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drewkittyYou are a spectator at a breakdancing event. You witness this:
http://www.youtube.com/watch?v=D3Lr70lwaVg
What do you do now?
For the sake of this exercise, the child does not get up, and the breakdancer is not a scene threat.
Answers behind the cut.
Bystander: Do not allow others to move the injured child, including the mother. Ask someone to call 911 or call yourself. Only if the child is choking to death, use the head-tilt chin lift maneuver to open the airway. Try to calm mother and child if possible until medics arrive.
First Aid: Do not allow others to move the injured child, including the mother. Identify yourself as first aid trained and ask people to call 911 and meet the medics at the street. Assess the ABCs of Airway, Breathing and Circulation. Try to hold the head and neck in the position which they are found. Upon discovering airway problems, consider carefully whether opening the airway is necessary. If trained and necessary, use the jaw thrust maneuver, remembering that a child's head does not need to be leaned as far back as an adult. At last resort use the head-neck tilt only if necessary because the child is unable to breathe. Do head-to-toe checks and continuous monitoring until higher levels of care arrive and take over. Try to calm and reassure mother and child if possible.
First Responder: Remember that calming or controlling the parent is essential to scene management. The child's injuries are likely severe and you should call for paramedics immediately. Pending their arrival, think about how the child was injured. Check for ABCs, then conduct a primary survey. Enlist a bystander to hold C-spine. Do a head to toe and evaluate the likelihood of head, neck, back and chest injuries. You may notice diminished breathing and altered breathing with one side not drawing air as well. You may also notice blood and/or clear fluid leaking from mouth, nose and ears. From the mouth could be cut mouth / broken teeth but could also be a lung injury. Nose and ears would be head injury. If equipped take vital signs and start a history with primary surveys repeated every five (5) minutes for an unstable patient. Be ready to assist breathing with mask ventilations and/or oxygen if equipped.
EMT: Consider mechanism of injury. We have two major MOIs. (Look at the video again.) #1 is blunt force trauma to the left chest, probably resulting in flail chest with rebound. Sufficient energy is imparted to cause the child to fly through the air for MOI #2. #2 is a head-down compaction injury to the cervical spine, possibly additional facial injury with airway compromise. Your initial assessment in the first moments will be critical.
Remember that flail chest (two or more ribs broken on two or more sides) is a likely outcome here and that a child's ribs may be deceptively soft, concealing the extent of internal injuries. Also remember that while children are capable of absorbing amazing trauma without injury, landing squarely on the head could have fractured the skull or broken the neck, or both, and this patient cannot be safely moved without pediatric packaging equipment.
This is a severe pediatric trauma with C-spine and possible multiple airway compromises. If you were not in a highly urbanized area, this would meet trauma criteria for evacuation helicopter activation (severe trauma MOI on a child, fall from greater than own height). Activate ALS immediately and request additional resources for crowd control.
If equipped once C-spine and primary survey has been established, give oxygen at 15L by non-rebreather, or if no pediatric mask, blow-by. If child is unconscious, consider oral airway. (Nasal is contraindicated by possible fractured skull.) Also check lung sounds and for other signs of serious airway problems (bright blood on lips, trachea deviation, reverse movement of the chest on inspiration and exhalation, etc.) Take BPs if equipped with peds kit, else pulse and cap refill checks.
When paramedics arrive, transition care and be ready to assist as a resource in patient stabilization, scene management and packaging for transport.
http://www.youtube.com/watch?v=D3Lr70lwaVg
What do you do now?
For the sake of this exercise, the child does not get up, and the breakdancer is not a scene threat.
Answers behind the cut.
Bystander: Do not allow others to move the injured child, including the mother. Ask someone to call 911 or call yourself. Only if the child is choking to death, use the head-tilt chin lift maneuver to open the airway. Try to calm mother and child if possible until medics arrive.
First Aid: Do not allow others to move the injured child, including the mother. Identify yourself as first aid trained and ask people to call 911 and meet the medics at the street. Assess the ABCs of Airway, Breathing and Circulation. Try to hold the head and neck in the position which they are found. Upon discovering airway problems, consider carefully whether opening the airway is necessary. If trained and necessary, use the jaw thrust maneuver, remembering that a child's head does not need to be leaned as far back as an adult. At last resort use the head-neck tilt only if necessary because the child is unable to breathe. Do head-to-toe checks and continuous monitoring until higher levels of care arrive and take over. Try to calm and reassure mother and child if possible.
First Responder: Remember that calming or controlling the parent is essential to scene management. The child's injuries are likely severe and you should call for paramedics immediately. Pending their arrival, think about how the child was injured. Check for ABCs, then conduct a primary survey. Enlist a bystander to hold C-spine. Do a head to toe and evaluate the likelihood of head, neck, back and chest injuries. You may notice diminished breathing and altered breathing with one side not drawing air as well. You may also notice blood and/or clear fluid leaking from mouth, nose and ears. From the mouth could be cut mouth / broken teeth but could also be a lung injury. Nose and ears would be head injury. If equipped take vital signs and start a history with primary surveys repeated every five (5) minutes for an unstable patient. Be ready to assist breathing with mask ventilations and/or oxygen if equipped.
EMT: Consider mechanism of injury. We have two major MOIs. (Look at the video again.) #1 is blunt force trauma to the left chest, probably resulting in flail chest with rebound. Sufficient energy is imparted to cause the child to fly through the air for MOI #2. #2 is a head-down compaction injury to the cervical spine, possibly additional facial injury with airway compromise. Your initial assessment in the first moments will be critical.
