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Re: [E-Chir] Scenario 5

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  • 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 1 of 13 , Jan 22, 2010
      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 2 of 13 , Jan 23, 2010
        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 3 of 13 , Jan 23, 2010
          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 4 of 13 , Jan 23, 2010



            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 5 of 13 , Jan 23, 2010
              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


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            • 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 6 of 13 , Jan 23, 2010
                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 7 of 13 , Jan 23, 2010
                  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 8 of 13 , Jan 23, 2010
                    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 9 of 13 , Jan 23, 2010
                      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 10 of 13 , Jan 27, 2010
                        --- 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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