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ThomD
05-31-2010, 02:11 PM
It started off with "we should have a first aid kit in the truck". That lead to Wilderness First Aid Training. Now we have a big first aid kit in the truck, and small ones in the other cars. I even carry gloves and dressings in my jacket on the motorbike when I commute.

Then I got CPR training at work. That lead me to look into the survival rates for out of hospital cardiac arrest. I'll save you the google - the rates are not good. Once again, TV has let me down. TV shows that CPR works most of the time. In reality, if you get CPR out of a hospital environment, you are toast. The CPR training at work also covered automatic external defibrillators. Did you know that you can buy those with flex spending money and Costco sells them? I'm thinking about buy one for my 60-something parents for Christmas. Unfortunately, AEDs also have a very limited application.

It's a dangerous world out there. Maybe I'll just wrap myself in bubble wrap. :)

Fireman78
05-31-2010, 02:15 PM
Don't feel bad... cardiac arrest survivial rates are grim regardless, you could have a paramedic unit eating at the same burger joint you collapse in and you could still assume room temperature. Cheers!

nbleak21
05-31-2010, 02:42 PM
It was all good until I read "I even carry gloves and dressings in my jacket." That's a little excessive for anything less than an EMT, IMHO.

Obtaining First Aid knowledge is great, and I highly recommend it for everyone... but there are restrictions, guidelines, and liabilities that some may not be aware of.

Ever heard of DNR (Do Not Resuscitate) cards? You're liable to find yourself in court, sued, over violating a person's wishes, if they carry the card.

Also remember that if you carry a Licence for First Aid, CPR, Lifeguarding, ETC, and have recieved proper training, you are heald liable for your actions, no matter how well and good your intentions are. Even by using your best judgement, if you make a "wrong" call, you're responsible... Also be very mindful of card expiration dates. You could be one day expired, have to use your skills and abilities, and then be held responsible for practicing first aid illegally, while otherwise someone without proper training, could be covered over the good sumaritain clause... Meaning, in the event of this ever happening, you may be better off Instructing someone with no licence to save, rather than doing so yourself with an expired license.

Just some food for thought.

Donsfast
05-31-2010, 02:50 PM
It is unfortunate that the only thing we all have in common is death....its great that you are learning about first aid with such detail though. It is a great idea, knowing what to do when needed will be an asset to yourself and others.

ThomD
05-31-2010, 02:58 PM
It was all good until I read "I even carry gloves and dressings in my jacket." That's a little excessive for anything less than an EMT, IMHO.

Obtaining First Aid knowledge is great, and I highly recommend it for everyone... but there are restrictions, guidelines, and liabilities that some may not be aware of.

Ever heard of DNR (Do Not Resuscitate) cards? You're liable to find yourself in court, sued, over violating a person's wishes, if they carry the card.

Also remember that if you carry a Licence for First Aid, CPR, Lifeguarding, ETC, and have recieved proper training, you are heald liable for your actions, no matter how well and good your intentions are. Even by using your best judgement, if you make a "wrong" call, you're responsible... Also be very mindful of card expiration dates. You could be one day expired, have to use your skills and abilities, and then be held responsible for practicing first aid illegally, while otherwise someone without proper training, could be covered over the good sumaritain clause... Meaning, in the event of this ever happening, you may be better off Instructing someone with no licence to save, rather than doing so yourself with an expired license.

Just some food for thought.

You'd think the gloves would be too much, but I see about 1 accident per year on my bike.

I'm not a medical professional, so the Good Samaritan laws apply,the Torti case not withstanding.

rjcj-8
05-31-2010, 04:07 PM
PPEs are always good to carry even if you are only CPR certified, I won't do any thing beyond chest compressions with out some sort of barrier device.

nbleak21 does bring up some good points about the DNRs but if your not part of the EMS system you should fall under the good samaritan rules but check ot see what they are in your state, not every states rules are the same.

But on the flip side of this with the more training and certifications you get the more that is expected and you can get in just as much trouble for not acting and providing aid.

If you want some good opportunity to train look to see if you have a local CERT or EMA volunteer team.

