Since Mary is now 50, she can not be classified as a "spring Chicken" any
more. All of us "non spring chickens" now know that the activities of the
day can leave us with all kinds of misc aches and pains, However Alarm bells
go off as soon as she mentions the fatigue, shoulder pain, shortness of
breath and nausea along with her story of exertion ( which could explain the
sweating, but somehow I doubt it ). I would also be enquiring about her
state of balance, has she experienced any headache or dizziness in the last
24 hours.

Although a heart attack is classically associated with severe pain across
the chest, many people feel only a tightness or squeezing sensation in the
chest. The discomfort of a heart attack may be confined to the arm, upper
back, neck, or jaw. Some people only experience a feeling of indigestion,
nausea, shortness of breath, or sweating. The discomfort associated with a
heart attack usually lasts several hours. Other ailments such as Angina can
cause identical symptons but are usually shortlived. I would be politely
asking Mary about any history of cardiac issues, and would want to check her
heart rate. If elevated then there is another clue.

In any case I would be stongly suggest higher level medical intervention as
soon as practical if not an immediate call to EMS

Farquhar

While reading it definitely starting have the "heart attack" flag go up.

Its been pointed out though it could be many other things.

From experience as a First Aider/Chirurgeon it is particularily awkward when the
1st Aider feels there is a potentially fatal situation developing.

Arranging for transport by paramedics is the way to go. It was particularily
frightening having a possible fatality in a POV (personally owned vehicle). Its
been a mental shift to be thinking "get them medical care" instead of "to the
hospital". Alot can happen on the road which the paramedics can deal with.

It is though very frustrating when the person goes "no no, don't call". Guidance
has been to favor calling 911 to have them encourage the patient. Also, as
someone else has already reminded us when they pass out "implied consent" comes
into affect.

Brian the Green
1st aider

Scenario 5 response from Brian Goodheart, the Green Guy

Well being as Green Guy is also a Marshall I would be pointing out that he had
lost the arm in the battle. ^_^ Unless he parried the haft of a weapon.. perhaps
a polearm haft. Nice 7 ½ ft of swinging goodness could have an impact 5ft up
that wasn't where the weapons "head" was. So yeah… he could do that and not
"lose" the arm.  Still not a good idea.

Check, Call, Care. #1 Check.
I would first want to check that we are during the assessment safely away from
the fighting. Also possibly someone watching over the fighting for us.

The assessment of the arm already reflects signficant internal damage. He is
talking so ABC are in good order.

As a Chirugeon noting a fighter having a majory injury I do not have the
authority to stop them fighting. If they dont take the recommendation you can
advise a Marshall you CAN make them stop.

Being both a chiruregon and a Marshall Im a one stop shop for this one.

Marshall of Armored aka Heavy combat. Rapier marshal would be needed if this was
a fencing matter.

With that bit of SCA delegation of duties mentioned....

Check, Call, Care. #2 Call.
As a first aider I believe he needs advanced medical care. I recommend that he
either get a ride to a hospital or we call 911 for an ambulance transport. He
will not be able to drive himself in this shape. Even if he thinks he currently
can there is worse affects building in that arm. Maybe the bones are grinding
against each other but later slip off ripping into the muscles.

If we do have a vehicle, such as my own, I probably might leave out calling 911.
Though… really could call them and tell them we are arranging for hospital
transport. (I'd like to here from you others on this).

As 911 is being called I will be trying to take notes (mentally if no paper
around). This will be used for reporting within 24 hours to the Kingdom
Chirugeon should emergency services come to the site. In this scenario there is
a good chance someone at the fight practice (or myself) will use a PoV
(personnaly owned vehicle) to transport them.

On using a PoV remember to point out that the drive is acting as a regular
mundane person and not performing an SCA function.

Check, Call, Care. #3 Care.
I do keep in my large first aid box in the van one of those mesh splints. I will
offer to use it.

We also need to see about getting him out of his armor while we arrange
transport. This brings up another bit of SCA Chirugery lore... medically
removing armor.

There are discussions/documents with more detail. This is a summary:

Generally on armor removal:
1) if they can take their own armor off… let them
2) ask their friends/canton mates/household to assist as they likely have seen
the armor coming on and off before
3) if those aren't around then another fighter or Marshal can often give you
tips on how the armor works
4) The armor may actually be stabilizing an injury
5) Get permission before cutting (implied if they are unconscious)
6) If you cut, cut straps. (much easier to repair)

Arrangements also need to be made to transport or store his gear. Usually what
ever vehicle he came in can store the gear. Even if he can't drive his own car
he can lock his armor up in the trunk.

