In The Blink of an Eye

Discussion in 'Survival Medicine' started by melbo, Aug 19, 2015.

  1. melbo

    melbo Hunter Gatherer Administrator Founding Member

    You’re enjoying a relaxing day at the range and finally sighting in your new carbine you built from all the spare parts you found in your parts bin, justifying the purchase of a new lower.

    Just as you’re finishing up, you hear a “Whoa! Be careful!!!” followed by a muffled pop and you see a young man fall to the ground clutching his head as blood sprays from wounds on the front and side of his head. His buddy with him yells for help as you tell him to call 911 and grab your D.A.R.K., put on your gloves and rush over to him.

    Gunshot wounds to the head have an extremely high mortality rate, exceeding 90% and out of all the traumatic head injuries, GSW's to the head have a less than 10% survival rate. This is due to your body's nerve center being contained in the cranial vault of the skull. Once that has interrupted, survivability is markedly decreased.

    Let's take a look at the victim in our scenario. What's the first thing we need to do? Make sure our scene is secure and that the firearm is cleared and secured. We are also talking to him and assessing his level of consciousness. Always get a baseline neuro assessment on any casualty. Look for and control any life-threatening hemorrhage.

    Airway is going to be a huge concern for us for a couple of reasons. 1) The facial region is extremely vascular and will bleed a lot in addition to the large amount of bones, teeth and soft tissue which can lead to an airway obstruction. 2) A head injury casualty may not be conscious enough to protect their own airway so it's up to us to ensure it's patency.

    Place the casualty on their side in the recovery position with their head slightly elevated to allow gravity to assist with the drainage of blood or other fluid away from the airway and help keep the tongue from occluding the airway as well as helping to prevent an increase in intracranial pressure. They are not a candidate for an NPA due to the facial trauma. If in a vehicle or in a seated position, you can also lean the victim forward. This victim will need an advanced airway with high concentration oxygen to ensure a patent airway adequate oxygenation of the brain is maintained. Do the best you can to prevent them from aspirating blood or vomit as aspiration of these substances can lead to a chemical pneumonia which has a 50% mortality rate. In this scenario, airway is king.

    Look, listen and feel for the breathing of the victim. Is it a regular pattern? Is it labored? Is it noisy?

    Get the bleeding under control as best you can with the use of direct pressure and with superficial bleeding, hemostatic gauze (not packing into a breached cranial vault, just superficially if it’s a laceration via “grazing wound”) and direct pressure/pressure bandages.

    Check their neuro status again (and very frequently).Talk to them to gauge their orientation and their response to stimuli. Look at their pupils and shine a light into them. Do the pupils react to the light by contracting? Are they fixed and dilated? Is one large and one small? If they are reacting quickly, this is a good sign as it shows the brain is being perfused well by blood and oxygen. (two of it's favorite things next to glucose) If they are sluggish, it can indicate decreased perfusion caused by swelling or lack of volume, which can lead to bigger problems (ie. build up of waste products, leading to high concentration of CO2 which leads to swelling and eventually the brain herniating, which is fatal). If the pupils are fixed and dilated and non-reactive to light, this is an ominous sign. If one pupil is larger than the other, this is also a cause for concern, especially if the larger pupil is non-reactive. (some people have a condition called “Anisocoria” in which one pupil is naturally larger than the other)

    Expose the victim for any further injuries and treat as necessary. Keep their head elevated, protect the airway and keep them warm. Watch for any signs and symptoms of shock and evacuate to a higher level of care immediately.

    A head injury is a game-changer, whether it’s a closed injury or an open injury. Even if you do everything in your power correctly, the outcome may not be in their favor. We can only treat what we can see and to the level of our training. The rest is out of our hands.

    At the end of the day, knowing that you put 110% of your effort into helping another person is what it's all about.

    Talk to them and assess their neuro function, control life-threatening hemorrhage, maintain airway, monitor breathing, treat other circulatory injuries, reassess neuro, expose, watch for shock, reassess, evacuate.

    Keep it safe and keep it simple.

    "What If? Wednesday""In The Blink of an... - Dark Angel Medical, LLC | Facebook
    Last edited: Aug 19, 2015
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  2. Ganado

    Ganado Monkey+++

    A great post melbo and I am going to ask/say something very controversial.

    If it is very traumatic injury are you/we/medical personnel doing the person shot and the family any favors by trying to save them.

    I think this is a critical question to ask in any situation. I think we do the best we can but I am not a 'life at any cost' person. Sometimes the kindest thing we can do is let go. The difficult part is ... when do you try everything you can and when do you let go. Just my 2cents
    Last edited by a moderator: Aug 19, 2015
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  3. Dunerunner

    Dunerunner Brewery Monkey Moderator

    Unless there is a good samaritan law in your state that protects you for trying to provide assistance, or if you have had any first aid training, be cautious about doing anything. If you are a medical professional, you may want to provide assistance if you have insurance.
    STANGF150 likes this.
  4. melbo

    melbo Hunter Gatherer Administrator Founding Member

    Sheep dogs gonna sheep dog :)
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  5. Ganado

    Ganado Monkey+++

    @melbo I feel you and I'm not trying to be difficult. I just think asking the question is valid
    melbo likes this.
  6. melbo

    melbo Hunter Gatherer Administrator Founding Member

    I see your point @Ganado but I consider the above information to be valuable for the situations I place myself in now and more perhaps post SHTF. I'm all about letting go if there is no chance for a recovery to normal life but I think that there are many instances of severe head trauma that are salvageable if the proper response is given. I've seen some pretty nasty car accidents where the people are living normally now even though they looked like death was already spread all over the road when the accident occurred.