I've been able to get advance CPR, Advance First Aid, and now currently taking First Responder training through my local CERT program for free or a significantly reduced cost.

Firetacoma
05-31-2010, 04:24 PM
It was all good until I read "I even carry gloves and dressings in my jacket." That's a little excessive for anything less than an EMT, IMHO.

Obtaining First Aid knowledge is great, and I highly recommend it for everyone... but there are restrictions, guidelines, and liabilities that some may not be aware of.

Ever heard of DNR (Do Not Resuscitate) cards? You're liable to find yourself in court, sued, over violating a person's wishes, if they carry the card.

Also remember that if you carry a Licence for First Aid, CPR, Lifeguarding, ETC, and have recieved proper training, you are heald liable for your actions, no matter how well and good your intentions are. Even by using your best judgement, if you make a "wrong" call, you're responsible... Also be very mindful of card expiration dates. You could be one day expired, have to use your skills and abilities, and then be held responsible for practicing first aid illegally, while otherwise someone without proper training, could be covered over the good sumaritain clause... Meaning, in the event of this ever happening, you may be better off Instructing someone with no licence to save, rather than doing so yourself with an expired license.

Just some food for thought.

Most state Good Samaritan laws cover all lay-people, and even volunteer rescuers, as long as they only operate within the scope of their training.

As for the DNR issue, when in doubt, provide care until a family member prevents you with proof they do in fact have a DNR. This could be a signed original document, or a medi-lert tag. But you should be checking for those before you start CPR anyway, right?

My 2 pennies, as an EMT.

SunTzuNephew
05-31-2010, 04:30 PM
Don't feel bad... cardiac arrest survivial rates are grim regardless, you could have a paramedic unit eating at the same burger joint you collapse in and you could still assume room temperature. Cheers!

You could be on a gurney in my (or any) ED for a hangnail, have a MI and the odds wouldn't be good. Or you could be on an operating table with a ECMO team standing by and your odds are still pretty horribly bad.

SunTzuNephew
05-31-2010, 04:33 PM
It started off with "we should have a first aid kit in the truck". That lead to Wilderness First Aid Training. Now we have a big first aid kit in the truck, and small ones in the other cars. I even carry gloves and dressings in my jacket on the motorbike when I commute.

Then I got CPR training at work. That lead me to look into the survival rates for out of hospital cardiac arrest. I'll save you the google - the rates are not good. Once again, TV has let me down. TV shows that CPR works most of the time. In reality, if you get CPR out of a hospital environment, you are toast. The CPR training at work also covered automatic external defibrillators. Did you know that you can buy those with flex spending money and Costco sells them? I'm thinking about buy one for my 60-something parents for Christmas. Unfortunately, AEDs also have a very limited application.

It's a dangerous world out there. Maybe I'll just wrap myself in bubble wrap. :)

The use of home AED's doesn't have a great track record, either. Obviously, the first requirement is that someone ELSE be there when it's needed, to use it.

But, be careful with your obsession: I had one and I wound up in medical school:Wow1:

Paul 3
05-31-2010, 04:36 PM
Obtaining First Aid knowledge is great, and I highly recommend it for everyone... but there are restrictions, guidelines, and liabilities that some may not be aware of. Certainly good advice.


Also remember that if you carry a Licence for First Aid, CPR, Lifeguarding, ETC, and have recieved proper training, you are heald liable for your actions, no matter how well and good your intentions are.
I am not a legal or medical professional and hopefully one on the many on this board will chime in on the subject, but I do not believe a First Aid or CPR Certification is a License. There is quite a bit of literature distinguishing between a License, Certification and the legal difference between the two.



Even by using your best judgement, if you make a "wrong" call, you're responsible... Also be very mindful of card expiration dates. You could be one day expired, have to use your skills and abilities, and then be held responsible for practicing first aid illegally, while otherwise someone without proper training, could be covered over the good sumaritain clause... Meaning, in the event of this ever happening, you may be better off Instructing someone with no licence to save, rather than doing so yourself with an expired license.I don't think this represents the Good Samaritan Clause accurately. Originally the Clause was created to protect licensed medical professionals and was eventually, legally, extended to non-professionals. To state that one might be "better off" instructing someone with no prior training is incorrect and potentially very dangerous. Maybe we can get Lance or Andrew to add their professional advice on this. Great topic.

