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Re: [E-Chir] Scenario 5

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  • Kathleen Gormanshaw
    My ears really perk up at the bones grinding together and that immediately tells me this needs advanced medical diagnosis. I d tell him that this is beyond
    Message 1 of 13 , Jan 20, 2010
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      My ears really perk up at the "bones grinding together" and that immediately tells me this needs advanced medical diagnosis.  I'd tell him that this is beyond my first aid skills and I think he needs a doctor and an x-ray machine to determine what's really going on.  I'd tell him I can call an ambulance for him, and that we want an ambulance to keep him comfortable and to make sure something more serious doesn't develop without expert help available on the way to the hospital.  At the same time I'll keep an ear & eye on his level of consciousness and ability to breath, make sure he's focusing on me, the answers make sense, he appropriately understands the questions, that he keeps breathing and that it become calmer and more even.  I'd arrange for some ice, it will provide a small amount of comfort and the feeling that we're doing something.  I'd try to arrange for him to lie down somewhere, so he can't hurt himself falling if he faints.  If possible, I'd contact the local seneschal and the kingdom chirurgeon, or do so soon afterwards.  I'd have as much armour as can be removed without hurting his arm removed, and find someone who can go to the hospital with him, and contact any family or other friends if appropriate.  I'd send someone out to meet the ambulance and direct them to the nearest door.
       
      Eyrny

      On Tue, Jan 19, 2010 at 8:29 AM, Ninka <dyscordant_rose@...> wrote:


      You're spending the afternoon at your local fight practice. It's been a good fighting day with a fair number of fighters out happily hitting each other with sticks. While watching one of the fights you (and everyone else around you) notices that one of the newer fighters ends up blocking a shot with his forearm and he is not wearing vambraces. At first it doesn't seem as if there is a problem as the fighter actually throws a couple more shots before he notices something is wrong. Knowing that you are at the practice the fighter and a couple of his buddies walk over to you. You see that the injured fighter is cradling his left arm to his body and while he looks a bit pale he is gracefully accepting the razzing that his friends are giving him for actually trying to block a shot with his arm, not his sword or his shield. He sits down in a chair as he gets to you. On exam you notice that his left forearm is bruised, deformed and starting to swell. There is no bleeding or broken skin noted. He tells you that it feels like his bones are grinding together and that it hurts. A lot. He can move his fingers though it does increase his pain somewhat. He is not complaining of any numbness or tingling and his fingers are warm and pink below the injury site.
       
      Discuss.


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    • b1laxson
      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
      Message 2 of 13 , Jan 20, 2010
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        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.
      • Bethoc (Lesley)
        Excellent points so far, especially the splinting and need for medical intervention (Xrays to diagnose and cast).   A couple more things to consider.. -closed
        Message 3 of 13 , Jan 22, 2010
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          Excellent points so far, especially the splinting and need for medical intervention (Xrays to diagnose and cast).
           
          A couple more things to consider..
          -closed wound, therefore you can put ice on it 15 mins on and off, with a cloth barrier to be nice to the skin
          -use a commercial sling or improvised sling to elevate and immobilize the limb to the body to prevent it from jostling around
          -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
          -take a book with you/the casualty to the ER.. you/he may be waiting a long time
           
          wincing at what would be a lot of pain for this person,
           
          Bethóc

          Per saltire purpure and gules, a sea-unicorn argent within a bordure per saltire Or and argent
           
          Golden Otter Pursuivant, Kingdom of Ealdormere
          Pursuivant, Canton of Vest Yorvik, the High Seat of Septentria
           
          Ut sit magna, tamen certe lenta ira deorum est
          The wrath of the gods may be great, but it certainly is slow
          what does {o'} mean? See Da'ud notation: http://www.sca.org.au/herald/commentary/Da'ud%20Notation.htm 
           
          solis sacerdotibus. Ave atque vale.


          --- On Tue, 1/19/10, Ninka <dyscordant_rose@...> wrote:

          From: Ninka <dyscordant_rose@...>
          Subject: [E-Chir] Scenario 5
          To: e-chir@yahoogroups.com
          Received: Tuesday, January 19, 2010, 8:29 AM

           
          You're spending the afternoon at your local fight practice. It's been a good fighting day with a fair number of fighters out happily hitting each other with sticks. While watching one of the fights you (and everyone else around you) notices that one of the newer fighters ends up blocking a shot with his forearm and he is not wearing vambraces. At first it doesn't seem as if there is a problem as the fighter actually throws a couple more shots before he notices something is wrong. Knowing that you are at the practice the fighter and a couple of his buddies walk over to you. You see that the injured fighter is cradling his left arm to his body and while he looks a bit pale he is gracefully accepting the razzing that his friends are giving him for actually trying to block a shot with his arm, not his sword or his shield. He sits down in a chair as he gets to you. On exam you notice that his left forearm is bruised, deformed and starting to swell. There is no bleeding or broken skin noted. He tells you that it feels like his bones are grinding together and that it hurts. A lot. He can move his fingers though it does increase his pain somewhat. He is not complaining of any numbness or tingling and his fingers are warm and pink below the injury site.
           
