Improv

Scenario: Broken femur, three pitches up an ice climb. You can't reach the patient from the top. Hence, you can only bring in whatever gear you can put in your pack. No littler, no sled. 600 feet of rope and an air splint. How are you going to bring him down?

Fuck it, assess it, splint it, toss him on your shoulders, and go...

Please Thank a Military Family This Christmas

Thank The Troops...

But Thank Their Families Too

My parents have always encouraged my brother and myself to give generously to charity growing up- especially around the holidays. I've always felt lucky and a little guilty to be from a family that (through no help of my own) has always been comfortable financially.

This year, we decided to help Military families. Despite giving up years of their lives for our country our soldiers are not paid very well and many of their families are hurting. There's a great website based out of my home state which has dedicated itself to helping these families:

http://www.thankmilitaryfamilies.com/

It may be a little late for this holiday season (contact them if you're interested) but please keep this in mind for the future.

Happy Holidays!

What will save your life?

Will this save your life?
Not without this:


Or This:

If you play in the woods in the winter there is absolutely no excuse for you not to have the proper gear. In the mountains, that means an avalanche beacon, AND and probe, AND a shovel. We just pulled our first two avalanche victims of the year out. One was air flighted out, the other wasn't. Why? They don't fly dead bodies. Guess which one we got to first? Guess which one had a beacon on?

Snowshoeing
Hiking
Skiing
Snow Boarding
Snowmobiling

If there is any white stuff on the ground you need to plan accordingly:

• First and foremost get trained. Take at least a basic avalanche course or better yet a level one certification. You can find a list of providers in your area here
• Second, make sure you have the right equipment. This means a beacon, probe, shovel, and extra batteries. EVERYONE in your party should have the same. Anything else is sure idiocy
  
• Finally, use your head. Be "that guy". The one who says the conditions are too dangerous and makes everyone turn around. Testosterone is a neurotoxin- most avalanche victims claim to have had a poor impression of the conditions, but pushed ahead anyway for reasons of pride or ego. Neither one of those do you much good if you're dead.

Be safe, be smart, come home alive!

Dear Mr. Flight Nurse

Dear Mr. Flight Nurse,
I'm sorry we weren't able to hand you our last patient with an IV ready to go. I know it must have been incredibly frustrating for you too have to do it yourself in the warmth of your helicopter. You see, for some reason I didn't quite have the sensitivity in my fingers to get it right. Oh yeah, that's right, because it was 25 degrees. That's maybe why the patient's skin was f-ing freezing, complicating matters.
We had the patient packaged well and he was alive, give us some credit. Yes, you got a helicopter ride to the top, I busted my ass for 2000 vertical feet. I'm sure all that turbulence was rough- I hope the barf bag treated you well.

Your's in this fine world of medicine,
Me

Link Love

How about a pre-Thanksgiving post for some of the blogs I enjoy:

1. Congrats to EE on a new kid! I hope he's as stubborn, hard headed, and smart as you are!
2. Sam moved her blog to wordpress, if you haven't read her writings before they're well worth it.
3. Receiving is one of my favorite blogs, they're Quizzes give me some hope for the future (I'm soooo much better at them than Ochem- but hey, an A in Ochem means you'll be a good doctor right?)
4. Does anyone know what happened to PJ country?
5. OMG doesn't seem to be looking forward to trauma surg... I hope it goes well. My experiences with the trauma surgeons has been a total dicotomy. They're either going for motorcycle rides with me and super nice, or complete pricks who need a cranial-anal disimpaction.
   

A Probie's First Callout- Part 3

"Hi, my name is Jason, I'm an EMT with ________ county search and rescue, what hurts?"

"My leg.... where's the helicopter?"

"Dude (yes, I called a patient dude...oops), there's no helicopter tonight, we're carrying you out."

"Oh shit"


I've certainly done better assessments in the past than I did that night. With my right foot and ass hanging off a 15 foot drop, the wind kicking up, and the excitement of my first night on the mountain I was scattered during my initial assessment.

'Shit, do I check his leg out first or give him a head to toe, what about vitals, god damnit- stop moving your head, how am I going to do all of this without exposing him to the elements?'

Kenny damn near smacked me up the head and I got my shit together in about 20 seconds. Talking= ABCs, a quick head to toe revealed no abnormalities except his ankle, and Kenny started on some vitals.