Remember that flail chest (two or more ribs broken on two or more sides) is a likely outcome here and that a child's ribs may be deceptively soft, concealing the extent of internal injuries. Also remember that while children are capable of absorbing amazing trauma without injury, landing squarely on the head could have fractured the skull or broken the neck, or both, and this patient cannot be safely moved without pediatric packaging equipment.
This is a severe pediatric trauma with C-spine and possible multiple airway compromises. If you were not in a highly urbanized area, this would meet trauma criteria for evacuation helicopter activation (severe trauma MOI on a child, fall from greater than own height). Activate ALS immediately and request additional resources for crowd control.
If equipped once C-spine and primary survey has been established, give oxygen at 15L by non-rebreather, or if no pediatric mask, blow-by. If child is unconscious, consider oral airway. (Nasal is contraindicated by possible fractured skull.) Also check lung sounds and for other signs of serious airway problems (bright blood on lips, trachea deviation, reverse movement of the chest on inspiration and exhalation, etc.) Take BPs if equipped with peds kit, else pulse and cap refill checks.
When paramedics arrive, transition care and be ready to assist as a resource in patient stabilization, scene management and packaging for transport.
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Don't Forget...
Date: 2007-06-07 05:45 am (UTC)No matter how tempting it is, a lynching is messy. Lawsuits are not as much fun, but you get more coin from them. Whomever organized that impromptu event and didn't ensure crowd control will get what they deserve.
I'd also add-
POLICE: See First Responder. Secure the area and ensure that all participants are retained. If they want legal council, allow them, but don't let them leave.
Get reports and information from bystanders and secure (with receipts) any video footage. Make sure an officer travels with the mother to the hospital. File full report back at the station, and ensure that legal notes are retained.
no subject
Date: 2007-06-07 01:14 pm (UTC)no subject
Date: 2007-06-07 03:01 pm (UTC)There were a few joking comments to the effect of "oh, the kid's fine" but with nothing at all to back them up. This is despite the far larger number of comments on various incarnations of the video saying "Gosh, I hope the kid's OK. . ."
Kids are strange. If they survive the initial hour and get to an advanced care facility, they'll heal in ways no adult can. But if they bleed extensively or crash out, they appear fine until they suddenly up and die on you. Like snapping your fingers.
Re: Don't Forget...
Date: 2007-06-07 03:06 pm (UTC)Other commenters from New York have said that the event was organized and common in that area. I'm much more likely to want to hook up the parent for negligence than the promoters of the event. However I'm willing to chalk it up as "tragic accident" because you know, kids do wander off and this kid could have wandered into traffic, too.
Police can do whatever they want. My jackleg guess (and it's only that) is that PD would call for medics and give first responder care (the level they're trained at) while hanging on to the breakdancer and the video cameras.
Since none of my friends are New York cops, I figured that wasn't something to test. Doing cop-like stuff when one is not a cop is illegal and fraught with peril.
I do have friends who work security, but it's a reasonable assumption that the breakdancer is moderately well known, and unlike a hit and run, is not going anywhere. That said, the crowd control issue is more preventing anyone from doing anything stupid to incite the crowd, than any other factor.
no subject
Date: 2007-06-07 04:58 pm (UTC)I was on one of those saucer things, that you can't steer at all, but God knows when I say the ramp, I tried. I hit it, square and flew up and over and landed on the top of my head. Complete silence. It hurt pretty bad and I concidered laying there for a while but I realized that my friends did not know that I was ok, plus the irony of me having the worst back and being the only one for this to happen to, I got up laughing and cussing. You could see the blood drain back into their faces.
The moral of this story is that if you are going to tabaggon, and someone wants to make a "ramp", kick the shit out of him.
I think that I was ok because the saucer was small so I had to tense my body on both ends to keep from dragging on the ground, then somehow, I landed JUST RIGHT. I was very sore but fine.
You just never know with kids and kittens, sometimes they are made of rubber. I have hear of small children falling 5 or more stories UNHARMED. Weird.
no subject
Date: 2007-06-07 09:35 pm (UTC)Seriously. What is wrong with people? Not a rhetorical question--I want your insight.
no subject
Date: 2007-06-08 01:00 am (UTC)What is right about people? Why do decent people refrain from making such comments?
What do we do as a society to foster the advance of civilization?
no subject
Date: 2007-06-08 01:02 am (UTC)The flail chest is anyone's guess. It's going to take a head and chest CT and lab tests, perhaps an ultrasound, to rule out internal injury.
The C-spine injury is pretty definite. Head-down, the spine-head connection can't take that much stress. This kid would be lucky to avoid a broken neck. Then again, I can think of worse angles.
no subject
Date: 2007-06-08 02:20 am (UTC)Re: Don't Forget...
Date: 2007-06-08 02:39 am (UTC)Yea, I would like to see some more context information on what happened with the kid. Did he get away from Mom? Did Mom get him tottling over to another friend?
no subject
Date: 2007-06-08 05:13 am (UTC)Okay, to interject a little hope into the conversation--what can I, as an individual, do to foster the advance of civilization, the spread of empathy, and the growth of honest compassion for others in the hearts of those around me?
no subject
Date: 2007-06-08 06:45 am (UTC)What else can any of us do?
no subject
Date: 2007-06-08 07:36 pm (UTC)no subject
Date: 2007-06-12 05:05 pm (UTC)www.youtube.com/watch?v=bOfAPHJTagY ,
which didn't have the silly sound effects and super-slo-mo. Another nice thing about the original is that you do see the kid move at the end.
no subject
Date: 2007-06-13 05:43 am (UTC)Yes, the kid moves at the end. But not very well. That may or may not mean anything.
no subject
Date: 2007-06-13 05:48 am (UTC)no subject
Date: 2007-06-13 04:16 pm (UTC)no subject
Date: 2007-06-14 02:35 am (UTC)