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Old May 8, 2019, 10:54 AM   #1
Bartholomew Roberts
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Trauma Care In Civilian Mass Shootings

A recent review of civilian mass shootings by the National Association of Emergency Medicine Physicians concluded about 7% of casualties in the mass shootings they examined could have been saved by immediate medical help.

Additionally, they noted zero victims died as a result of exsanguination due to a wound on an extremity.

The unanimous agreement of the physicians doing the review was that the vast majority of the 139 victims from 12 different mass shootings were unable to survive their wounds even with immediate medical attention.

Source: https://www.thetruthaboutguns.com/20...ve-been-saved/

So, what does this suggest for strategies to survive mass shooting events?
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Old May 8, 2019, 11:12 AM   #2
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Don't get shot?

Seriously though, strategies? It's not as if we can choose where to get shot, and if we could we'd choose not to get shot.

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Old May 8, 2019, 12:40 PM   #3
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Quote:
So, what does this suggest for strategies to survive mass shooting events?
It says the:

Quote:
National Association of Emergency Medicine Physicians
Thinks they are doing a good job.


I would say the issue is not with EMT's or Emergency physicians. The area with the most room to improve would be good samaritan and untrained first responders at the shooting sight.

Keeping such things as tourniquets, quick clotting bandages, defibrillators, AMBU bags, Oxygen, Ringers, Normal Saline IV, etc as well as the training to use them should be a part of every school faculty, place of worship, and community center.

It does not take very long to learn to use any of these items and they should be available in first aid kits.

Basic first aid training should be something every responsible gun owner seeks out independently.

Additionally, a trained first responder kit should be maintained which has things like controlled meds such as Adrenaline shots and morphine to pushed to any trained responder that happens to be present.
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Old May 8, 2019, 12:43 PM   #4
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I'm starting to see Bleeding Kits on the walls of some places along with the Defib kits.

I agree that getting training is a good thing.
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Old May 8, 2019, 12:43 PM   #5
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Aside from not getting shot in the first place, I believe the most effective strategy is to shoot back. According to a few articles I've read, armed resistance tends to stop mass shootings pretty quickly. The attacker is either neutralized or kills himself.

I think it is also important to get some first aid training. While you may never need it for a self-defense situation, it is always better to have the knowledge and not need it, than to need it and not have it. I was certified in American Red Cross First aid quite a few years ago. I think it is time to get re-certified.
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Old May 8, 2019, 12:54 PM   #6
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Isn't the argument in this article that stop the bleed kits or similar wouldn't have had a significant impact? That's what I'm reading from the claim that immediate care wouldn't have made a difference, and a tourniquet is of somewhat limited value if no one is dying of blood loss from an extremity (obviously a tourniquet isn't the only thing in a stop the bleed kit). This isn't me downplaying the importance of those things as I think they're critical, but this article seems to be saying that the vast majority of wounds were mortal almost immediately.

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Old May 8, 2019, 01:02 PM   #7
shafter
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7 percent sounds like a really low number.
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Old May 8, 2019, 01:31 PM   #8
Bartholomew Roberts
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Reading between the lines, the article seems to be saying that the 12 civilian mass shootings they evaluated happened in circumstances where A-zone hits were extremely likely, and given good A-zone hits, immediate first class medical care won’t help much.

I believe they mentioned an average wound count of 2.7 per victim, so it is possible the fatal wounds are inflicted after the victim is wounded; but not fatally.

Tunnel Rat’s first response seems a little snarky; but it is hard to draw a different conclusion after reading that. It does make me wonder though if our current mass shooting strategies might be abetting this by creating easier targets for an active shooter? Would teaching the use of cover and the difference between cover and concealment be more effective than blowout kits easily on hand?

On the other hand, we should acknowledge the limitations of this data too:
1) It examines only 139 fatalities in 12 mass shootings, and 14 of those fatalities lacked autopsy data.
2) By examining fatalities, it excludes those who were shot and survived or not shot at all, so hard to draw conclusions about more general efforts to mitigate.