Cheers,
Paul

1leglance
05-31-2010, 06:03 PM
It was all good until I read "I even carry gloves and dressings in my jacket." That's a little excessive for anything less than an EMT, IMHO.

Obtaining First Aid knowledge is great, and I highly recommend it for everyone... but there are restrictions, guidelines, and liabilities that some may not be aware of.

Ever heard of DNR (Do Not Resuscitate) cards? You're liable to find yourself in court, sued, over violating a person's wishes, if they carry the card.

Also remember that if you carry a Licence for First Aid, CPR, Lifeguarding, ETC, and have recieved proper training, you are heald liable for your actions, no matter how well and good your intentions are. Even by using your best judgement, if you make a "wrong" call, you're responsible... Also be very mindful of card expiration dates. You could be one day expired, have to use your skills and abilities, and then be held responsible for practicing first aid illegally, while otherwise someone without proper training, could be covered over the good sumaritain clause... Meaning, in the event of this ever happening, you may be better off Instructing someone with no licence to save, rather than doing so yourself with an expired license.

Just some food for thought.

Well we already had a Dr. post in this thread so I will simply backup and add a bit of my thoughts...

First of all, getting all the training and supplies you can is the BEST THING YOU CAN DO, not so much for the random stranger but FOR YOUR FAMILY and YOURSELF.
We are often in remote areas, places where being able to know if something is serious or not can make or break a trip. Places were treating a cut/scape can make the difference between a little pain and a serious infection.

Now on the random stranger & the Good Samaritan law...there are 3 things to remember:
1) Scope of Practice- only do things you KNOW, things you have been TAUGHT & REMEMBER and everything will be fine. If you aren't sure then don't do it. I am an ICU RN & Wilderness EMT level, those are actually in conflict at times on paper but in reality one applies to the Urban setting & the other to remote areas...either way, just because I might understand how to place a breathing tube doesn't mean I will.

2) The law is on your side - the reason we are allowed to work on people is that we are trying to do more good than harm. As long as that is the case then all is well. I challenge anyone who is itching to type some fear mongering response to first go out and find some convictions that show a person acting reasonable for the benefit of another, within their scope and was fined/imprisoned for their actions.
Sure lots of urban legends, lots of "what if's" but finding convictions or even cases tried is tough.

3) DNR and med-alert bracelets - yeah look for them, but AGAIN I challenge anyone to find a case tried or a conviction of someone who gave CPR to a DNR and was prosecuted. Again the law is there to protect you in efforts to render aid. And I ask you, deep down inside how well can you sleep at night if you watch someone die that you could have helped and didn't? The importance of the med-alert bracelet is more about allergies and pacemakers before you give a med or shock someone.

Oh and on the CPR thing...well I assist with a "code" about once a week to every other week, I do lots of chest compressions, give lots of drugs, shock plenty of people....I am not a Dr but an ICU RN which means I am often there before the Dr's and after, I am the one doing the compressions (for a while, we switch often since you will be worn out in minutes)......and all I have to say is that while I will do CPR in the field anytime, I know that it just isn't likely to get a person back home from the hospital. However I will do it anyway because THAT person might be the ONE person it does save.

And on AED's...I am looking to buy one, because in the case of Ventricular Fibrillation or Ventricular Tachycardia shocking someone is pretty much the only thing that will help. And if you do it quickly and properly it has the highest chance of survival.
But then again I would install it in the WAVE as we have a higher risk population, and I am a Boy Scout Leader with a high risk group of parents & grandparents that come to hikes & campouts.
For the average person I don't think an AED is worth having.

Lastly...on the subject of First Aid kits...have lots of Kerlex type rolled gauze vs those little single packs, a good size syringe (20ml) for washing wounds, PLEASE DON'T USE THAT QUICKCLOT STUFF, carry hydration solutions, and learn learn learn how to use what you have.
Oh and if you ever travel in groups ask your Dr for a script for an Epi-pen, that could save a life of someone who didn't know they were allergic to something, or knew and lost/forgot their pen.

