RTE Firefighters overkill

Bang Bang · 22-09-2012 09:33PM

If you get a chance to look at the programme with the N81 RTA again then take a look at the NAS and DFB personnel in the background have a friendly chat, banter and what looks like a laugh too. Then ask them where they not concerned for the supposedly seriously injured occupants of the silver car who might be paralysed by one false move (oh the drama). If they (the crew in the background) speak the truth to you then they will inform you that the occupants of the car where out walking about after this very minor impact. Cue the cameras and all the hype and everyone is back in the car!

Dramatisation at it's very best;)

mr.dunkey · 22-09-2012 10:08PM

apc wrote: »

If I am ever in an RTC I dont want you coming near me with that attitude. A medics role is not to diagnose but to respond to symptoms. If a casualty complains of back pain it is a symptom and should be treated accordingly. Once you immobilise the head and/or put on a collar you are dealing with a suspected spinal injury.

Two medics cannot safely board a suspected spinal casualty from a car and they are foolish to try to. I have seen medics try to bend peoples necks while trying to extricate them through car door openings with the roof on.

The reason the roof is cut off is
1. It gives better and safer access to the casualty.
2. In the event of deterioration of the casualty it allows for safe rapid extrication
3. From a manual handling and health and safety point of view it is safer for the crews in attendence to extricate the casualty with roof and doors off.

Ok if you just say roll your car into a bollard and scratch it and your buddy in the back cries neck pain. Ill let the Fire service chop it up. Medics day in and out manage spinal percautions with two people, More hands would be nice but not always available.

23-09-2012 10:49AM

It's good discipline to say "Protect the spine, f*ck the car" at an RTC if there's a question. Better to do more than needed , than kill someone when you don't do enough.

I can remember a story told by an instuctor (an AP) of a woman in a car crash brought to *will not name* hospital who had been extracted correctly, but was on a gurney being prepared to go to X-ray by ER team. Father comes into the room, goes to give daughter hug....

Snap. Lifeless. Gone. Just the daughter turning to look at him was enough to do it.

C-Spine is C-Spine is C-Spine. F*ck the car. When there's such thing as a handheld tricorder X-ray machine, then you can start deciding C-spine on scene.

But till then, treat as worst until you get the X-ray.

That's why it's always "suspected simple fracture", never "simple fracture"

spatchco · 23-09-2012 11:14AM

yep have to agree with earlier comments MGM production for the camera crews,also series is running out of steam should have been narrowed down to 3-4 episodes at the most not 8 we have seen most types of fires and accidents myself am loseing interest

dfbemt · 23-09-2012 08:10PM

supermedic wrote: »

Opinion is all well and good, but PHTLS, BTLS et al. clearly state that stable patients should be managed by the use of a KED like extrication device.

Glad to see somebody mention a KED. I thought it was a dirty word in the job. Suggested it recently to an AP and he looked at me as if I had 10 heads. Young Sub also looked at me as if to say 'you oul' fellas haven't a clue' (and I'm not that old !!!)

We used to use this a lot but for some reason its use has vanished over the past 10 years or so. Progress I guess

Paulzx · 25-09-2012 09:49PM

Spoke to one of the fellas at the flooding on the program tonight.
He said the DFB blocked all the shores around the apartments, opened all the hydrants and then flooded the kip.

They then dragged members of the public off the street and forced them into the apartments. As soon as the cameras started rolling they then rescued them from the apartments.

Disgusting

civdef · 25-09-2012 10:15PM

I heard the house fire was only a chimney fire till the cameras arrived...

Medic475 · 25-09-2012 11:42PM

Paulzx wrote: »

Spoke to one of the fellas at the flooding on the program tonight.
He said the DFB blocked all the shores around the apartments, opened all the hydrants and then flooded the kip.

They then dragged members of the public off the street and forced them into the apartments. As soon as the cameras started rolling they then rescued them from the apartments.

Disgusting

No way! I don't believe that for a second!

Sterling Archer · 26-09-2012 12:20AM

Watch from 49 min on this video, gives a good explanation of why to chop off a roof, it only last about a min or so.