Last edited by Bartholomew Roberts; May 8, 2019 at 02:19 PM.
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Old May 8, 2019, 01:34 PM   #9
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Military First Aid isn't the same thing as civilian First Aid. Explosions aside, those usually cause traumatic amputations or worse, even the current lot of bad guys pestering our troopies use FMJ bullets. Ain't the same 1st Aid that applies to commercially available HP or SP ammo. And it requires training, especially the psychological kind, to deal with the huge amount of blood that's involved. You can have 100 first responder kits that'd be useless with a trained first aider.
"...things like controlled meds..." Not a chance morphine will be left hanging on a wall in an unlocked box. It'd be stolen in minutes. In any case, morphine doesn't stop bleeding or deal with shock.
This says its shelf life is only about 6 weeks too.
https://www.ncbi.nlm.nih.gov/pubmed/7876368.
"...to shoot back..." First one must have a firearm and the skill to use it.
The real issue is how 'soft' people really are. Slightest wound and they fall apart. Human do not survive like say a deer can. There are lots of pictures, stories and videos of deer with horrific wounds(like legs hanging off, etc.) that will kill a human.
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Old May 8, 2019, 04:08 PM   #10
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Quote:
Military First Aid isn't the same thing as civilian First Aid. Explosions aside, those usually cause traumatic amputations or worse, even the current lot of bad guys pestering our troopies use FMJ bullets. Ain't the same 1st Aid that applies to commercially available HP or SP ammo.
Cause the Military bleeds differently??? LOL

Hopefully you will never have to sort thru the limbs, torso's, and heads in the aftermath. In personal experience, I can say that when 9 men get blown up at once, it creates a lot of blood. In fact, it rains a red mist for an uncomfortably long amount of time.

Honestly, your point on their being some difference based upon a hollow point rings...well....hollow.

The article does note that injuries to the extremities are more common in the Military.

Quote:
...things like controlled meds..." Not a chance morphine will be left hanging on a wall in an unlocked box. It'd be stolen in minutes. In any case, morphine doesn't stop bleeding or deal with shock.
You do know that controlled med kits are fairly common in the first aid world. We have em at our civilian company workplace. No we do not have doctors and EMT's roaming the hallways either.

Nor are controlled med kits hung on the wall in an unlock box....that would be the "uncontrolled" first aid items, LOL.

Because you are not read into the availability and location has nothing to do with the fact they are available when required to those who are trained.

Quote:
You can have 100 first responder kits that'd be useless with a trained first aider.
Which is the point I made....

If you want to improve survival rates at mass shootings then train the untrained first responders likely to be present and have controlled med kits available for those who are trained.

You would be surprised at how many trained first responders are off duty without necessary equipment when a crisis occurs. Have a kit available.
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Old May 8, 2019, 04:09 PM   #11
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Reading between the lines, the article seems to be saying that the 12 civilian mass shootings they evaluated happened in circumstances where A-zone hits were extremely likely, and given good A-zone hits, immediate first class medical care won’t help much.
The author seems to be saying that more guns is the answer. Of course the faster the shooter is stopped, the less damage he can do.

However, to conclude medical care is not required or is "good as it stands" I do not think is the correct direction.

For example in a typical mass shooting we see that 44.6 out of 100 casualties are going to have a fatal wound.

Quote:
The case fatality rate for civilian mass shootings was 44.6%
Out of the 44.6 people, 7 of them had wounds that would have been survivable had they had there been level 1 trauma care available.

That is not including 14 people whom there is not enough data to evaluate because no autopsy was performed which is statistically significant considering our small sample size.

That still leaves 55.4 injured people who need to be treated and on the front side, 100 people that need to be triaged.

Given some good data such as the lack of extremity wounds, we can conclude that using that cool tourniquet is not as likely as it is on the battlefield.

However given the fact most injuries are to the thoracic region we can conclude that controlled med kits, sucking chest wound first aid, kirlex, thoracic bandages, etc..

Are going to be important as well as the training to use them.

Quote:
The most common survivable injury was a wound to the chest (89% of all survivable injuries) without obvious evidence of vascular or cardiac injury
https://www.thetruthaboutguns.com/20...ve-been-saved/
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Old May 8, 2019, 04:12 PM   #12
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Originally Posted by davidsog View Post
Cause the Military bleeds differently??? LOL

Hopefully you will never have to sort thru the limbs, torso's, and heads in the aftermath. In personal experience, I can say that when 9 men get blown up at once, it creates a lot of blood. In fact, it rains a red mist for an uncomfortably long amount of time.

Honestly, your point on their being some difference based upon a hollow point rings...well....hollow.

The article does note that injuries to the extremities are more common in the Military.



You do know that controlled med kits are fairly common in the first aid world. We have em at our civilian company workplace. No we do not have doctors and EMT's roaming the hallways either.

Nor are controlled med kits hung on the wall in an unlock box....that would be the "uncontrolled" first aid items, LOL.

Because you are not read into the availability and location has nothing to do with the fact they are available when required to those who are trained.



Which is the point I made....

