Accident, please give me some feedback

[severou]

I wanted to post it here, maybe I can get some feedback as to what to do next time and was the patrol doing their job..

Yesterday skiing at Hakuba Tsugaike. Morning frost turned upper part into ice. Was me and wife. When making some turns down intermediate run, I notice a guy across slope sliding down head first, body limp. I manage to make my way under him and stop him. He is face down, not moving at all. I never took first aid.. but I think I got roll him over make sure he can breeze. I manage to dig front of my boots in so we both don’t slide. Turn him over, he is completely out, blood all over the face and mouth. Eye open but not moving. I try talk to him, and decided to take his helmet off, make sure strap is not stopping him from breathing(does this make sense?)

After a bit, he is starting to wake up. When I was a teenager I used to do Taekwondo and Judo so I seen people wake up from KOs and chokes. He looked completely out of it. I basically try to stop him from standing up and falling down rest of the slope. Snowboarder shows up, I tell her to find number of the patrol and call them. His friends show up, he and them are probably in their 60s-70s. None speak any English(all Japanese) my Japanese is pretty bad especially with adrenaline flowing, they are being utterly useless. Basically I try to make him understand he been knocked out cold and he needs to sit and wait for Patrol. My wife(who is Japanese, gets to us finally, she is not that comfortable on that slope when it is frozen). She start translating a bit but the guy is not listening, trying to standup etc.

I could restrain him, but I am not sure we would both not just slide down. So I try to just support him and etc. (what to do in this situation?)

After some time and a lot of gesturing screaming etc from me and translating from wife trying to get the guy to stay put. Patrol shows up, one woman. I try to convey to her that the guy been KOed cold for a good 2-3 minutes. After wife manages to get that information to her, and we see that nothing else we can do(his friends are there, they are all being useless and just saying everything is OK). We leave. We alter see patroller ski down herself and him and his friends skiing down themselves. What the actual fuck? Have you had situation like that am I overreacting

 

[Andy Mink]

You can only do what you can do. You did that.

 

[François Pugh]

Injured party is within his rights to refuse treatment.
You can lead a horse to water, but you can't make him drink.
It sounds like you did the best you could.

 

[scott43]

I personally wouldn't have taken his helmet off if he was unconscious but breathing..but..otherwise, what can you do? He may have had a severe head injury and should be checked out but is that your job or patrol's job? All you can do is advise strongly.

 

[François Pugh]

I personally wouldn't have taken his helmet off if he was unconscious but breathing..but..otherwise, what can you do? He may have had a severe head injury and should be checked out but is that your job or patrol's job? All you can do is advise strongly.

Yes, next time avoid all movement of head/neck, unless he is not breathing (breathing comes first), so as not to agravate a cervical spine injury.

 

[stan51]

I would have been cautious about rolling him onto his back, too, for fear that he had a spinal injury. Stopping him from sliding downhill, yes, moving him more than that, probably not, unless its was clear that he was not breathing, in which case opening his airway and keeping him from dying is more important than worrying about exacerbating a spinal injury.

Once he regained consciousness and coherence, he would have the right to refuse further care (at least in the States) if that were his choice. Sounds like that is what happened.

 

[severou]

If he is face down how I can make sure he is breathing? Is there a good resource to read about what bystander should do that is specific to ski accidents. Removing helmet was a bad idea, my mistake, perhaps seeing all the blood and guy being out of it I felt I need to do something, that was stupid of me. Thank you everyone

I am gona take a first aid course, don't know why I never done that before.

 

[Andy Mink]

I am gona take a first aid course, don't know why I never done that before.

Some community colleges offer classes and maybe Red Cross. Definitely a good idea since you never know when you may need it. I've done CPR, splinted broken limbs, stopped bleeding (usually my own), and lots of minor things. Best first aid I ever got? Boy Scouts.

 

[James]

People walk out of er's all the time refusing treatment. I have a friend who's walked out many times against all doctor's wishes. One time a doc in nyc offered to drive him home if he stayed the night. Nope.

Unless he's groggy and about to walk off a cliff, or belligerent and a threat, I don't think you have any foundation to restrain him. At least in the US. But, I have no knowledge of the legalities.

Afaik, if you start cpr you have to continue it until relieved by someone with more medical training or a doctor declares them dead.

 

[Pat AKA mustski]

Afaik, if you start cpr you have to continue it until relieved by someone with more medical training or a doctor declares them dead.

Yes, in the US, this is the law.

 

[Doug Briggs]

I'd say you did everything as best as you knew how. The helmet and rolling over are things you have to consider carefully whether to do or not but you did what you thought was right and necessary.