Link http://www.youtube.com/watch?v=1_btwD1O5Bo&feature=watch_response

supermedic · 26-09-2012 05:49AM

Video means nothing, again done for the cameras. The fact that the experienced cop is questioning this course of action speaks for itself. Less than 14% of all bony injuries of the spine affect the cord, transection is much less common. Probably less than 1% of the patients that are immobilised have a bony injury. (ref. RCSEd)
I am not saying for one second that we should not treat for the worst possible scenario, but there is a way to do it correctly. It the case in the video, again the damage to the vehicle was minimal, the speed must have been very low and therefore the extrication, if required, was routine in nature and should have been properly managed with a KED or similar device. If it was properly placed, the patient can be removed with only the same degree of movement as any other method.

26-09-2012 08:11PM

Protect the spine.

F*ck the car.

F*ck "percentages".

F*ck looking over a colleague's shoulder & whinging about how he did it.

supermedic · 26-09-2012 09:26PM

Well done SeaSlacker, intelligent, well informed and considered comments!!!

27-09-2012 06:43AM

Trolltastic supermedic, trolltastic.

What worries me is the idea that anyone responding to any RTC would keep your thoughts in mind.

There should one consideration and one consideration alone on scene.

The situation that presents itself in front of the responder.

Countless times I've been on an exercise watching two people bicker over the "right" way to extract a casualty from a rescue situation. The best answer is one I got from my rescue instructor.

"There is no right way or wrong way, as long as the end result is best for the patient."

I realise the Internet is bicker central, but I'm just annoyed that there's someone looking over a crew's shoulder having a bicker. I'm just glad the crew involved don't have to hear it.

mr.dunkey · 27-09-2012 11:05AM

Deleted User wrote: »

Protect the spine.

F*ck the car.

F*ck "percentages".

F*ck looking over a colleague's shoulder & whinging about how he did it.

What people are whinging about is a thing called triage and MOI.
Let me put it into a comparison to a different scenario.

A 30 year old rings for chest pain he will get treatment but low risk factors of MI,
A 50 yr old cardiac hx,same symptoms the crew will be more worried
Both will get an ECG and treatment but we will be more worried for the 50 yr old.
30 yr may walk out but the other will definitely get a chair.

In the hospital if any medic has brought the two of these in who will the nurse throw her eyes up in the air at?

So lf we are to be worried to the same level for every patient we would be bringing everyone into resus. A good medic can triage and make decisions and not have to have aggressive treatment every time. Identifying Low MOI in trauma etc.

Bang Bang · 27-09-2012 11:23AM

mr.dunkey wrote: »

A good medic can triage and make decisions and not have to have aggressive treatment every time. Identifying Low MOI in trauma etc.

Well put and straight to the point.

supermedic · 27-09-2012 12:37PM

It seems pretty clear SeaSlacker from your last post about being on lots of exercises and listening to your rescue instructors, that you are a member of a voluntary organisation. Along with many other posters here, I have being doing the job professionally for 25 years and have been an instructor for many of them. I agree that Mr. Dunkeys post is simple, accurate and to the point.

27-09-2012 02:45PM

What does my voluntary/professional/superhero/supervillain status have to do with anything? That's personalising the argument, playing the man not the ball.

Is the complaint about doing more than necessary? We all would love a super efficient world where the exact amount of action required is the exact amount that is done, but we don't. There are two sides we can fall on, too much done, or too little.

I can remember an old saying: "Training is learning the rules, experience is learning the exceptions". Are there exceptions? Of course there are. But the fact is here, reading this, is not where you are going to learn about them. You're going to learn them when you're out there, with the situation in front of you.

The real crux I have with online second-guessing, is someone having the training, but not the experience reading it & drawing dangerous conclusions. supermedic, I don't doubt your experience, and I'm sure you're making your decisions to the best of your professional capability. But I'm also sure there's all manner of readers from the best in the business to the brand new lads to the screwed-on-head volunteers to the mad yoke gombeen wanabees who've no business in an ambulance. It's important for the new folk not to have a debate, to have a go-to side of the "too little/much" dilemma when they have a question of what to do. The inexperienced *need* to do more than strictly necessary, because only field experience will tell them what that is.

