but operationally we are in charge of the scene below the Gardai. So we have a responsibility in that regard. Rightly yourselves advise on what you want and if possible we deliver. We do ask I hope, do we have a bit of time?, if we do we try and provide a scenario where the casualty is removed as easily as possible.

Bearing in mind we can slipe someone out the side door no problem but we all have to take in to account their injuries and comfort. Being realistic and being present on many scenes as well as many HSE employees, the car is a wreck and is gonna be a write off anyway, our concern isn't about saving that company money but getting that person out of the car the easiest way possible. They may have many fractures as yous will advise and we will say look, lets take the roof off and take them out inline, why not. The whole spinal thing is mute because if yous say there is a spinal then lets take them out without the least movement as possible. If they have multiple fractures, in my opinion lets take them out with the least pain as possible. If that means remove the roof then why not? The airbags are gone, there is a massive dent in the car! and if we have to remove a door for example the car is gone anyway.

And just on this, fairly recently we had a person with fractures of the leg but that person was stable. We had to remove doors but because of the injury we all thought we can take them out at an angle or take them out inline. Best decision was roof off. Car was destroyed anyway.

Schindlers Pissed

I get your point derossi, I really do, and thanks for replying. But the question still remains.....was THIS call overkill?

Just because there is a phobia about immobilisation does it mean it's right? Does it mean that a person who was ambulatory on scene and sits into a car can ONLY be removed by taking apart a perfectly good car?

Dial Hard

derossi wrote:

Being realistic and being present on many scenes as well as many HSE employees, the car is a wreck and is gonna be a write off anyway, our concern isn't about saving that company money but getting that person out of the car the easiest way possible.

But she wasn't in a damaged car, she was in a bystander's absolutely untouched car???

derossi

Schindlers Pissed wrote: »

I get your point derossi, I really do, and thanks for replying. But the question still remains.....was THIS call overkill?

Just because there is a phobia about immobilisation does it mean it's right? Does it mean that a person who was ambulatory on scene and sits into a car can ONLY be removed by taking apart a perfectly good car?

Oh absolutely probably overkill, as the most recent word about spinal as you may advise better than me is different than it used to be. Fire Service should never determine a roof off, but if it is appropriate and is the best course of action (appropriate not just spinal) being then why not.

derossi

Dial Hard wrote: »

But she wasn't in a damaged car, she was in a bystander's absolutely untouched car???

I was more responding to the feeling that it is all about spinal injuries. Granted that situation seems unusual, a paramedic should be able to determine a scenario where that response is not warranted. Sometimes though, as a firefighter, even though a paramedic may say for example, we can take that person out the side, we might say, based on the injuries, give us two minutes and we will have the roof off and the extraction is much more easier on the causalty.

sjb25

Bit of light reading for those interested

http://www.emdocs.net/pre-hospital-management-of-spinal-injuries-debunking-the-myths-of-the-long-backboard/

Schindlers Pissed

I've just looked up some statistics there, I found a paper going back to 2000 in Ireland about Spinal Cord Injury. It states that in 2000 there were 46 people who suffered a spinal cord injury in Ireland. (RJ O'Connor, PC Murray, "Review of Spinal Cord Injury in Ireland").

Of those, 23 were as a result of an RTC.

Of those 23 people, only 35% were occupants of cars.

Given those numbers, there were 4.36 spinal cord injuries per 1,000,000 population from occupants of cars as a direct result of an RTC.

Given the fact that in 2000 there were 415 road deaths, and in 2016 there were 139, there were 2.98 (3) times more deaths in 2000.

The population in 2000 was 3,841,000. (415 road deaths, or 1 death for every 9,255 people).

The population in 2016 was 4,750,000. (139 road deaths, or 1 death for every 34,172 people).

So to round off the figures, it seems that there is a 3 fold DECREASE in road deaths plus an INCREASE in population of nearly 1,000,000 people so can we assume a 3 fold decrease in spinal cord injury per head of population? (and that's not even counting the extra million people). Plus then we add in the fact that cars are safer, crumple zones, better restraints, surround airbags, safety ratings etc......

So by my calculations (without all the safety factors I've mentioned), plus the fact that those numbers are fatalities in RTCs, cars, trucks, bikes, pedestrians, etc etc etc.....given all those numbers, I give a number of 1.45 spinal cord injuries per 1,000,000 of population, and that's not even a conservative number due to the extra 1,000,000 in population. Plus we need to separate all those who are only car occupants. So it's a tiny, tiny number of people who truly suffer a spinal cord injury due to an RTC.

Anyway, time for bed.

ectoraige

I don't think it's fair to second-guess the crew that were on scene and assume that NEXUS/Canadian rule-out protocols weren't followed based on that article. It was reported elsewhere that the patient was lapsing in and out of consciousness. This could mean anything really and could cover a host of reasons for her to be deemed high-risk. Low GCS alone will do it, and if she presented with any sort of neurological deficiencies or paresis the crew cannot ignore that. Note also it appears to be an assumption that she self-extricated, she could have been ejected.