          Discuss.


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        • Kathleen Gormanshaw
          Since I chose to call an ambulance I deliberately did not look for a splint. I m not highly experienced with splints and slings, just basic training, and I
          Message 4 of 13 , Jan 23, 2010
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            Since I chose to call an ambulance I deliberately did not look for a splint.  I'm not highly experienced with splints and slings, just basic training, and I don't need this person to move more than a couple of feet before the experts come.  Therefore, the experts can decide if he needs a splint for the ride to the hospital, and deal with it if they do.
             
            If opting for personal transport, I'd probably look at a simple sling and splint.
             
            Eyrny
          • Bethoc (Lesley)
            That s the best part about improvisational first aid - you don t need to be good with commercial splints!   For long limbs, pick something that won t bend, is
            Message 5 of 13 , Jan 23, 2010
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              That's the best part about improvisational first aid - you don't need to be good with commercial splints!
               
              For long limbs, pick something that won't bend, is wider than the limb and is long enough to stabilize the joint above and below the injury.
               
              In this case, for a forearm, you could use a piece of wood (the lid of a feast gear box for example), thick carboard (cut up a cardboard box used to carry in food items for the kitchen and make a dual layer so it won't bend), or a hardbacked book (of the larger coffee table variety). Alternatively, just splint the arm to the body by wrapping the person's arm, elevated, against their torso with fabric. Triangular material is great for both creatings slings and longer rectangular shaped wraps to tie stuff up.
               
              For toes and fingers, "buddy tape" the injured finger to the adjacent non-injured one in the absence of a splint.

              An ambulance is not necessarily warrented for this kind of injury, although they do carry the commercial splints on board, it is unlikely that they will encourage EMS transportation to the hospital.
               
              Also consider that although we do pay OHIP, there is a "top up" charge for the use of EMS. I think that applies whether or not you transport but I'm not sure. I'll find out. I think it's about $90. A taxi would be cheaper. It's likely a full charge for out of province participants (we used an ambulance for my son in Nova Scotia and got dinged for $600).
               
              with regards
              Bethóc
               
              who is all for improvisational first aid as long as it works (you should see some of the stuff I've seen..Oi!)
               
              Per saltire purpure and gules, a sea-unicorn argent within a bordure per saltire Or and argent
               
              Golden Otter Pursuivant, Kingdom of Ealdormere
              Pursuivant, Canton of Vest Yorvik, the High Seat of Septentria
               
              Ut sit magna, tamen certe lenta ira deorum est
              The wrath of the gods may be great, but it certainly is slow
              what does {o'} mean? See Da'ud notation: http://www.sca.org.au/herald/commentary/Da'ud%20Notation.htm 
               
              solis sacerdotibus. Ave atque vale.


              --- On Sat, 1/23/10, Kathleen Gormanshaw <kgormanshaw@...> wrote:

              From: Kathleen Gormanshaw <kgormanshaw@...>
              Subject: Re: [E-Chir] Scenario 5
              To: E-Chir@yahoogroups.com
              Received: Saturday, January 23, 2010, 8:57 AM

               
              Since I chose to call an ambulance I deliberately did not look for a splint.  I'm not highly experienced with splints and slings, just basic training, and I don't need this person to move more than a couple of feet before the experts come.  Therefore, the experts can decide if he needs a splint for the ride to the hospital, and deal with it if they do.
               
              If opting for personal transport, I'd probably look at a simple sling and splint.
               
              Eyrny


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            • Ninka
              ________________________________ From: Bethoc (Lesley) To: E-Chir@yahoogroups.com Sent: Sat, January 23, 2010 9:09:45 AM Subject:
              Message 6 of 13 , Jan 23, 2010
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                From: Bethoc (Lesley) <bethoc12thc@...>
                To: E-Chir@yahoogroups.com
                Sent: Sat, January 23, 2010 9:09:45 AM
                Subject: splints Re: [E-Chir] Scenario 5

                 >Also consider that although we do pay OHIP, there is a "top up" charge for the use of EMS. I think >that applies whether or not you transport but I'm not sure. I'll find out. I think it's about $90.
                 
                Actually, if you are covered under OHIP the uncovered cost of EMS is $45 and that is only if we transport a patient. If we arrive on scene, treat and do not transport then there is no charge. If you are from another province or another country and you are not insured then you will be dinged with the full bill.
                 
                Xristina


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              • Kathleen Gormanshaw
                Do you know if group insurance, such as a company provides, typically covers the EMS transport cost? Eyrny
                Message 7 of 13 , Jan 23, 2010
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                  Do you know if group insurance, such as a company provides, typically covers the EMS transport cost?
                   