Is low speed in a collision a contra-indicator of a spinal injury? Yep, but without proper training, it means nothing. Better to do more than needed than less than needed.

Mycroft H · 27-09-2012 03:11PM

supermedic wrote: »

It seems pretty clear SeaSlacker from your last post about being on lots of exercises and listening to your rescue instructors, that you are a member of a voluntary organisation. Along with many other posters here, I have being doing the job professionally for 25 years and have been an instructor for many of them. I agree that Mr. Dunkeys post is simple, accurate and to the point.

I really hate that attitude. The idea that because your a volly does not make you inferior to a statutory or private member. The only hierarchy there really is, is what NQEMT qualification you have. They're no less professional.

supermedic · 27-09-2012 04:40PM

I have no issue what so ever with membership of a voluntary organisation, I was a member for one for almost 15 years. I cannot however agree with the idea of there being no difference in how skilled you are regardless of who you provide care on behalf of.
A practitioner at any level is going to be more experienced and skilled when working full time with an organisation who's role it is to attend 999 emergency calls rather than being involved in a voluntary group who occasionally attend to calls.
This whole debate was about the right way to manage a low velocity, minor or no damage RTC, without resorting to destroying the car for an injury that did not exist.
I have no problem , again, with treating for the worst based on what presents at the scene, but again, experience and clinical judgement allows seasoned practitioners to make informed decisions about the most appropriate extrication.

Mycroft H · 27-09-2012 05:00PM

Who says that the pratitioner that is in a voluantary uniform that day isn't working for the HSE/DFB the other 4-5 days of the week? Almost all of the Paras and the APs would be doing so or have done in the past. Brian Power, Advanced Paramedic, who wrote the clinical practice guidlelines, is a very active member of OMAC. So it's unfair to to have the chip on the shoulder attitude that the statutory services are instantly more experienced then the voluntaries. You just don't know who is in the uniform.

EMTs are slightly different as they wouldn't be usually be on Alpha/Omega/Bravo calls, but as regards to the discussion, they wouldn't be using keds (I wouldn't be anyway).

supermedic · 27-09-2012 05:33PM

Again you have completely missed the point, the members of a voluntary group who just happen to be fulltime professional Paramedics or Advanced Paramedics are experienced, seasoned practitioners who can draw on their years of doing the job at real incidents. They bring this experience to their service with the voluntary group. To suggest that someone who is a full time member of the service is on a par with those voluntary only members is simply not correct.

Mycroft H · 27-09-2012 05:38PM

supermedic wrote: »

Again you have completely missed the point, the members of a voluntary group who just happen to be fulltime professional Paramedics or Advanced Paramedics are experienced, seasoned practitioners who can draw on their years of doing the job at real incidents. They bring this experience to their service with the voluntary group. To suggest that someone who is not a full time member of the service is on a par with those voluntary only members is simply not correct.

I never suggested that, you are. Again, you just don't know who is in the uniform.

apc · 27-09-2012 05:57PM

supermedic wrote: »

Again you have completely missed the point, the members of a voluntary group who just happen to be fulltime professional Paramedics or Advanced Paramedics are experienced, seasoned practitioners who can draw on their years of doing the job at real incidents. They bring this experience to their service with the voluntary group. To suggest that someone who is a full time member of the service is on a par with those voluntary only members is simply not correct.

But earlier you made a comparison between DFB who are full time fire service and the retained Fire service which are part time inferring the opposite.

The issue is that the Fire Service cut roofs off cars to make is safer for both casualty and crews.
You as a supermedic would obviously prefer to handle things yourself, your call ,your the supermedic.

Note the Fire service only cut the roof off the car after consulting with the normal medics as to what they require of the Fire Service. The Fire service dont not just jump in and attack the car. Unless the Fire Service you deal with are different, then you should really address it with them.

