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Domestic Violence and Abuse

Extracting the patient from a road traffic accident (2/2)

Hi, guys. This is Jim. He’s a 20-year-old male,
high speed RTC. He’s got abdominal
haemorrhage internal, a right tib and fib,
he’s time critical. We need a rapid extrication
out the back of the vehicle. Can you take the back and
you take the front passenger seat? Okay, Jim, my colleagues
are here now. We’re going to get you out of the
vehicle as quickly as we can. From a point of reassurance, it’s most important that
the paramedic remains calm and confident throughout. Remaining confident gets transmitted
across to the patient and by taking control of a situation,
it’s vitally important that the patient knows
that somebody’s there, they need help
and they’re getting their help. And that certainly does alleviate
the worry and stress of a situation. I’m going to lower the seat back. Take hold of his torso, Mark. We’re going to lower the seat down
from behind you, Jim. Okay, so go with us. I’ve got the top part. Sliding at about six inches
at a time. Ready, set and slide. Okay? Mark, take hold of the pelvis.
You’ve got the arms. Ready, set, slide. And rest. Okay. Are his feet clear? Yes. Okay. Ready, set, slide. And rest. One of the key things
is hands on the patient. Keeping your hands on them
reassures the patient, especially when
it’s a prolonged extrication. Just a hand on the patient
reassures them, they know someone’s there with them because they can’t see
what’s going on. Okay, we’re going up
another six inches. Ready, set, slide. And rest. Okay, positioning, happy? Another six. Ready, set, slide. And rest. Ready, set, slide. And rest. Can you take over the head for me? Okay. Mark, move forward as well. How are you doing, Jim? Okay, you’re nearly out of the car. Communication is really important and people associate
the ambulance service and people turning up to assist them with trust and also comfort. Relieving anxiety through talking
to a patient and communication, responding and listening to them
as individuals goes a long way to start
the process of alleviating anxiety, pain
and discomfort. We’re going to slide forward
to the edge of the car to start with. Everybody ready? Ready, set, slide. About a third of the way up.
Everybody ready? I just need to reposition. Okay, everybody ready? Okay, ready, set, slide. And stop. Okay, ready, set, slide. And stop. I want a quick reassessment of Jim
if I can. Just stick your tongue out
for me, sir. Take a deep breath for me. And out. In and out. Again. And once more. Thank you, Jim. Take a deep breath for me. Lovely. And his trachea’s still central. Pulse is still tachycardic. I’m just going to have another feel
of your tummy. Still hurting. Okay, fine, guys. With abdominal trauma, we don’t know
what’s ruptured under there. Something has with the bruising and
the guarding on the abdomen. It needs a surgeon’s knife and if we don’t get him there
quickly, it’s beyond our scope. The golden hour is what we use
to describe the first hour of what’s happened
post the traumatic incident. Patient survival is dependent
on rapid assessment, management and transportation
to hospital and the golden hour ends when the patient reaches
the receiving hospital and gets seen by a surgeon. It’s the surgical intervention
that will save a patient’s life. Traumatic incidents like that, you
get a lot of movement of the neck and there is a severe risk
of any neck damage. And with the spinal chord running
very close to the spinal vertebrae which are the bones in the spine, there’s a risk of damage
to the nerves there and any damage there is irreparable. Excellent. Well done. Okay, I’ve got control. Jim, you’re going to feel some blocks
coming on the side of your head. Try and keep still. And another one on your chin. Once we’re in the back
of the ambulance with the patient packaged
on a spinal board, we then go back to basics again. We do the primary survey which you saw us do
when we first approached the car, checking airway, breathing
and circulation again. Just to make sure nothing’s changed. We’d also establish two wide-bore
cannulars into a vein which gives us a drug route and also a route to give some fluids
to the patient because they’re bleeding
into their body so we just need
to maintain their profusion and maintain a radial pulse, keep
their organs functioning effectively. We then also give the patient
some pain relief. In this situation it’s probably
morphine, small amounts initially because otherwise
it drops the blood pressure which you don’t want to do any more. Just to make them more relaxed
and reduce the pain. We then also get round
to looking at that leg which you saw us mention it was
fractured, the tibia and fibia. So we then look at putting
a box splint around it just to immobilise that leg and
prevent any further damage. The reason we didn’t
do anything at the scene was because
that wasn’t our main priority. That was not
a life-threatening injury whereas the abdominal trauma was.

Cesar Sullivan

6 thoughts on “Extracting the patient from a road traffic accident (2/2)

  1. I wanna be a paramedic when im older and this helped…..was that an actual accident or just an actor?

  2. @MidgetBuddie
    I would say no real accident, because it looks like a training, and in a real accident normally the Fire Dept. would assist in the rescue.
    Good luck in your future profession!

  3. Hey! Have you ever tried – fast abs magic (should be on google have a look)? Ive heard some great things about it and my friend got great 6 pack abs and lost a ton of belly fat with it.

  4. Enjoyed the extrication.One small point have you tried saying, "Is anybody NOT ready?" when you are ready to lift or move. If one person is not ready their voice can be lost in the rest of the teams affirmative.

  5. so if this patient has a tib and fib fracture surely you wouldnt let his fractured limb frail about as it does wen you first start to slide him up the board surely you would immobolise the fracture and most likely have to give him entonox as he would be in a lot of pain ? and im not even a paramedic although i have just joined as an ECA and even havnt had one days training yet !!

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