The kid's ankle was bad. Not quite bone sticking out of the skin bad, but bad enough that I lost a pedal pulse in his foot as it swelled to the size of a nalgene bottle. We splinted it and hoped for the best. I know EE hates them, but I love SAM splints, especially in situations like this. One posterior and plantar on the foot, the other medial and lateral under the heel and both shaped as best as possible around the foot/crus made for a fine splint with the requisite duct tape. I put my spare socks on the patient (they are XXL just to fit over a splint) and we wrapped him back up in the survival sack.

At this point, we had a dilema. Everything was in place for a potential spine injury that couldn't be cleared via the NEXUS criteria- MOI, intoxication, and a distracting injury. But, we had no C-collars, no KED, and no Bean Bag. We packed the patient's head into the litter with his boots, our first aid kits and a jacket, put a helmet on him, and I taped it all in. Was it perfect? No... but it worked. I've already placed both an adult and peds C-Collar in my pack...

Skip forward 10 hours and 25 assisted belays later. The eight of us were black and blue from tripping down scree and being torn off the litter team by scrub. Backs were strained, eyes were scratched, hands were bleeding, and everyone was hungry. I have no doubt that this is what 90% of resuces are all about- and I loved it.

I had taken to 5min catnaps while the next belay was being set up. I have a wonderfull talent (wonderfull for EMS at least) in which I can fall asleep anywhere, anytime. The patient was quiet, cooperative, and docile even as we were cussing at the trail and struggling to lift him over downed trees and stumps.

We loaded him into the ambulance at 7:30am the next morning as the sun was coming over the peaks behind us. I gave the bullet to the medic (who looked far to warm, comforatable, and well rested having slept in our command post all night) and we all hid from the TV cameras.

After the debriefing I ate $16.32 worth of food at a breakfast diner and collapsed onto my girlfriend's couch (which may still stink because of it). It was, without a doubt, everything I had expected a mountain rescue to be, and I loved it.

I don't want anyone to get hurt in the hills... but I like knowing that if they do we'll be there, again, to get them out.

A Probie's First Callout- Part 2

"Jason, you have your pack ready?"
"Yes maam"
"Good, follow Kenny, you're chief medical, don't fuck up"

You
Have
Got
to be
Kidding
Me

That was, word for word, what went through my head. I shoved the trauma kit and an extra pig rig into my pack as it was thrown at me (memo to self, bring a bigger pack next time), an extra liter of water, and resisted the urge to piss and vomit.

We started up the "trail" in two teams that quickly caught each other. Trail is really a loose term for a deer path up some quasi scree. After a wrong turn, Kenny and I found ourselves at the front of the group and were able to stretch our legs out a little.

I would like to digress for a second into one of the reasons I really liked this rescue (and hopefully rescues in the future). I've always had an aptitude for endurance sports. I was an elite cyclist, I ran in high school, I've always been able to hump the heavy pack really fast for a long time. This was, however, the first time that it actually meant something. Whatever genetics I was born with or hard work I've put into my heart, legs, and lungs finally was able to do something other than just cross a white line in the middle of nowhere....

Because there was no helicopter in the air it was hard for us to know exactly where our patient (victim?) was. We had a general idea from the team members in the helicopter who had dropped a survival bag to him but the perspective from the air and from the ground are vastly different. The survival bag contained glow sticks but they were all but worthless in the deep scrub oak we were fighting.

Kenny and I found ourselves in deeper vegetation and on a steep side hill fighting the branches that obstructed our way, and periodically yelling but never getting a response. In the 45min it took us to hike the 1800 vertical feet in there were a lot of thoughts in my head. Was our patient still conscious? Still alive? Are we in the right draw? Did we pass him? I had no frame of reference with which to base anything on and we kept pushing.

Bright yellow green is not a color that belongs in the woods, but visualizing the glow sticks from the survival bag made my bag feel lighter and upped our pace. Kenny had not been able to find them but trusted me and we plowed oh so ungracefully through the woods towards it, cliffing ourselves out twice, and finally descending to the patient.

I approached from the uphill side and the patient's head- usually not a good idea (I don't want to startle him nor make him crane his neck) but dictated by the terrain. He looked good, in the survival bag and yelling at us. I could see about 25feet of scree that had been disrupted when he fell- the MOI for a spinal compromise was certainly there.

"Hi, my name is Jason, I'm an EMT with ________ county search and rescue, what hurts?"

"My leg.... where's the helicopter?"

"Dude (yes, I called a patient dude...oops), there's no helicopter tonight, we're carrying you out."

"Oh shit"

Oh shit is right....