If you want to improve survival rates at mass shootings then train the untrained first responders likely to be present and have controlled med kits available for those who are trained.

You would be surprised at how many trained first responders are off duty without necessary equipment when a crisis occurs. Have a kit available.
Well said!
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Old May 8, 2019, 10:17 PM   #13
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While most may not survive, there have been many cases where someone may have survived with prompt care. There is one of these in every classroom in our schools. LE is getting better at ending these situations faster. But in some cases it has taken over an hour to clear the buildings for medical staff to safely enter.

I keep several in my truck and keep one in a pack. It is really a good idea for hunters. Not just for treating gunshots, but any type of bleeding.

https://www.amazon.com/Adventure-Med...s%2C153&sr=8-7

I actually had to use one a few weeks ago and it may have saved an expensive dog's life. While searching for a missing person one of the dogs cut her leg badly on a piece of metal roofing. It severed an artery in the lower leg and it was an hours drive to the closest vet. The blood clotting powder slowed the bleeding enough to make it to the vet. The dog required surgery, but will be OK.
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Old May 9, 2019, 10:15 AM   #14
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Out of the 44.6 people, 7 of them had wounds that would have been survivable had they had there been level 1 trauma care available.
For those of us not well versed in the terminology and not knowing where to go to look it up, would you please explain WHAT level 1 trauma care is? Is it a first aid kit? EMTs? the ER? the OR??

Quote:
While most may not survive, there have been many cases where someone may have survived with prompt care.
Quote:
A recent review of civilian mass shootings by the National Association of Emergency Medicine Physicians concluded about 7% of casualties in the mass shootings they examined could have been saved by immediate medical help.
Note the difference in the three statements, "would have been survivable" and "may have survived" and "could have been saved..."
Of the three, I think "may have survived" is the only one with validity.

Doctors (or anyone else) playing with numbers from reports and studies making flat statements about who would and would not have survived are presenting their guesses and opinions as fact.

"May have, could have, might have" are good words to use when one does not and CAN NOT know with certainty. Some might consider those words only giving "wiggle room" but I consider the use of them important so as not to create a false impression.

The problem is that people don't want to expend effort and spend money on "may have, might have, could have", but they will spend it on "will have", so despite the truth, that's how things get presented.

That is also the fallacy of gun control laws. Accepting what MIGHT be as what WILL BE, and acting on that in the direction the agenda drivers want.

We do our share of it, too.
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Old May 9, 2019, 11:26 AM   #15
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Whatever you have available to you either by design or by happenstance.. may help in any number or situations or maybe it wont. Being more prepared is typically a better position vs being less prepared. So just decide what you want to do.

If you want to carry first aid "stuff".. fine. Put some thought into what would be more practical in your particular setting and have at it. I tip my hat to you.

I don't think it makes much sense to do any handwringing over statistics or mass shooting data. Maybe "a mass shooting" is not the circumstance you happen upon or are thrust into.

I carry a fairly average med kit in the trunk of my car. I will carry some basic essentials on my person is I am in the wilderness or somewhere remote but I am not walking around the mall poised to render medical assistance. I will call someone , that just me.
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Old May 9, 2019, 01:05 PM   #16
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The only thing I have to add is that you don't have to stop bleeding to help someone - it might be enough to reduce bleeding. With abdomen or chest wounds you are unlikely to see the bleeder until you are in surgery, but if you slow the bleeding with broad pressure to the abdomen (ideally a compression bandage of the entire abdomen, and if not ideally as close an approximation as you can improvise) or covering and applying pressure on the visible chest wound, it could make a difference in whether they get to surgery. What you are doing by these techniques essentially is creating indirect pressure on the bleeder. Sometimes it is going to work and sometimes not, but it can be worth a try.
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Old May 9, 2019, 01:11 PM   #17
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The following link has an in depth explanation of the different levels of trauma care provided by a hospital. The ER is the emergency room, and the OR is the operating room. The EMT's are emergency medical technicians trained to respond to emergency situations such as medical emergency, truama injuries, and accident scenes. They normally are the people that ride and drive the ambulances.

https://www.amtrauma.org/page/TraumaLevels
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Old May 9, 2019, 04:16 PM   #18
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The thing many gloss over is that medical aid is not coming from the outside until the scene has been deemed secure by the responding LE. You are literally on your own, plus if you are engaged with the killers you are in danger of taking fire from responding LE.
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Old May 9, 2019, 04:36 PM   #19
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^ this is why as a church safety team member we train in tactics and first aid, local EMT will stage a safe distance waiting for all clear. So we become first responders by default.