We have a number of medical/SAR/EMS folks on this board, I would advise anyone who has interest in this topic to read what they write carefully vs some of the knee jerk fear mongering reactions that are often posted no forums.

Dave Bennett
05-31-2010, 06:21 PM
Well said Lance :)

SunTzuNephew
05-31-2010, 06:31 PM
I carry, and have used, Quikclot....the powder (original formula) might have had some problems (all anecdotal) but the new stuff (combat gauze, sponges) is good stuff and I recommend it for anyone that might need it.

Dave Bennett
05-31-2010, 06:35 PM
I carry, and have used, Quikclot....the powder (original formula) might have had some problems (all anecdotal) but the new stuff (combat gauze, sponges) is good stuff and I recommend it for anyone that might need it.

Me too. The new combat gauze is great.

FYSA to those wondering, powder type quick clot exhibits a thermogenic reaction (gets HOT) that rapidly forms large clots - the downside to this is it must be SURGICALLY removed...

nbleak21
05-31-2010, 06:49 PM
FYSA to those wondering, powder type quick clot exhibits a thermogenic reaction (gets HOT) that rapidly forms large clots - the downside to this is it must be SURGICALLY removed...

Not sure if they've stopped issuing to all units, but I know we are no longer issued them in our First aid pouches nor CLS bags for that very reason.

ThomD
05-31-2010, 06:51 PM
But, be careful with your obsession: I had one and I wound up in medical school:Wow1:

Now there is a scary thought. Happily I'm too old to start a new career that takes so much education. My next career will be at REI.

SunTzuNephew
05-31-2010, 07:13 PM
It was all good until I read "I even carry gloves and dressings in my jacket." That's a little excessive for anything less than an EMT, IMHO.

I disagree. They're called UNIVERSAL PRECAUTIONS for a reason.

Back in 1983 (way before I went to medical school) I was just an EMT/SAR guy. Returning home from a training exercise I was first on scene of a pretty bad traffic accident, and as part of my attempts to render aid I crawled through blood covered broken glass and got cut up.

A few months later, I had Hepatitis-C (back then we called it Non-A/Non-B). I may need a liver transplant (if I can get one) at some point in the future. Universal precautions, and the mind-set they created, were barely being taught then, if at ll. I think everyone who thinks they may administer first aid should start out with a box of gloves, a CPR shield and maybe eye protection.




Obtaining First Aid knowledge is great, and I highly recommend it for everyone... but there are restrictions, guidelines, and liabilities that some may not be aware of.

Ever heard of DNR (Do Not Resuscitate) cards? You're liable to find yourself in court, sued, over violating a person's wishes, if they carry the card.Not really. This came up as a question from one of my medics (I'm an EMS Medical Director). To be sued, you'd have to be knowledgeable that they had a DNR, that a reasonable person in your position with your training would have acted differently, and that you did something wrong.

Since people don't usually carry DNR orders around, and a medic-alert bracelet is not adequate notification (DNR's specify the nature of a persons illness and the degree of care they want or don't want, you can't fit it on a line - or as one person I saw, a tattoo on the chest) field personnel, unless TOLD by competent medical personnel, are pretty much immune. Even if they did have the orders with them, odds are they hadn't specified whatever accident they were in.




Also remember that if you carry a Licence for First Aid, CPR, Lifeguarding, ETC, and have recieved proper training, you are heald liable for your actions, no matter how well and good your intentions are. Even by using your best judgement, if you make a "wrong" call, you're responsible... Also be very mindful of card expiration dates. You could be one day expired, have to use your skills and abilities, and then be held responsible for practicing first aid illegally, while otherwise someone without proper training, could be covered over the good sumaritain clause... Meaning, in the event of this ever happening, you may be better off Instructing someone with no licence to save, rather than doing so yourself with an expired license.


Just some food for thought.

Well, we were going to fly up to Ryan airstrip (http://www.airnav.com/airport/2MT1) today but the weather is craptacular so this is kind of long...


