Accident, please give me some feedback

[kayco53]

In Canada we are instructed in CPR class to do it as long as you can or told to stop by a higher level such as Doctor or Paramedic. Here it is your call if you are going to it or not just like AR. If you find somebody and you do not have your AR mask along you might not chance it.

 

[Andy Mink]

too exhausted to continue.

This. It goes back to you do what you can do. As far as liability I believe most states have a good samaritan law.

 

[luliski]

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

Bingo

 

[Jwrags]

There are criteria one should use to stop CPR once started. They include the person shows signs of life and no longer needs it; medically trained personnel arrive and either call it or take over; you are physically unable to continue because you are exhausted; your life may be in jeopardy should you continue.

Also, patients can refuse treatment if they are coherent and of sound mind. If they are intoxicated or confused from a head injury they will likely get treated whether they are happy or not. If you let a drunk accident victim get up with their c-spine fracture and they become paraplegic you can guess who will get blamed and sued and probably lose...the medical personnel who were in charge.

 

[pais alto]

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.

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

...or you are in touch with Medical Control. They can advise an EMT to stop. Here in NM, I’m pretty sure a paramedic can call it.

 

[Pat AKA mustski]

...or you are in touch with Medical Control. They can advise an EMT to stop. Here in NM, I’m pretty sure a paramedic can call it.

Absolutely. You are relieved as soon as the paramedics take over. A civilian can also be relieved by another civilian.

 

[CalG]

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

^^^^^THIS IS TRUE IN VT>

 

[CalG]

In the same way'''''''' an aside......

I was first to come upon an in town auto collision. A big guy in a little car pulled into a small guy in a large commercial electric utility truck.

The big guy broke out the windshield of his car with his face.
The drivers door was jammed, so I went in via the DS passenger door. The fellow was a wreck, with blood coming out everywhere.
I just reached around the head restraint and held his head stable and waited for the first responders. (fire fighters)
When they arrived, I stated we had been holding like this for about 6 minutes, with no change in mental status or vitals (they were surprisingly good , Heck, he was bleeding and breathing! Circulation and respiration? CHECK!)
The responder and I exchanged hands, and I slipped out and back to my car without another exchange. I hoped for a good outcome.

 

[RuleMiHa]

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

One of the things to be careful of is the rate of chest compressions. It's a lot less exhausting at 100 beats per minute than at 150. And way slower than you think. There are CPR playlists that have songs with appropriate speeds for CPR. I think the BeeGees Stayin' Alive is perfect for that.

 

[newfydog]

The priorities are A-B-C Airway first. Don't worry about anything else if breathing is compromised. B: Bleeding next. Severe bleeding or bleeding causing choking takes priority over #3: C:C-Spine concerns. I guess it is better to be paralized than dead, Try to address A and B with minimal movement.

The right to refuse treatment is there, but irrational behaviour in the event of a head injury is a gray area. They can be downright compative, but not exercising free will in their refusal.

Sounds like you did everything right.

 

[pais alto]

The priorities are A-B-C Airway first. Don't worry about anything else if breathing is compromised. B: Bleeding next. Severe bleeding or bleeding causing choking takes priority over #3: C:C-Spine concerns.

This has changed. Current protocols and guidelines from the American Heart Association now put Circulation ahead of Airway. Research shows that perfusion is more important than ventilation. Compressions come before checking airway under current guidelines:
https://eccguidelines.heart.org/ind...rt-and-cardiopulmonary-resuscitation-quality/

Go to Executive Summary 2017 update, then Part 5, then to Bystander CPR:
https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/executive-summaries/

Easier to read version:
https://www.rn.org/courses/coursematerial-10008.pdf

At one time, there was essentially, one protocol for CPR--A (airway), B (breathing), and C (Circulation/Compressions), but now there are three: C, CAB, and ABC. A notable change is the relationship between compressions and breathing. In earlier protocols, “look, listen, and feel” with 2 rapid breaths was done prior to beginning compressions; but now, in most cases, compressions are done first.

Also important: C is for Circulation, not C-Spine. This shows the importance of staying current on your CPR training.

 

[newfydog]

You are referring to CPR protocol. I'm giving our patrollers protocol of priorities for finding an unresponsive person on the slopes. In the incident reported here, CPR was not in any way appropriate treatment.