Schindlers Pissed

I get ya, I'm not second guessing the crew on scene....I would go so far as to say that PERSONALLY if I was at scene I would've found some way to removing the casualty without taking a bystanders car apart. It's really that simple. I've also heard it may have been an ejection.

My previous post was for easygoing1982 who really doesn't seem to be that easy going, seeing as my opinion means "f all".

easygoing1982

Schindlers Pissed wrote: »

I get ya, I'm not second guessing the crew on scene

Sorry now but that's exactly what's going on in this thread. Granted I'm not in a position to look at who posted what now but basically this thread is about second guessing the crew and critising them with one poster more or less saying they failed to work within current CPGs

Schindlers Pissed

easygoing1982 wrote: »

Sorry now but that's exactly what's going on in this thread. Granted I'm not in a position to look at who posted what now but basically this thread is about second guessing the crew and critising them with one poster more or less saying they failed to work within current CPGs

Who said they failed to work within CPGs?? If anything they worked absolutely to the letter of the law regarding CPGs, THAT is the object of the discussion. I suggest you reconsider that opinion.

sjb25

easygoing1982 wrote: »

Sorry now but that's exactly what's going on in this thread. Granted I'm not in a position to look at who posted what now but basically this thread is about second guessing the crew and critising them with one poster more or less saying they failed to work within current CPGs

Sorry now but it's not We are discussing as practitioners all the possibilitys I've said already the paramedics at the that incident did nothing Wrong
This part of the cpg book in particular is what we are discussing in general and the wider issue of spinal immobilisation being over used

"CPGs are guidelines for best practice and are not intended as a substitute for good clinical judgment. Unusual patient presentations make it impossible to develop a CPG to match every possible clinical situation. The practitioner decides if a CPG should be applied based on patient assessment and the clinical impression. The practitioner must work in the best interest of the patient within the scope of practice for his/her clinical level on the PHECC Register. Consultation with fellow practitioners and or medical practitioners in challenging clinical situations is strongly advised."

Suppose you are taking it that we are having a go at the crew but we are not we are just saying COULD it have been done another way and possibly it could possibly it could not but nothing wrong with discussion
Like just for example I could have turned up to that accident and treated the patient a different way that does not mean I was correct and they are wrong or they are correct and I'm wrong we both could be completely correct possibly we have been going of topic a bit and that is confusing things but I think u are taking up thing wrong easy going

Schindlers Pissed

I'm a bit disappointed that "Easy Going" hasn't come back to let us know what he thinks of the latest comments.....

easygoing1982

Schindlers Pissed wrote: »

This was total overkill to take a decision to cut up a bystanders car. She was walking around at scene.....any potential damage would be done in the milliseconds during the impact. Spinal rule out, why wasn't it done? Maybe the mechanism was there so we'll give the crew the benefit of the doubt.

If the patient was walking around at scene we can assume she was pretty stable, so why

Cutting the car is NOT standard procedure.

Overkill and dogma was the cause of that car getting cut.

Mycroft H wrote: »

There's also differences in ability between paramedics; experiences, confidence or education. Some may be very up to speed on current research attending lots of CPD opportunities whilst others may just play through the motions. Some may be more risk averse than others too. Yes, there is a minimum standard but there is differences in abilities.

Spinal immobilisation is something that was ingrained into practitioners minds for many many years until it became dogma. Thankfully, evidence based practice is moving us towards selectively immobilising with better clinical tools (canadian c-spine, NEXUS etc) and better hardware; combi-boards, vac-mats. Won't be long before the hard collar is put in the bin too, evidence is mounting against

sjb25 wrote: »

As you said I wasn't on scene but a lot of other options open to paramedics seems strange to rip the roof of a car for a stable patient who had self extricated in the first place and even if the patient had become unstable that quickly dunno if I'd be waiting for a roof to be cut of as I say I wasn't there but seems strange not wrong but bit OTT on the face of it

Schindlers Pissed wrote: »

As previous posters have said, this car was taken apart due to dogma, "it's the way we always did it". The spinal rule out tool isn't just an AP skill, but lots of paramedics seem to think it is. We need to move away from all this spinal thing......vast amounts of research is now out there to back up a move away from boarding everyone.

A patient that gets out of the RTC herself, is ambulatory on scene, has no neurological pathology, but gets a car cut up?

Schindlers Pissed wrote: »

Who said they failed to work within CPGs?? If anything they worked absolutely to the letter of the law regarding CPGs, THAT is the object of the discussion. I suggest you reconsider that opinion.

I'll hold my hand up and say no one said anything about CPGS. I stand by my second guessing comment.

Schindlers Pissed wrote: »

I'm a bit disappointed that "Easy Going" hasn't come back to let us know what he thinks of the latest comments.....

I hope you got over your disappointed.