Not even close. You don't have licenses for CPR, lifeguard, whatever. I have a license from several states to practice medicine. Some states license prehospital personnel (some don't) but specify fairly strictly what the limits of that license is (scope of practice). In most cases for advanced EMT's they can do what I say they can do but its on MY MEDICAL license....and for anyone but an EMT-basic, they must be on duty in most cases, or they only have -basic scopes of practice.

Volunteer first aiders/lifeguards have is a 'certificate' that certifies on a particular date you met a standard of performance after completing a standard course of instruction. Do it wrong? Oh, well. As long as 'doing it wrong' doesn't involve practicing medicine, there's not much you can get into trouble for. If I do it wrong, aside from civil liability (my malpractice insurance) I can lose my license to practice, and conceivably be sentenced to jail for manslaughter or murder.

Here's what one of my CPR cards says:


Successful Completion Card
National Cognitive Skills Evaluations in accordance with
the guidelines of the American Heart Association®
Research and curriculum of the ProCPR, LLC Healthcare
Provider Program. Adult/Infant/Child CPR & AED.Not even a certificate.

As far as the various Good Samaritan laws go, each state is different and some don't have any at all. But it's safe to say that as long as you perform at your level of training (and not in excess of it) and do what a reasonable person with the same level of training would have done, you're OK. And I've been admitted as an expert witness in a few states in suits against medics.

There is more of a risk, IMHO, that if you identify yourself as a whatever, and don't perform then you're liable. A tort (a civil lawsuit seeking monetary recompense for a harm that was done to you) requires 4 elements be proven: Each element has to be present for the suit to go against you.



There has to be a Duty to Act...There is an expectation that you will perform....Put a bunch of EMS stickers on your car and it's at least possible that a lawsuit can go against you, although I don't think it's ever been done yet;
Having a duty to act (expectation of care) you have not provided that attempt (you can fail, but you have to try) If you fail, thats another issue (malpractice). This is called a Breech of Duty
That breach of duty was the cause, or close to being the cause in the law, of someone being harmed, (Proximate or near proximate cause);
Someone actually was harmed because of your breech.

Most people think that it's #3 that causes the trouble, really it isn't for volunteers. Now, if you're getting paid to be a lifeguard or whatever, thats different: You're not a volunteer, and thats why there are usually higher standards of training and certification for 'professionals' than volunteers. For example, the fact that I got a Boy Scouts Lifesaving Merit badge 40 years ago is nice, but its not quite the same as being a LA County Lifeguard...and I wouldn't be held to the same standards. And even if it was, hey - I did the best I could with the training and resources I had.

Now, issue #1 is why medical abandonment is such an issue. You create an expectation that you're going to handle something, and a more qualified individual passes by, or someone doesn't call for more help. For example, say you see a kid in a stream having trouble. You jump up and say "I'll take care of it" and the pros don't get called? Better get him, quickly, without hurting him. You have created an EXPECTATION that you will help and are competent to do so...thats #1 and #2. That same action applies to a professional dumping a patient. Not a good thing to do.

Anyway, most volunteers, unpaid (and upaid means you receive NOTHING, not even a free cup of coffee, I'm told there have been attempts to claim that a free meal created a situation where people tried to get Good Sam laws tossed), are OK. And realistically, if you don't have much to lose, you don't have much chance of someone taking it away from you. If you have a lot to lose, malpractice insurance (even for medics) might be a good idea.

SunTzuNephew
05-31-2010, 07:17 PM
Now there is a scary thought. Happily I'm too old to start a new career that takes so much education. My next career will be at REI.


I was 40 when I started med school...Run AWAY!!!!

SunTzuNephew
05-31-2010, 07:19 PM
Not sure if they've stopped issuing to all units, but I know we are no longer issued them in our First aid pouches nor CLS bags for that very reason.

Got combat gauze? It's got quikclot in it...Also part of the standard IFAK/CLS bags according to AMED.

SunTzuNephew
05-31-2010, 07:23 PM
Me too. The new combat gauze is great.