 

[pais alto]

You are referring to CPR protocol. I'm giving our patrollers protocol of priorities for finding an unresponsive person on the slopes. In the incident reported here, CPR was not in any way appropriate treatment.

That wasn’t clear, especially since the entire last page of this thread had moved on to discussion of CPR, you used ABC which is the old classic CPR acronym, and you didn’t have a quote you were responding to in your post. I’ve been a full-time patroller for over 12 years, and as one of “our” patrollers I understand it’s important to be clear and contextual.

And in any event, checking circulation when approaching/assessing an unconscious patient should be the priority over airway.

 

[newfydog]

And in any event, checking circulation when approaching/assessing an unconscious patient should be the priority over airway.

So you find a lot of them who are breathing but have no pulse? How long do they last?

You are still hung up on CPR, where the compressions etc have proven to be more important than the breaths. When we find someone unresponsive in the snow ,the easiest, fastest first thing we look for is breathing. If they are breathing, they'll have a pulse. Not breathing, check pulse to see if cpr is needed. No breathing but with a pulse (much more common) you need to get the airway clear and working.

 

[Beartown]

So you find a lot of them who are breathing but have no pulse? How long do they last?

You are still hung up on CPR, where the compressions etc have proven to be more important than the breaths. When we find someone unresponsive in the snow ,the easiest, fastest first thing we look for is breathing. If they are breathing, they'll have a pulse. Not breathing, check pulse to see if cpr is needed

Nobody without a pulse is breathing. Current BLS recommendations no longer include rescue breathing in a pulseless patient (whereas in the past, a 30/2 ratio of compressions to breaths was the standard, even in a pulseless patient). Evidence has show that continuous CPR without interruptions leads to best outcomes. Even in the hospital, we don't stop CPR to intubate/give breaths. Just intubate during compressions or during pulse checks, or not at all if difficult intubation. Also, pts who have a pulse can also require chest compressions (severe hypotension/bradycardia). Gotta circulate O2/CO2/meds.

 

[NZRob]

Truth. Liability begins because you started. .

Hard to fathom that lawmakers didn't foresee the perverse unintended consequence of that law, i.e. a significant incentive for people NOT to start CPR. WTF?

 

[newfydog]

Nobody without a pulse is breathing.

Exactly. In our ABC ,if the airway is breathing we know damn well they have a pulse and can move onto bleeding and spinal issues

On the Canadian patrol, our CPR protocol tossed out any pause in compressions for breaths, and survival rate went up quite a bit. So yes, once you find there is no pulse, circulation takes priority over airway.

However, I'm not just discussing CPR here, I'm talking first responce. But when you just find a skier face down in the snow, or in a treewell, we check their breathing first. Pulse can be week and tough to find right off on the slopes, but breathing is pretty obvious. If they have a mouthfull of snow, we clear it out before anything else.

Guys I worked with pulled one out of an avalanche not breathing. No one took the pulse or started CPR, they right away put an O2 mask on full blast and the breathing kicked right in. Had that not worked, they would have gone right to checking pulse and starting CPR if it wasn't there.

 

[pais alto]

So you find a lot of them who are breathing but have no pulse? How long do they last?

You are still hung up on CPR, where the compressions etc have proven to be more important than the breaths. When we find someone unresponsive in the snow ,the easiest, fastest first thing we look for is breathing. If they are breathing, they'll have a pulse. Not breathing, check pulse to see if cpr is needed. No breathing but with a pulse (much more common) you need to get the airway clear and working.

As an EMT, that is one of the more interesting interpretations that I’ve encountered of assessments as well as the current CPR guidelines. I guess I appreciate your telling me how to do the job I’ve been doing for all these years, I’m sure it will lead to improvement. At least you didn’t get patronizing or condescending...oh, wait, cancel that last part.

 

[Pat AKA mustski]

Hard to fathom that lawmakers didn't foresee the perverse unintended consequence of that law, i.e. a significant incentive for people NOT to start CPR. WTF?

Yes. California's Good Samaritan laws had to be rewritten recently because they were so poorly written.

 

[François Pugh]

I'm sure CSP, NSP and EMT will follow their training and protocol regardless of internet advice. I know I will.