In this episode of RoyOnRescue, Roy talks about why cardiac arrests secondary to traumatic injuries, especially rapid deceleration accidents are so hard to resuscitate. Roy goes a bit more in depth about how every deceleration or rapid acceleration accident really is more like three different collisions. Car hits wall, body hits car and organs hit inside of the body…that’s 3. Now take a closer look at how it happens in this episode of RoyOnRescue.
Hello Everyone!
On this episode of RoyOnRescue, Roy answers a question that came in some time ago about how to do CPR if the person has an object imbedded in their chest. Roy sheds some light on the simple yet affective way to rescue without causing harm to yourself and to the patient. If you’ve ever wondered what to do if a person had a knife in the chest and was in cardiac arrest, you’ll want to watch this video blog.
RoyOnRescue Team
What does Turkey, Trauma, and Road Rage have in common? Black Friday! In this episode of RoyOnRescue, Roy shows how crazy it can be when waiting in line for that “perfect” gift that one could just die for?
Don’t miss this episode of RoyOnRescue where Roy sheds some light on how to stay safe while getting those Black Friday bargains.
In this episode we talk about the subject regarding when a cut may need to have stitches or when it can be simply treated at home. So if this question has perplexed you in the past, you may not want to miss this episode where Roy sheds some light on this sometimes confusing situation.
Happy Memorial Day Weekend!
Roy
Hello Everyone, 
I had a royonrescue.com reader who had a concern that the post about the Good Samaritan Act might scare rescuers into not providing care while off duty. I think this may have been a misunderstanding and I must clarify that I’m speaking to medical professionals that have training and expertise in the area of rescue, not those volunteers, family members, bystanders without any training who may want to try and get involved. Below is the comment from this individual and my response back to them with references. I hope this helps anyone else who may have had the same concern or question.
Question/Comment: 4-3-11
Dear Mr. Shaw,
I found your video, Professional Rescuers and The Good Samaritan Law, discouraging. I agree with just about everything you advised, but I have one major complaint. You said, “You can do care up to a specific level. In fact, that of which you are trained to do proficiently.” I think what you have said is misleading.
If you apply those restrictions to Good Samaritan laws, you defeat the intent of those laws*. Here’s a quick example: I would guess that 90% of civilians who have taken CRP classes (as I have) are not proficient in CPR. They have a good idea what CPR is, but in an emergency with the adrenalin flowing, I can see them making numerous missteps, which may or may not affect the outcome. According to your advice even a Red Cross card carrying volunteer should not attempt CPR because he/she is not proficient. And what about the AEDs appearing in malls and schools? According to your advice, the average passer-by who’s had no training should only call 9-1-1 and leave this new fangled equipment for the experts! I’m sure that is not what you would advise.
Then, there is the example of your buddy, the snowmobiler, with the crushed & torn larynx. It sounds like you let him die? You knew what needed to be done, a surgical tracheotomy. Of course your snowy scene was “an uncontrolled environment”. Isn’t that’s why it’s an “emergency”. You had the equipment and you had the training, but you chose not to do that which you could do. Personally, I think you should have at tried. (Jas 4:17) Sure, like you said, the scene was far from perfect but you had what you needed to perform the procedure. And yes, you may be right, there’s a good chance you would not have been successful. But if your friend could have, don’t you think he or his wife would have wanted you to at least try?
Instead of encouraging guys like me to do what they reasonable can, you’ve lead us to believe we need to be trained or we will be held liable for trying. The best way to ensure that one follows your advice to “Do No Further Harm” is to look the other way.
FYI: I carry Celox & QuikClot, which I know state protocols does not allow EMTs and medical professionals use. I’ve never used it nor been trained, but if on the firing range someone gets shot and I have no other means to stop a bleed out, I intend to try it. Hopefully, I will never be put to the test on the highway or the rifle range, but despite your warning about “level of training” and “proficiency” it is an option I may have to pick.
Despite my disapproval of this video, I have check out some of your other stuff and I think you do a pretty good job, esp. your written responses (unlike mine).
Thanks for sharing
My Response:
Hello “Name Not Disclosed” ,
I appreciate you taking the time to respond to the royonrescue.com blog entry, “Professional Rescuers and The Good Samaritan Law”.
I wanted to clarify the “providing care up to ones level of trained proficiency”.
The Good Samaritan Act in the State of Michigan states;
“691.1501 Physicians, physician’s assistant, or nurses rendering emergency care or determining fitness to engage in competitive sports; liability for acts or omissions; definitions.