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Old May 9, 2019, 05:23 PM   #20
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I object to Medical professionals acting as shills for gun control

What I really object to is the medical profession acting as shills for gun control. A while ago 60 Minutes ran this piece: (Note: unfortunately you can’t watch it unless you subscribe to “CBS All Access”.)

https://www.cbs.com/shows/60_minutes...e-of-his-life/

In it were the following quotes:

Quote:
An AR15 victim from the Parkland mass shooting was saved
“because Broward county EMS recently equipped itself for the battlefield wounds the AR15 inflicts.”
Of course, because the AR15 creates wounds totally different from other firearms (the implication is that’s why the AR15 should be banned).

One of the EMT’s said,
Quote:
“We carry “active killer kits” in our rescues (ambulances).” Kits that contain 5 tourniquets, 5 decompression needles, 5 hemostatic agents, 5 emergency trauma dressings.
Of course there would be no “active killers” and no need for these kits if we had decent, “common sense” gun control.

Broward county medical director said
Quote:
“We never used to [before recent mass shootings] carry tourniquets, we never used to carry chest seals,”
Then sir, I would suggest your EMTs were woefully under equipped to deal with a tornado, multiple car collisions on the freeway or any type of explosion.

After one of the school shootings a doctor’s 12 year old son was scared to go to school.
Quote:
“After the shooting he looked at me with the fear of God that he had to go to school that day. My first instinct was that he needs a bleeding kit”
Tell me this isn’t pandering to the anti-gun crowd.
Also, if your kid is shot badly enough to need the bleeding kit is he going to apply it to himself? If he’s got it, do others know he has it? Are they going to know what to do with it? And before every single parent starts outfitting their kid with a bleeding kit (because aren’t all other parents just as concerned about their kids as you are?) maybe suggest the school have some folk trained and equipped for first aid.

And I would suggest you as parents were greatly responsible for instilling this fear. Consider the odds of a school shooting happening at HIS school. Before you get your get kid all frightened, think about what other dangers could befall your kid at school or on the way to and from.
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Old May 9, 2019, 08:34 PM   #21
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MANY moons ago, I wrote a composition for my English class in college. The main theme was that the middle schools in the US should have instruction on very basic emergency medical techniques (opening airway, controlling bleeding etc.) I said that there would be plenty of EMTs around if the teachers didn't want to get trained to do it. (Later, I even went to my twin sons' grade school {I was an EMT} on parent day and, with the aid of a training model that I got at my EMS service, I showed the kids how to check and safely open an airway as well as putting pressure on an open bleed. The kids were very attentive and I got a lot of very positive responses from the kids, the parents and the teacher. )

I also said that there should be a full course on first responder level emergency medicine in every high school and the students should have to pass this class in order to graduate.

I got a great grade on the paper but that is about as far as it went.

Imagine the number of lives that would be saved every year in this country if there was this type of program in existence? I'm not talking about just mass shootings, which is the theme of this thread, but everyday living emergencies. Just my .02.

PS - I even was given the opportunity to give a bunch of my fellow employees (Oscar Mayer) a quick and dirty lesson on basic emergency medical treatment, on company time I might add.
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Old May 10, 2019, 10:20 AM   #22
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Quote:
7 of them had wounds that would have been survivable had they had there been level 1 trauma care available.
Thank you for the link, it seems level I trauma care is what is provided by a level I trauma center, and the link describes what a level I trauma center is, and that is a major hospital.

which makes the quoted statement somewhat confusing to me.

Unless there is another list somewhere stating what Level I trauma care IS, and that is different from a Level I Trauma care center. IF level I trauma care is what you get at a major hospital, then its NEVER available "on scene" (unless the shooting happens in the hospital). SO, isn't it always "available"??? The only difference would be the transport times to get the victim from the scene to the level I trauma center.

SO, shouldn't the statement be
7 of them had wounds that would have been survivable had they had there been level 1 trauma care available before they died. or 7 of them had wounds that would have been survivable had they had there been level 1 trauma care available immediately on scene. Or something like that??

tell me what is the good of some doctors saying, in effect, "we could have saved these people if they had been shot at the operating room door..."

I feel I must be missing something, some difference in definition between "level I trauma care" as used in the quote and what my net searches turned up, which was always "level I trauma centers".

If you know what the difference is (if any) please enlighten an old soul, because if there isn't any difference then those docs are spouting bullcrap.
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Old May 10, 2019, 10:51 AM   #23
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Quote:
Imagine the number of lives that would be saved every year in this country if there was this type of program
Blackwidowp61---are you saying the average person might be able to do something USEFUL???