Concussions are tricky to deal with because the victim's reasoning is usually diminished, often quite considerably from the concussion. It's a catch-22 as they think they are ok because the concussion impairs their reasoning yet they are actually (possibly) quite severely injured. There is a reason coaches are required to undergo concussion training. It is not always obvious (not so in this case) and what appears to be minor may develop serious repurcussions later.

Know, from my POV, that you did what you could and it was the right, compassionate thing to do. I've had a few concussions, two quite serious, and I'd have been happy (eventually) for the assistance you offered this stranger although not necessarily in the moment.

 

[RuleMiHa]

If a physician touches someone who is refusing treatment it is assault (even if they've previously signed formal consents for treatment). Adults can make decisions about what treatments they receive and people often make bone headed decisions. There isn't much that can be done without legal intervention.

Airway/Breathing are more important than cervical spine protection but you can cause more damage by moving someone, so there is no easy answer. Because if his airway was obstructed and he died, exascerbation of a spinal injury would be irrelevant.

In the US you are protected by good Samaritan laws if your care was reasonable, so if you do the best you can with the intention aiding, that's OK. In this case the fact he could ski away is probably a good sign.

 

[François Pugh]

Canadian c-spine rules
https://www.researchgate.net/figure...-alert-Glasgow-Coma-Scale-score_fig1_49801806
BTW should I crash and require assistance from Ski patrol, I'm 39 years old.

 

[kayco53]

If we have a patient that refuses help we have a paper we try to get them to sign that says that they refused. We need to ask permission to help. We would also follow the person down to make sure they are ok. Sometimes they rethink it. Breathing you could listen for, as well you can put your hand on them to feel for breathing like you would for counting breaths. If they are breathing you would get more people and roll them on a spine board. If they aren't the patroller would just need to roll them over and try to get them breathing as you have very little time. You would still roll them carefully. Airway and breathing are number one. There is a way of removing the helmet for patients with spine problems but it is best done with two people and needs to be done before you can put a collar on them.

 

[dbostedo]

Yes, in the US, this is the law.

I find that hard to believe. Since you're not required, legally, to start, I can't imagine that once you do it's illegal to stop.

 

[Pat AKA mustski]

I find that hard to believe. Since you're not required, legally, to start, I can't imagine that once you do it's illegal to stop.

Truth. Liability begins because you started. As far as I know this is explained in every basic CPR class. In EMT training, we are taught not to start unless prepared to continue...this is only a choice as a civilian. In other words, I pull over in a car accident situation. DO NOT start and then stop because you are liable unless you are a physician and can call it.

 

[dbostedo]

Truth. Liability begins because you started. As far as I know this is explained in every basic CPR class. In EMT training, we are taught not to start unless prepared to continue...this is only a choice as a civilian. In other words, I pull over in a car accident situation. DO NOT start and then stop because you are liable unless you are a physician and can call it.

Perhaps that's because you are trained. In some states that changes the rules, and in some states requires you to help.

Again, I can't imagine that if I, as an untrained person, started CPR, and say, broke some ribs or got confused and decided it would be better to stop, I would be committing a crime.

I tried to look up relevant laws, but I can't seem to find anything.

 

[Beartown]

Truth. Liability begins because you started. As far as I know this is explained in every basic CPR class. In EMT training, we are taught not to start unless prepared to continue...this is only a choice as a civilian. In other words, I pull over in a car accident situation. DO NOT start and then stop because you are liable unless you are a physician and can call it.

I don't know how much CPR you all do, but this is pretty ridiculous. I did some this afternoon and I'm good for 2-3 minutes of good chest compressions and maybe a few more minutes of suboptimal compressions. If no one is there to take over/help out, I'd be too gassed to provide any meaningful CPR, and it'd probably be futile in an out-of-hospital arrest situation anyway. In the end, you can only do what you can do. Don't worry about the law.

 

[DanoT]

As a former F.A. Attendant (retired) I would not have rolled him over. I would have got my face close to his and "Look. Listen Feel" for breathing. If not breathing then roll him over, if breathing leave face down. This is because with a head injury there is a risk of vomiting and if face up and vomits, then the airway can be compromised. Face down is also known as the "Drainage Position" and is the safest way to position and transport an unconscious patient.

However, once properly secured on a spine board and face up, if the patient starts to vomit then the board can be rotated so the vomit will drain away and not enter and block the airway. So with no help and no spine board present, then leave face down if breathing.

 

[Doug Briggs]

My last CPR class instructed us to continue until relieved or were too exhausted to continue.