                  Eyrny

                  On Sat, Jan 23, 2010 at 9:48 AM, Ninka <dyscordant_rose@...> wrote:





                  From: Bethoc (Lesley) <bethoc12thc@...>
                  To: E-Chir@yahoogroups.com
                  Sent: Sat, January 23, 2010 9:09:45 AM
                  Subject: splints Re: [E-Chir] Scenario 5

                   >Also consider that although we do pay OHIP, there is a "top up" charge for the use of EMS. I think >that applies whether or not you transport but I'm not sure. I'll find out. I think it's about $90.
                   
                  Actually, if you are covered under OHIP the uncovered cost of EMS is $45 and that is only if we transport a patient. If we arrive on scene, treat and do not transport then there is no charge. If you are from another province or another country and you are not insured then you will be dinged with the full bill.
                   
                  Xristina


                  Be smarter than spam. See how smart SpamGuard is at giving junk email the boot with the All-new Yahoo! Mail


                • MaryCatharine
                  Yes smile If you have extended coverage, by all means, It does cover the fee. We are very fortunate here in Ontario. The cost of having an ambulance just show
                  Message 8 of 13 , Jan 23, 2010
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                    Yes>smile
                    If you have extended coverage, by all means,
                    It does cover the fee.
                     
                    We are very fortunate here in Ontario.
                    The cost of having an ambulance just show up to a call is
                    Approximately $950.00 and up.
                    I am thankful for the $45.00 fee and any extended coverage>smile.
                     
                    MariaKatharina
                     
                    -------Original Message-------
                     
                    Date: 01/23/10 10:45:06
                    Subject: Re: splints Re: [E-Chir] Scenario 5
                     
                     

                    Do you know if group insurance, such as a company provides, typically covers the EMS transport cost?
                     
                    Eyrny

                    On Sat, Jan 23, 2010 at 9:48 AM, Ninka <dyscordant_rose@ yahoo.ca> wrote:





                    From: Bethoc (Lesley) <bethoc12thc@ yahoo.ca>
                    To: E-Chir@yahoogroups. com
                    Sent: Sat, January 23, 2010 9:09:45 AM
                    Subject: splints Re: [E-Chir] Scenario 5

                     >Also consider that although we do pay OHIP, there is a "top up" charge for the use of EMS. I think >that applies whether or not you transport but I'm not sure. I'll find out. I think it's about $90.
                     
                    Actually, if you are covered under OHIP the uncovered cost of EMS is $45 and that is only if we transport a patient. If we arrive on scene, treat and do not transport then there is no charge. If you are from another province or another country and you are not insured then you will be dinged with the full bill.
                     
                    Xristina


                    Be smarter than spam. See how smart SpamGuard is at giving junk email the boot with the All-new Yahoo! Mail


                     
                  • b1laxson
                    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
                    Message 9 of 13 , Jan 23, 2010
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                      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
                    • b1laxson
                      I liked these reminders. ... PS: for limb splints the SCA has a habit of being heavily stocked in 3ft long, 1 1/4 rattan.... Brian the Green
                      Message 10 of 13 , Jan 23, 2010
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                        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
                      • Bethoc (Lesley)
                        The only thing I don t like about rattan being an arm splint is the narrow width. Ideally even an improvised one should be wider than the limb.. and
                        Message 11 of 13 , Jan 23, 2010
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                          The only thing I don't like about rattan being an arm splint is the narrow width. Ideally even an improvised one should be wider than the limb.. and considering some of the sizes of our fighters (muscled up and molson muscle both) a rattan sword may not be sufficient. Now, for lower limbs, with one secured to either side of the length of the leg (groin to beyond the foot) that's another matter altogether.
                           
                          regards
                          Bethóc
                           
                          ps and thanks for the prompt clearing up of OHIP/EMS surcharges! I don't work until later in the week and wouldn't have an answer for the group until then.

                          Per saltire purpure and gules, a sea-unicorn argent within a bordure per saltire Or and argent
                           
                          Golden Otter Pursuivant, Kingdom of Ealdormere
                          Pursuivant, Canton of Vest Yorvik, the High Seat of Septentria
                           
                          Ut sit magna, tamen certe lenta ira deorum est
                          The wrath of the gods may be great, but it certainly is slow
                          what does {o'} mean? See Da'ud notation: http://www.sca.org.au/herald/commentary/Da'ud%20Notation.htm 
                           
                          solis sacerdotibus. Ave atque vale.


                          --- On Sat, 1/23/10, b1laxson <b1laxson@...> wrote:

                          From: b1laxson <b1laxson@...>
                          Subject: [E-Chir] Re: Scenario 5
                          To: E-Chir@yahoogroups.com
                          Received: Saturday, January 23, 2010, 11:46 AM

                           

                          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



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                        • dyscordant_rose
                          ... 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
                          Message 12 of 13 , Jan 27, 2010
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                            --- 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
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