I can't count the number of times I've taken away a gun or worked with one pointed at me by getting there first. That was a different time, younger and faster...and not so fat. I agree with TAM, if I am forced to shoot someone to survive an attack, why would I endanger myself by rendering aid beyond the call to 9-1-1?dicion wrote:hheremtp wrote: While the law may not require medical personnel to render aid; the licensing agency may look at things totally differently when it comes to the obligation to fulfill ones duties as a medical professional. It may seem cut and dry for the non medical professionals, "that guy attacked me, why should I help save him?" but it becomes a real grey area when it comes to us medical professionals.
Well, if that's the case, I would say, "Better to be judged by <Insert # of people on the board>, than carried by 6."
I still do not believe that would be true. As said above, security of the scene is the first priority. If you were responding to a shooting as an EMS, you would literally sit there and wait, while the guy was bleeding, until the police secured it, and deemed it safe. Why would this be any different in your own home or anywhere else? Shoot the guy, Call police and EMS, then, once they arrive and deem it safe, by all means, feel free to start assisting the perp at that time if you really want to. Just because you 'arrived' first (Because you were already there) Doesn't get you a pass to not wait for the police. This scenario is no different in that respect than a 3rd party shooting.
A word about CPR:
A witnessed medical arrest (or unknown time of arrest) is a compressions only protocol now. The thinking being that residual oxygen in the blood will perfuse the tissues enough to stem off brain death for the few minutes it takes EMS to arrive. Oxygen exchange from mouth to mouth or other ventilation simply is not that effective when compared to compressions only. Definitive ventilation (intubation, oxygenated air via bag or positive pressure mask) is the only means by which a reasonable O2 saturation can be hoped for. In adult CPR, ventricular fibrillation is the cause in the vast majority of cases and defibrillation, early and aggressively is the fix. That's why publically accessible AEDs are a good thing.
Trauma CPR:
When you poke holes in someone and they arrest there are several causes to consider. The body is a closed circuit with fluid exchange on a molecular level. There is a pump, control circuits, plumbing and a gas exchange system that must operate within parameters to keep you alive much less conscious. As these systems are compromised the body will shut down in regression to attempt to preserve life.
Leakage - Sanguinary depletion (leaking pipes) is the most common cause. Hypovolemic shock can only be treated by first plugging the leak, then replacing the volume. CPR in this case is an act of desperation as there is simply not enough "stuff" to push around. EMS can abate the fluid loss, replace the volume with salt water, ventilate and manually work the pump while hoping for the best but time critical definitive care is the only hope. That's why in metropolitan systems, trauma (not arrested) will go to nearest trauma center while trauma CPRs go to the nearest hospital period regardless of capabilities. CPR due to leakage has a dismal survival rate. Secondary to that is in many cases, the pipeline is irreparably damaged and emergency workers often get to watch a life slip away while they are helpless to stop it.
Pump Damage - A hole in the pump is a major problem but remarkably, the body will try to stave off the imminent death by spasmodic contractions of the muscles surrounding the wound and stemming leakage. That said, the wiring can be damaged and there is of course the likely hood of catastrophic damage. There is a lot of important stuff and sometimes the body's own protections will backfire. The pericardium can fill with blood for instance and strangle the heart. If the cause is the pump and CPR is the result, the outlook is grim but ironically not as much so as the simple plumbing failure. I have seen a man revived after the ER doc use a cardiac needle to enter the pericardium and pull the blood off. I have also seen a man shot with a .45 (presumably FMJ) which turned out to have a hole (through and through) in the right ventricle (which is critical but not as bad as the left ventricle) conscious and talking all the way to a hospital and later out and alive.
Gas Exchange System - Poking wholes in this area is bad, real bad, but it is also survivable. Tension pneumo-thorax is one of the deadliest consequences of this kind of damage. It results from what we call in the vernacular a "sucking chest wound" more precisely a perforated chest wound. What occurs is the lung deflates and fills the pleural space with air, every time the person inhales the negative pressure created by the diaphragm "sucks" air into the void space but it does not let it out readily. So pressure increases, the lungs displace and cannot fill adequately and the heart cannot keep up the work load and the person suffocates. As severe as this is a temporary treatment can be affected by placing a one-way valve dressing (usually a make shift using a venti-cover or dressing packaging) and needle decompression.
Hemo-thorax works much the same way except the void is filling with blood. Sitting the patient up and poking wholes is about the only thing you can do in the field, but the bleeding is internal and must be abated surgically.
Then there is bleeding into the lungs themselves resulting in drowning. Ironically with quick intervention there is a decent chance of success even in CPRs (know time of arrest and mitigation methods used).
Circuitry - The control center and wiring can be switched off or disconnected and the pump, plumbing and ventilation system will continue to operate for a brief time and slowly they will degrade and shut off. CPR here is useful only to provide a viable organ donor to the emergency room.
Short story is this, a trauma CPR has little chance of success in the field, time to definitive care is the only mitigating factor. Someone who is leaking but not dead is still a danger. Activate 9-1-1 and stay clear...keep safe.