Haven't we been indoctrinated that to put a bandage on a wound would take years of medical, legal and psychological training in order to TRULY help the person? Don't we need to leave these things to the PROFESSIONALS?

Here's an old article (from England) about 1st responders being forbidden to wade into a 3 foot deep lake to rescue someone because they didn't have the training to do it.
https://www.dailymail.co.uk/news/art...ety-rules.html

Yeah I'm being sarcastic, but the link above is real.

I totally support the idea of first aid training in high school.
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Old May 10, 2019, 02:40 PM   #24
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Level 1 trauma care basically means that specialized care for that certain individual can be provided due to the resources available at that hospital. The resources could be a neurosurgeon, a cardio thoracic surgeon or some other specialized trained medical team. For example in my hospital when we had a patient with severe life threatening burns, the patients brought in would bypass the ER and go directly to the burn unit where the burn unit team was ready to receive the patient and provide care.

General surgeon can provide great care and immediate life saving care but if the more specialized care like listed above is needed their knowledge and expertise is limited and the facility or hospital may not have the specialized resources needed for long term specialized care. This is the difference between a major level one hospital and the others.

I worked at a level one Trauma Center and provided support at the emergency room at Brooke Army Medical Center for many years. When ever we received a trauma patient that needed specialty care the general surgeon would request that the appropriate doctors with their specialized skills and training be called, if not everything was handled by them. The emergency room all it does is stabilize the patient further until proper immediate and long term care for their specific needs are met. The EMT guys do a fantastic job of stabilizing the patients enough to get them to the ER. The real heroes are the EMT guys in my opinion.
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Old May 10, 2019, 06:58 PM   #25
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Just an example of not being allowed to do what you need to do which actually happened to me. It was one of the first calls I had after becoming an EMT.

I was on one night at the Town of Madison EMS. The crew had turned in for the night when, about 2am, the pagers went off for a shooting. We were on-scene within 10 minutes but were told by PD to stay a couple of blocks away until they called us in.

While we waited, we kept getting more details from dispatch about what was going on. The scene of the shooting was in a fast-food place (Taco Bell). Dispatch had one of the employees on the phone. The employees were locked in the office, but they could hear the employee who had been shot moaning in the store outside the office, which told us that the employee was still alive. (As time went on, we were told that the moaning stopped.)

We also learned that the reason that we were waiting off-scene was because the LEOs on-scene didn’t know if the shooter had left or not. They weren’t going to call us in until they had cleared the store.

What they didn’t tell us at the time, but we found out afterward, was that there were three different departments on-scene; Town of Madison PD (primary), Fitchburg PD (mutual aid) and the Dane County SO (in the area at the time?). They were arguing around about who was in charge and how they were going to go in and clear the store!

After what seemed like an eternity to my crew (the crew chief, another EMT and myself), the crew chief decided to call in the Madison Fire paramedics for ALS (advanced life support) when we were called in to the scene. The crew chief stayed in the ambulance talking with Madison Fire while I grabbed the jump kit and ran in the back of the store and found the victim lying prone on the floor with a pool of blood by his head and a hole about the size of a ping-pong ball in the back of his shirt. When I started talking to the kid, he actually answered me! Whew!

Anyway, I started treating the kid with the help of one of the Town officers until Madison Fire showed up, stuck an IV in the kid, loaded him in their ambulance and took off.

In another instance, I was working with a private ambulance service one day when we were sent to a racetrack for medical standby. Well, as fate would have it, there was a heck of a rollover in one of the races. Before the car had even stopped, I was running for it from the infield. When I got to the car (first one there), I looked at the engine compartment and saw small blue flames licking away on the motor. I didn’t even hesitate; I went under the back of the car to where the driver was hanging upside-down, flailing away in a panic. I started calming him down until he got his harness disconnected and I pulled from under the car.

Well, no good deed goes unpunished. I got chewed out by the rescue crew for what I had done and I wasn’t invited back. (No big deal since racing isn’t on my list of things to do.)

So, as you can see, sometimes you’re damned if you do and damned if you don’t. If somebody’s in trouble, I want to jump in with both feet if I believe that it is safe enough to do so, although my idea of what’s safe doesn’t always agree with somebody else. (sorry for the length!)


PS - The kid had been shot in the back with a shotgun slug which lodged in his shoulder, which is where the doctors left it. I was able to visit him in the hospital afterward. I asked him if he remembered me and he goes "Yeah, you were the one who kept askiing me all those questions!"
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