    I live in a 'Good Samaritan' state and would do all that I can based on my skills and training.
  7. Ganado

    Ganado Monkey+++

    @you have a good heart xoxo
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  8. chelloveck

    chelloveck Diabolus Causidicus

    I understand where you are coming from @Ganado, but although the chances of survival may look awfully low, the injured person deserves a chance at life, even if their trauma results in the prospect of somewhat lesser cognitive functioning. The brain is an amazing organ, and has the capacity to repair itself. It is remarkable what recoveries have been achieved from the most horrific looking head wounds once the injured person gets to the Hospital emergency OR. However, they must survive until they get there, and that is much dependant on the application of competent first aid at, and on the way from the scene of the injury.

    Tucson Shooting: Like Gabrielle Giffords, Some Survive Being Shot in Head - ABC News

    I agree.

    Having the necessary resources (D.A.R.K.) with you also means that if someone at the scene has better first aid knowledge and skills than you have, (but no FAK/ D.A.R.K.), then they can use your kit to offer treatment without having to make MacGyver improvisations with duct tape elastic bands and string.

    Last edited: Aug 19, 2015
  9. melbo

    melbo Hunter Gatherer Administrator Founding Member

    Maybe. We should probably ask my wife ;)

    I think my stance is Golden Rule based. I'd like it if skilled people with good gear tried to save me in a situation like this. I'd also like to give the family the opportunity to make the decision later rather than me doing nothing at the scene.

    My wife was once the first car to pull up on a motorcycle accident. She made the driver comfortable by covering him with a blanket while waiting for life flight to arrive.

    He bled out from a radial artery before rescue services showed up. She wasn't trained but could have possibly saved him if she were.
  10. duane

    duane Monkey+++

    The comment I would like to make about all first aid, accident response and such is something that happened to me about 15 years ago. It was snowing and there is a stop sign on the slope of the hill and it is hard to start back up when the road is covered with snow. A neighbor kid, about 19, with an old beater of a car did not stop and went across the road. Of course the car coming down the hill, that he did not see, could not stop and t boned him. I got there about 10 min later and arrived just about the time the local first response team arrived. There had been people present at all times from when the accident happened. The kid was slumped over in his seat and had his head leaning forward and his body restrained by the seat belt. He did not get enough oxygen and suffered brain damage and is still in a nursing home and does not respond. The guy I know on the fire department team said that if someone had held his head up, not even cleared his airway, he probably would have been home in a couple days. Yes the fireman signed me up for the refresher Red Cross First Aid as well as about 15 other people in our church. It hit just a little too close to home and it is a lot different than seeing it on the 6 o clock news. First Aid knowledge does two things,it may help save a life or may prevent you from making the situation worse. Even before TSHTF the odds of you being first on the scene of an accident are probably many times higher than an EMT being there as it happens. We tend to forget what accidents were like before the ever present cell phone. If we lose them, we are back to 15 to 20 minute response times with land lines and half an hour or more without them. Back in the 1940's they used to say that if a barn caught fire, bring marsh mellos and hot dogs, as if the farmer could not stop it, by the time the fire truck got there 30 minutes later and had only had a few hundred gallons of water they would not save it.
    Last edited: Aug 19, 2015
  11. Airtime

    Airtime Monkey+++

    As a former EMT in a previous life, this is not a hard to answer question. Assuming your continued efforts are not depriving someone more savable of that chance (now or in the future thru comsumption of non-replaceable resources post SHTF) or putting you or your team in unnecessary risk, you absolutely do everything you can to save a life. Period. Even when you know it probably can't be saved. The last thing you want is any residual question residing in the victim's family's minds that your discontinuing efforts possibly killed the victim. You want the family to appreciate and love you for doing everything possible. You don't want then full of grief AND consumed with hate towards you. Because if there was just a .001% chance of being successful in saving the victim, it is 99+% probable they will honestly believe their family member was that unique 1 out of 100,000 that could have survived.

    And even more importantly for the rescuer, you don't want to lay awake at night struggling with the same question of yourself!

    I once did CPR through vomit and blood with no mask (I knew the victim and infection risk was low) for 20 minutes until more help arrived on a person I knew had a broken neck and probably a ruptured aorta. I knew she wouldn't make it. I did it to give the screaming husband the comfort I did everything I possibly could. I did it to give myself the same comfort.