For those of you who have worked Pennsic Chirurgeon's Point, Rannveigr has been
one of the keystones of the Point for literally decades. I've known and worked
alongside her forever and my heart's shattering.  She was the chirurgeon on-call
who treated Bjarn after that fall which I sing about.

TSivia


Many on this list will know Viscountess Rannveigr Haakonardottir, OL,
OP, 3rd Viscountess of Aethelmarc.
It is with great sadness that I pass on the news that she has entered
hospice care, and is expected to live for only 3 more weeks.
She was diagnosed with stage 4 breast cancer on December 27th, which
has not responded to treatment.
She was elevated to the Laurel by Aethelmarc in November for Norse
Studies, Fiber Arts, and Equestrian.

The latest message from her husband, Viscount Sir Alexander, is given below.

Sorry to be the bearer of such bad news,
Brusten

**********************************************************************

Hi Gang,
Mary Ellen has been sent home and is now in hospice. If you want to
visit or send her a letter or card please do so ASAP. Phone calls are
problematic since she has good days where she can speak and bad days
where she sleeps a lot and has a raspy voice. As the days go by she
will get weaker and weaker and not be as lucid as she could be.

Our home address is:
1605 South Shore Drive
Erie PA 16505

Our home phone is:
814 459 1156

She does appreciate visitors. We just ask that if you have been
exposed to a cold /flu don't come, she won?t be able to handle and
infection very well.

Thanks,
Duane

Okay, a little complexity here...

Case 1)
OHIP covered chirurgeon calls for a non-covered patient. Patient refuses
ambulance. Is there a fee and who pays?

Case 2)
If I act as a Chirugeon at an event in the states. (Lets say not Pennsic which
has EMT on site anyway). Visiting chirurgeon calls for EMT but patient refuses.
Does the chirugeon get a bill?


Brian the Green

I liked these reminders.
> -keep fingertips visible for distal circulation check
> -NO use of traction.. just spint as you find it. Traction cannot be properly
maintained without the use of specialized and expensive equipment
> -consider if this person is on blood thinners or has a bleeding disorder
(internal bleeding may be more severe and/or serious sequelae)
> -remove rings/watches if any on affected limb

PS:
for limb splints the SCA has a habit of being heavily stocked in 3ft long, 1
1/4" rattan....

Brian the Green

Yahoo! Canada Toolbar : Search from anywhere on the web and bookmark your favourite sites. Download it now!

--- In E-Chir@yahoogroups.com, "b1laxson" <b1laxson@...> wrote:
>
> Case 1) OHIP covered chirurgeon calls for a non-covered patient.
> Patient refuses ambulance. Is there a fee and who pays?

It does not matter if the person who calls 911 is OHIP covered, covered by other
insurance or completely uninsured, you will not get charged a bill for calling
911. The ambulance fees only go to the patient and only if there is a transport.

> Case 2) If I act as a Chirugeon at an event in the states. (Lets say > not
Pennsic which has EMT on site anyway). Visiting chirurgeon calls > for EMT but
patient refuses. Does the chirugeon get a bill?

AFAIK, the person calling 911 will not get charged a bill for making the phone
call. How the rest of the ambulance billing works however, I don't know and I
suspect would be state specific, just as ambulance billing in Canada is
different between provinces.

Xristina

Hello everyone,

It seems I missed something at the end of last year. In order for everyone's
warrants to remain valid I am in need of a report from each of you (as well as
current certs - which most of you have already provided).

These reports can be very simple and sent in an email. I just need a quick
report on your chirugeon activities in the last year (i.e. I was chirugeon at X
number of events but nothing happened or I was chirugeon at X number of events
and had only minor treatments, I oversaw CiT whoever at 2 events, etc) and
that's pretty much it (unless you do need to send me current certs, then I'd
love the info on those too).

I have a quarterly report coming up soon so I can add the info in at that point.
Please send the reports to me privately (not on the list)by the end of February.

If you have any questions, please feel free to contact me.

