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Not On My Truck

June 9 2012 at 9:26 AM
mooster  (no login)

Response to Agree with your view.........

Speaking COMPLETELY from a civilian point of view (and when I was working ambulance full-time) there's no way I would let a guy who is essentially a bomb in the back of my truck. No way would I take him to the hospital.

In pre-hospital emergency response, the first rule is don't become part of the problem. Don't become a patient. Scene safety, crew safety and utltimately the safety of the hospital is paramount. Not the patient. He's already fucked. If you can do something about it, then you do. There isn't a line that cannot be crossed. It's more like a large grey area DMZ. I've done some dangerous type things over the years, and even found myself unexpectedly in life-threatening situations (my own life). That's going to happen in 21 years and any shift you can walk away from is a good one. I've walked away from them all - knock wood.

There are also times when you leave people dead. If you have a single patient situation, you might provide some highly aggressive treatment in a futile attempt to save that person even if you believe their situation is likely hopeless. On the other hand, in multiple casualty incidents with limited resources, you ignore the walking wounded and also ignore the ones with tickets punched. You treat the ones who you know have the best chance for a positive outcome. So a severely critical patient or even a non-breathing patient who would normally receive maximal care is left lying to die or dead as is. That's extremely rare in an urban/suburban setting because you have more resources, but it happens.

Even being totally aware that this situation with the Marine who had an RPG in his leg is a military situation and not a civilian one, my view is that there is a couple of different ways of looking at this. Was this evac crew above and beyond courageous? Hell and Yes! Was what they did also bat-shit irresponsible? Yes. They took a vote and decided to transport this guy. What about the doctors, nurses and medics back at the hospital or surgical receiving area? Do they get a vote? You can get a whole lot of people killed based upon a snap decision made in the field. The fact that this situation ended more or less happily doesn't mean that transporting this Marine wasn't a whole lot of batshit regardless of outcome.

What I would have done if I was the medical authority in the situation would be to call in ordinance guys to remove or disarm the RPG. I don't want to armchair a bunch of bravery, but it would be likely I would also stay with the patient to keep him stabilized as much as possible. Launch dual large-bore IV's, put lots of fluid in him, control the bleeding as much as possible, keep him oxygenated and get the RPG taken care of. A lot of critical time (we call it "The Golden Hour" in trauma situations) would be lost, and we might lose the Marine. But like I said above, he's already fucked. He's got a live RPG in his mangled leg afterall. If we can mitigate that and save the guy then smiles all around. If not, then that's life in a combat zone. Or death as it may be.

There was actually a situation similar to this during the Korean War. Surgeons at a MASH type place were working on a dude and discovered unexploded ordinance inside the patient's abdomenal cavity. No one knew it until the surgeon discovered it. I think it was mortar or something similar. Point in this case is that the ordinace wasn't deliberately brought in. That story ended happily and was used as a story line in the MASH TV show - with that preachy lefty fucker Alan Alda starring as "our hero."

To me, the key difference was the accidental discovery. I'm glad this situation ended well with the Marine. The courage of all involved is reassuring in a world where most people refuse to accept responsibility, where people are becoming more and more self-entitled and self-important. I don't like to see myself in that sort of negative light, but I'm here to tell you that I'm not knowingly and deliberately transporting a live bomb to a hospital. Not on my truck...

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