(1) A physician, physician’s assistant, registered professional nurse, or licensed practical nurse who in good faith renders emergency care without compensation at the scene of an emergency, if a physician-patient relationship, physician’s assistant-patient relationship, registered professional nurse-patient relationship, or licensed practical nurse-patient relationship did not exist before the emergency, is not liable for civil damages as a result of acts or omissions by the physician, physician’s assistant, registered professional nurse, or licensed practical nurse in rendering the emergency care, except acts or omissions amounting to gross negligence or willful and wanton misconduct.
(2) A physician or physician’s assistant who in good faith performs a physical examination without compensation upon an individual to determine the individual’s fitness to engage in competitive sports and who has obtained a form described in this subsection signed by the individual or, if the individual is a minor, by the parent or guardian of the minor, is not liable for civil damages as a result of acts or omissions by the physician or physician’s assistant in performing the physical examination, except acts or omissions amounting to gross negligence or willful and wanton misconduct or which are outside the scope of the license held by the physician or physician’s assistant. The form required by this subsection shall contain a statement indicating that the person signing the form knows that the physician or physician’s assistant is not necessarily performing a complete physical examination and is not liable under this section for civil damages as a result of acts or omissions by the physician or physician’s assistant in performing the physical examination, except acts or omissions amounting to gross negligence or willful and wanton misconduct or which are outside the scope of the license held by the physician or physician’s assistant.
(3) A physician, physician’s assistant, registered professional nurse, or licensed practical nurse who in good faith renders emergency care without compensation to an individual requiring emergency care as a result of having engaged in competitive sports is not liable for civil damages as a result of acts or omissions by the physician, physician’s assistant, registered professional nurse, or licensed practical nurse in rendering the emergency care, except acts or omissions amounting to gross negligence or willful and wanton misconduct and except acts or omissions that are outside the scope of the license held by the physician, physician’s assistant, registered professional nurse, or licensed practical nurse. This subsection applies to the rendering of emergency care to a minor even if the physician, physician’s assistant, registered professional nurse, or licensed practical nurse does not obtain the consent of the parent or guardian of the minor before the emergency care is rendered”. http://nspc203.com/leg/MichiganGoodSamaritanActForMedicalProfessionals.htm
And in one other source I found an explanation that goes on to describe the Good Samaritan Act this way; “While Good Samaritan laws vary from state to state, these laws typically apply when you take purely voluntary, good-faith action to help another person at the scene of an emergency, and the person does not object to your help. If you provide help to another person under a Good Samaritan law, keep in mind that you must exercise the same standard of care and/or treatment that you normally help to in your profession. In other words, if you’re a trained medical professional, then you must act according to medical professional standards. However, if you are not trained in a medical professional, then your duty may be only to call for help or other forms of help, but not to render medical care or first aid. So long as you act reasonably in light of the circumstance, and in keeping with professional standards, you probably will not be liable in a jurisdiction that has enacted a Good Samaritan law”.
http://resources.lawinfo.com/en/Articles/personal-injury/Federal/what-are-good-samaritan-laws.html
So you see, this is why no matter how much I would like to re-assure professionals that they are completely safe when rendering aid and especially “creative solutions medicine” to a person without repayment as a Good Samaritan, the professional still needs to understand that because of their training, they do have a duty to perform to a “standard of care” appropriate for their profession even if it’s frustrating and they may think that they can do more.
Individuals who offer Good Samaritan aid and have never been trained in any medical area may not be held to the same standards if they are sued, but the original blog was directed toward those with training and professional expertise in the area of rescue which is a different scenario.
I hope this helps to clear up any misunderstanding or confusion and please don’t hesitate to contact me for more clarification or for any future subjects down the road.
Best Wishes,
Roy Shaw, RoyOnRescue.com
royonrescue@gmail.com
Hello Everyone,
Back and Rib pain
This week I got a letter from a person who injured their back and ribs after they were thrown from their horse. They were seen by a Chiropractor but sounds as if they were never given an xray or diagnosed with broken ribs by xray, just a hunch. She asks, “can my ribs still be broken after a year and if not, what could be causing my pain to come back from time to time?”
Though I’m not a doctor and surely wouldn’t want to diagnose this, I will share some of my thoughts from a paramedics viewpoint.
The possibility that one or more of your ribs were broken is very likely, especially because it only takes a relatively small amount of pounds per square inch of pressure to fracture a rib.