In service,
Xristina

Worked Estrella War and Pennsic in 2009.
C.I.C. for a Harrowgate Heath event (nothing to report other than one
band-aid used)

CPR recert Jan 2010.
TSivia


> Hello everyone,
>
> It seems I missed something at the end of last year. In order for
> everyone's warrants to remain valid I am in need of a report from each of
> you (as well as current certs - which most of you have already provided).
>
> These reports can be very simple and sent in an email. I just need a quick
> report on your chirugeon activities in the last year (i.e. I was chirugeon
> at X number of events but nothing happened or I was chirugeon at X number
> of events and had only minor treatments, I oversaw CiT whoever at 2
> events, etc) and that's pretty much it (unless you do need to send me
> current certs, then I'd love the info on those too).
>
> I have a quarterly report coming up soon so I can add the info in at that
> point. Please send the reports to me privately (not on the list)by the end
> of February.
>
> If you have any questions, please feel free to contact me.
>
> In service,
> Xristina
>
>

Yahoo! Canada Toolbar : Search from anywhere on the web and bookmark your favourite sites. Download it now!

Just to let you all know my lady-love Emeyln and I are getting a place together.
Plan is to move in on May 1st. Got lots to do before then so Im out of action
until that is done.

Brian Goodheart the Green Guy
Most happily absent

Hello everyone,

Could all CiTs (or those who want to be CiTs) please contact me off-line? I
would like to know where each of you are in regards to your status/training
time. I haven't received a lot (or any) reports on CiTs in quite some time. If
you could let me know how long you've been a CiT and what events you've worked
at (if any). Please pass this on to any CiTs you know who may not be on this
list.

Thank you.

In service,
Xristina

Scenario 6 Response
Brian Goodheart

The first task is to assess for my own safety.

For this scenario it includes my own cooking fire. In this situation I have a
definite injured vs a possible injured from the fire. Assuming my cooking fire
is moderate in size then I can leave it. If it's a bonfire then I must make sure
someone will look after it my absence.

Now on the approach to the patient things to look for:
- the size of their fire
- the direction smoke is going (is it coming onto the patient?)
- is there loose objects on the ground?
- Is their anything cooking on the fire?
- Is the tripod holding their cooking in good condition or is it about to fall
over onto someone?

In assessing the patient the first item is their ABCs. Giving that they are
crying that is all in good orders. While blood loss is occurring the amount lost
through a still impaled object is not yet life threatening. If the blood was
squirting out in pulses that would be an artery strike which is quite serious.

On arrival I would first identify myself by name and as a first aid responder. I
will attempt to move the patient away from all the other objects on the ground.
Preferably to a place to sit her down.

While doing so I will ask someone to call 911 and to stay near me as my hands
will be busy. I will ask if she travelled here with someone. If yes to a travel
companion I will send someone to quietly get them.

Now is a good time to be glad of the chirugeon belt favour. Inside is latex
gloves which I will put on due to blood exposure. There is also 1 or 2 gauze
pads and normal bandages. If there is only one gauze it will to be split to make
a sterile pad on each side of the impalement. The few band aids in the belt
favour are going to be used to hold down the edges of the gauze.

For an impaled object the desired first aid is to stabilize the object leaving
extraction to occur in medical facilities. The gauze pads will be pressed around
it on both sides. I will ask for a clean napkin if available to augment the
gauze pad. If necessary the belt favour itself can be used as a wrapper.

The patient can be the best one to apply pressure for various reasons. One is
that they will be able to know how much pain they feel. Secondly they are
already exposed to their own blood so no one else is exposed to blood exchanges.



While this is going on I will try to sort out between 911, the patient and their
travel companions how they will be going to the hospital. Preferably by the
ambulance with the travel companions following in another vehicle with the
person's belongings.

If a travel companion has not been found I will send someone to start asking the
SCA "chain of command" from canton mates, to baronials to royals in hopes of
someone being able to identify those familiar with the patient.

At this point I will send someone to find if another chirugeon is present and if
so to have them bring more gauze. It isn't just a matter of skill but also a
matter of supplies. I have more in my vehicle but would need to search around
for it.


To help hold in the dressing place I really need some tape. This being the SCA
duct tape should be findable. Care is to be taken to avoid getting the tape gunk
into the wound. Only the sterile gauze I had should be put in direct contact
with the wound.

I will now start to escort the patient, and any travel companions, to the
ambulance or where the ambulance will be coming. The EMS need to be queried as
to what hospital they are going to.

The event steward and kingdom chirugeon should be informed as soon as possible.

When taking the gloves off I will be careful to twist the edge so I get no
exposure to the blood. The sandwich bag I kept them in within the pouch is used
to hold them for disposal in a garbage or with the EMS medical disposal.

Once the gloves are off the paperwork begins.