FYSA to those wondering, powder type quick clot exhibits a thermogenic reaction (gets HOT) that rapidly forms large clots - the downside to this is it must be SURGICALLY removed...

There was one or two anecdotal reports of severe burns from the powder. the USUHS did some tests and couldn't duplicate the problems. You know those surgeons, always whining when you don't tell them how great they are. Almost like fighter pilots :)



As far as having to be surgically removed, no kidding? EVERYTHING in the wound had to be debrided by a surgeon. Some pantywaist navy surgeon (sorry, redundant) complained about having to spend a minute extra cleaning out the wound. Boohoo. Its not like some patient that needed it got it and then had to have surgery BECAUSE of the QC.

The main reason the powder was replaced by the sponge and gauze is because it works better. The powder was a pita to get into the wound in a breeze (and it's always windy in Iraq, I think) and could actually wash out of where it was needed from bloodflow before it was effective. The sponge is much better.

1leglance
05-31-2010, 08:01 PM
Great news on the Quickclot gauze vs powder...I will revise what I tell people and might just add some to the kit.
I have seen a few folks flown into our trauma bay with the powder and it was a mess in the wound...and yeah the main folks complaining were the trauma dr's :)
Personally I am all for direct pressure but I can see when & where a clotting agent would be good to have.

Thanks Sun for the more indepth response than what I wrote, I think the fact that EMS is often under the license of a Dr is often overlooked.

For me it is less about my Duty to Act than it is about how I would feel if I could have helped and didn't.

Amauri
05-31-2010, 08:03 PM
Ever heard of DNR (Do Not Resuscitate) cards? You're liable to find yourself in court, sued, over violating a person's wishes, if they carry the card.

If someone does not show you the proper documentation your ok.

I am an EMT, my first day working I went on a "trouble breathing" call. We show up there's a large man in his late 70's laying on a bed obvious signs of COPD, on oxygen, first thing I do while my partner is checking out the patient is turn up his oxygen. His daughter and wife are there the man and the wife don't speak a lick of English so I had to have the daughter translate, she had a very thick Russian accent and kept claiming the man had a DNR. My partner call me over, there's what appears to be a bone protruding from the guys upper abdomen. Turns out it's an aneurysm that he has had for years. If this guys dies on us we can't perform CPR because he would be dead anyway. We needed to get this guy to the hospital NOW! He starts breathing his breathing slowed and we where having trouble getting a pulse, I'm thinking this guy is dead. All the while his daughter is yelling at us telling us he has a DNR but couldn't find it. She grabs a large file and jumps in the ambulance with us, my partner is driving and I'm taking care of the patient. The daughter is asking us to take to take her dad to a hospital that is 30 min. away running code 3, dispatch sends us to one that is 10 min. She starts nagging. I'm asking the daughter to translate for me and she decides to get on the phone. If you have ever met me you know I am soft spoken and very calm, I rarely loose my cool. But this lady... I yell at her "Ma'am get off the damn phone and answer these questions or your dad is going to die! So she complies. We are almost at the hospital when she finally finds his DNR. I take a look at it basically he just did not want any artificial ventilation(tubes down his throat). I don't say anything to her I just keep doing my thing. We get to the hospital and turn him over. He lived.

Good times.

ThomD
05-31-2010, 08:34 PM
I was 40 when I started med school...Run AWAY!!!!

So, it is official - you are crazy! I'd be 50ish before I could even get into Med school, so that isn't going to happen.

My next challenge is to find a way to reinforce what training I've had. Work is going to run some mass casualty drills later this year, but maybe I need a set of flash cards or something.

SunTzuNephew
05-31-2010, 08:43 PM
So, it is official - you are crazy! I'd be 50ish before I could even get into Med school, so that isn't going to happen.

My next challenge is to find a way to reinforce what training I've had. Work is going to run some mass casualty drills later this year, but maybe I need a set of flash cards or something.

LOL, I had students in the Caribbean (there are some decent med schools there, classes in English and everything) who were in their late 50's...talk about guts. A few were medical professionals (mid levels, one was a British/Pakistani dentist trying to become an oral surgeon), a few were very brave people. Most did OK.