    Last edited: Aug 19, 2015
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  12. kellory

    kellory An unemployed Jester, is nobody's fool. Banned

    My daughter just got hired on as an EMT. She is out of state, and did it almost all on her own. (Lots of phone calls;)) she had her first run as crew while training. First call comes in, and she is excited!! Then the call gets spelled out......mother to be with a pace maker, which stopped.:eek: my young lady did CPR all the way into the hospital, would not give up, would not stop. Both mother and child lived. She will receive two save pins for her very first run. (One is rather rare.)
    I took training as a boy scout. No where near the level of many others here, but mock disasters, plane crashes, that sort of thing.
    We were traveling once and saw a car flip, as the driver dosed off and caught a pole stabilizer cable. We were the only one who could speak Spanish. The cops, the paramedics, could speak not one word.
    My wife and I were the linguistic link all the way to the hospital ER, where another could take over. Language, is also a medical tool.
    Last edited: Aug 19, 2015
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  13. Dont

    Dont Just another old gray Jarhead Monkey Site Supporter+++

    @melbo , you do exactly what was done in your scenario.. If anyone here was to stand by and watch someone bleed out and had not acted, they would be haunted with the what if's.. I am assuming a great deal here, however, I do know a mother that calls twice every day to find out how her son is doing, does he seem happy that day, did he go to an activity and is his favorite aide working that day.. She prays every day that the Lord will heal her son and every day I promise that I will go in and tell him that she loves and miss's him. I always add that he is her angel. Then I comment on the gal on the TV and how she has big ...... All ways makes him lough. Some things never die, a mothers love for her son and a young man's appreciation of big .....
    Last edited: Aug 20, 2015
  14. Clyde

    Clyde Jet Set Tourer Administrator Founding Member

    When Melbo and I used to drive to school together, we had an occasion where a rabbit was injured and needed to be humanely put down. We had a couple choices. Stomp on it's head or slit it's throat as all there was in the care was a pocket knife. I guess we could have taken it to a vet clinic, but it was a wild rabbit.

    So, when it come to a life that really matters like that of a human being, putting one out of their misery is not an option; therefore, the only real option is to help (911) + what ever you can do to stop the bleeding and maybe keep the person alive until the medical team arrives. Without some sort of training, the option one is left with is to be an observer -- and that is the worst of all options.

    Last edited: Aug 20, 2015
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  15. Ganado

    Ganado Monkey+++

    I knew several people were going to miss the point.

    @Airtime I really appreciate your honest and thoughtful post. I see your point.

    I've had two friends with tramatic brain injuries. .. one cursed being alive every day for 5 yrs. The other was an LEO and it took her 15 years to function again. And on cloudy days she still has problems and can only get out of bed from one side of the bed or she can't function. .. it was why I asked the question
  16. vonslob

    vonslob Monkey++

    These are some really great posts. I can see both sides but in the end I would rather help then not. Ganado I understand what you are trying to say, TBI's are rough. I was involved in a serious injury situation almost a year ago and with the training I have (wilderness first responder) I felt hopeless, never want to feel that ever again. Watching the life drain out of someone you love is indescribable and still lose sleep over it. I day dream about it everyday and hope that someday it will go away, looking at a grandfather watch his teenage grandson leak his life away haunts me. We stabilized him but it was his youth that saved him. I say learn all you can so that you can do what you can.
    Ganado likes this.
  17. melbo

    melbo Hunter Gatherer Administrator Founding Member

    I understand what @Ganado is bringing up. Sometimes a life saved is not really a life as we'd like to live it. My family has clear instructions on what I'd like them to decide should I be in a state like she's described. I would still rather give that family the decision or at least the time to say goodbye.

    I'm a doer. I will not stand idle while someone bleeds out in front of me especially since I have the knowledge and carry the tools EDC.
  18. Airtime

    Airtime Monkey+++

    Amen. I understand all too well with family members there may be situations where death may be the better outcome. In the context of the original discussion regarding first responders, I concur it is not the prerogative of the responder to make that decision. It belongs to the family and their doctors.

    Interestingly Granado raises a good question with a data point of a person who struggled for 15 years before being able to function again. But that person DID function again. Would it have been right for the responder to have made the decision to eliminate the possibility for that to have ever occurred? I think it argues for the perspective to do all you can.

    People who seriously attempt suicide but don't succeed, as a rule after recovering acknowledge that attempt was a really bad idea and are thankful it failed. I believe a good majority of people who survive a horrific injury with a severe handicap or bad outcome have a comparable thankfulness to be alive. And the few who aren't thankful, how is the aid responder to know who those few exceptions may be when deciding to render aid?

    Post TEOTWAWKI may well be a different scenario and the ability to render long term aid and rehabilitation may rightfully alter the decision matrix. But until then or until I can predict the future and injury outcomes with near perfect accuracy, I too will do everything I can to save a life.

    Last edited: Aug 21, 2015
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  19. melbo

    melbo Hunter Gatherer Administrator Founding Member

    Amen brother.
  20. Dont

    Dont Just another old gray Jarhead Monkey Site Supporter+++

    I am a firm believer that, 1: I do not hold the right to decide the fate of another. Well, if they have placed themselves into that position by an act of aggression directed at my family or bretheren, I will quickly decide. 2: Fate or God places us into situations that require us to act, if it is the right action or not is only determined within ourselves and our conscience.
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