BTW what is a Supermedic?

supermedic · 27-09-2012 06:10PM

It's a name used for this site, means nothing...., whats an apc??
As stated before, this whole topic related to the apparent overkill at the scene of a minor RTC on a TV programme. It has since been stated by another poster that the "patients" were out of the car initially and then got back in. The DFB then used about 20 members of the various emergency services to remove them to a hospital where they were all released within the hour.
My point, for the last time. is the vast majority of experienced practitioners out there will use knowledge, training, experience and common sense to deal with these minor rtc's without having to resort to cutting the roof off every time. I interact with extremely professional retained fire crews on a weekly basis, where we do things appropriately, which does not include cutting the roof off everything we go to. The KED is appropriate for most minor prangs if indeed anything is needed.

mr.dunkey · 27-09-2012 06:51PM

Deleted User wrote: »

Is low speed in a collision a contra-indicator of a spinal injury? Yep, but without proper training, it means nothing. Better to do more than needed than less than needed.

If a rtc is low speed and patient,Is out walking,low MOi, no neck pain. you can consider clearing on scene. i have done a few times.
Its not all spinal boards and straps.

apc · 27-09-2012 09:00PM

supermedic wrote: »

It's a name used for this site, means nothing...., whats an apc??
As stated before, this whole topic related to the apparent overkill at the scene of a minor RTC on a TV programme. It has since been stated by another poster that the "patients" were out of the car initially and then got back in. The DFB then used about 20 members of the various emergency services to remove them to a hospital where they were all released within the hour.
My point, for the last time. is the vast majority of experienced practitioners out there will use knowledge, training, experience and common sense to deal with these minor rtc's without having to resort to cutting the roof off every time. I interact with extremely professional retained fire crews on a weekly basis, where we do things appropriately, which does not include cutting the roof off everything we go to. The KED is appropriate for most minor prangs if indeed anything is needed.

A response to an RTC by a Fulltime Fire Service is normally 10/12 minimum add an ambulance or two thats 4 crew maybe an AP 1 extra and then the Gardai 2/4 so 20 at an RTC is not that unusal.

But see you inferred that the Fire Service were cutting roofs of regardless of the mechanics of the situation. That maybe your interpretation but its wrong. My experience of the Full time services is that they liaise with the Ambulance Crew and plan accordingly. .:D

19hz · 28-09-2012 01:40AM

CharlieCroker wrote: »

Someone complains of neck/back injury, they'll immobilise them and remove anything in their way as a matter of procedure.

Car can be replaced, your spinal chord can't.

They're are 500 other ways of taking someone out of a car without cutting the roof off of every single car with ?cspine injury in it.
Esp when there is outstandingly minor damage if any to the car...
#overkillshanter

19hz · 28-09-2012 01:44AM

Muas Tenek wrote: »

Basics - take the car from the person, not the person from the car. WE are all human beings and cars are metal, plastic and glass.
You can buy a new car but can you buy a new life?

Agreed...but for real rta's, not fender benders.. I can safely bet these lads were at the bus stop outside the a&e 10mins after they got there..

19hz · 28-09-2012 02:07AM

BX 19 wrote: »

I really hate that attitude. The idea that because your a volly does not make you inferior to a statutory or private member. The only hierarchy there really is, is what NQEMT qualification you have. They're no less professional.

Ahh lets be honest...they're are plenty non professionals in the voluntaries!!!
Plenty in the stats too..

I think what he might have been hinting towards is maybe the lack of experience a voluntary might have...no fault of his own like...just not his full time job..

19hz · 28-09-2012 02:16AM

apc wrote: »

A response to an RTC by a Fulltime Fire Service is normally 10/12 minimum add an ambulance or two thats 4 crew maybe an AP 1 extra and then the Gardai 2/4 so 20 at an RTC is not that unusal.
.:D

20 people at an RTC?...stop willa...what a waste of resources and complete overkill.....waaaay too many...too many to work there man, end up with groups forming for a chat like in the video when they could be available for other calls..

law of diminishing marginal returns.. leaving cert economics...BOOM!!!

RTE Firefighters overkill

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