You may have strained the intercostal muscles and even irritated some of the many nerves that run along the ribs. All of which could cause a great deal of discomfort and when that effected rib is pushed on, twisted or bumped again, it could even cause a re-injury of the same fracture point or muscle or cartilage.
Sometimes it turns out worse when we don’t get a good solid diagnosis from a doctor, because we can only guess what could be causing the pain and discomfort. Others may think we’re not really injured and insist on regular activities that could re-injure or aggravate the same injury.
If after a year, you are still feeling pain, pops, “crunchy” sounds on certain movements, I would strongly suggest that you get into your family doctor and let them know when this happened(how long ago), how it happened, how you were treated after it happened, any times where you may have twisted funny, landed wrong or re-bumped or re-injured the same painful area. I would imagine that they may want to take a series of xrays to get to the bottom of what’s causing the discomfort or pain.
I do think you’re justified in wanting to be seen. Pain is the way our bodies help us understand that something is not right and we should pay attention to it.
I hope this helps and I hope you get back to your normal functions without pain very soon!
Best Wishes,
Roy, RoyOnRescue.com
royonrescue@gmail.com
I received a question from a person who after watching the “Chest Injuries and CPR” video blog asked:
Dear Roy,
Reading your letter, I would agree if the injury is just soft tissue injury. However if a # is suspected, It would be dangerous to do CPR as the # might or will puncture the lungs and cause immediate death, if immediate intervention is not available.
Kindly comment.
Bent Steering Wheel From Drivers Body
Here is my response:
Hello,
Regarding your question about Chest Injuries and CPR. It’s important to make a distinguishing point whenever we talk about CPR. When a person is in need of CPR, it means that the person is in cardiac arrest. This is to say that they are unconscious, not moving, not breathing normally. If this is the case, they are presumably in cardiac arrest or in a state that justifies Cardio Pulmonary Resuscitation.
If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death otherwise known as biological death(permanent).
This is why, regardless of the chest injury, if the person is “dead” or in need of CPR, compressions are to be given per the American Heart Association guidelines even if the complications could include those of punctured lungs, lacerated organs, or bruised/punctured heart muscle. This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.
If however, the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and complicate the victims injuries. As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services would be contacted and CPR would be initiated regardless of the injuries of the patient.
I appreciate the question and hope that this clarifies any confusion caused by the article. Please don’t hesitate to email me again if you would like to continue dialogue on this subject.
Best Wishes,
Roy Shaw, RoyOnRescue.com
royonrescue@gmail.com
This week Roy answers a question that came all the way from France where a student asked a great question about how to perform CPR if a person has had major trauma to their chest after a motor vehicle accident. You know, starting CPR on a victim can be a difficult decision to make in any normal situation, then add the complication of internal or external truama and without guidance, it may be a temptation to avoid providing CPR all together. On this episode of RoyOnRescue, Roy Shaw, EMT-Paramedic and Trainer sheds some light on why it’s okay to perform CPR on a person with a chest injury or on someone who has recently had thoracic surgery and what to consider while providing this life saving skill.
Be sure to keep the questions coming and send them to:
royonrescue@gmail.com
Hello Everyone,
This question came in from my friends out in California.(I’m not sure if they wanted to be named and I haven’t asked them yet.)
They had many patients and only their small team of volunteer rescuers without transportation services to organize a serious mass casualty incident.
They were on scene first when an all terrain racing vehicle left one of the desert roads and launched into a crowd of spectators. There were many killed, many more injured and to top it all off, no response from EMS transportation services for more than an hour! The team of volunteers had to work fast and hard to help organize absolute chaos. They were wondering if I could share my opinion on how to organize bystanders and volunteers during a situation like this. In this RoyOnRescue episode I give some of my ideas combined with advice from several of my colleagues working in dispatch, quality assurance, risk management and EMS response. My answer to how to organize volunteers and bystanders to help in a triage situation where there are mass casualties took a total of two videos in order to fit them onto YouTube. There’s a lot covered here but I really have only scratched the surface of a very important topic. I hope it helps. If you need me to spin off onto one given section of this subject and cover it more in depth, please email me at: RoyOnRescue@gmail.com.
Best Wishes,
Roy
RoyOnRescue.com
Part 1
Part 2
On this episode of RoyOnRescue we take a closer look at a questions a person had about what to do if a person falls, has a potential neck injury, is face down and is unresponsive. This can be a complicated scenario when it comes to assessing the person for airway, breathing and circulation. Watch this episode to hear one way to respond to a person in this situation, treat them without causing further harm and maybe save a life.
