Chasers As: First Responders

[Scott Roberts]

[Hmm...this also makes me wonder about a chaser's liability from helping out if someone dies or something similar and tries to blame the chaser)]

I haven't read the rest of the thread before posting this, so it may be somewhere else...

One of the first things we were taught in EMT class is the "Good Samaritan" doctrine. If you are making your best efforts to help, within the limits of your training (or lack of training), you are not liable for the outcome of your actions.

The key is in only doing what you know how to do. If a person has a heart attack after you help them out of their basement, you aren't liable. If you don't know basic first aid and try to splint an injury, you may be in a legal grey area, but Good Samaritan laws (or common law in a lot of cases) would likely still cover you.

Just don't hold yourself out as knowing things you don't -- i.e. don't tell someone it's safe to go back in their house and look for Fluffy. Unless you're a structural engineer, you probably don't have the knowledge to make that determination.

 

[Scott Roberts]

We helped a gentleman by the name of Unruh who crawled out of his basement 6 miles south of Greensburg.

I was two houses south of you, at Don Edmiston's trailer. According to Don, who was not hurt, the two-story house that was collapsed was Dorothy Unruh's. Not sure what relation she is to the gentleman you helped, but I do remember them being related.

 

[Scott Roberts]

I’ve been doing some research on AED’s (Automated External Defibrillator) and considered adding one to the chase vehicle. It is important to remember that these “consumerâ€￾ AED can only diagnose and shock ventricular fibrillation or ventricular tachycardia. They are not designed to shock asystole or 'flat line' patterns. I’m not a medical professional in any form, but those I have consulted suggested that a consumer AED would be of limited life saving value to a lightning strike victim (my primary interest in purchasing one). Cardiac arrest in lightning strikes is usually asystole instead of ventricular fibrillation from what I have been told.

Asystole is not a "shockable" rhythm, no matter what equipment you have. I'm sot so sure about asystole being the primary mode of heart arrythmia in a lightning strike victim...I believe it would be V-fib. Depends on the exact nature of the strike, just as in a regular electric shock patient. Going on my personal understanding or the heart and how it works, and I'm only a Basic EMT (an expired one at that), so I'm not an authority on it, for sure.

 

[Scott Roberts]

Yes, but if there is V Fib, the AED would help. More important and useful for chasers would be a CPR mask and training.. The heart will often restart on its own but spontaneous respirations can take longer. Thus CPR can be very beneficial until the person starts breathing on their own.

Although rescue and life saving is best left to the professionals, early after the event chasers can be very helpful. Once the authorities arrive, check in and find out how to best serve the area.

One thing to be aware of is the concept of triage. Others who are trained in this will understand what I'm saying, but to the general public, what I'm about to say sounds callous...it's not meant that way at all.

Generally, in a mass casualty incident, it is not considered the best use of limited resources to try to save a person who is pulseless, for whatever reason they became that way. Because of the situation, you sometimes are forced to leave the side of someone you'd normally do everything within your power to save.

The people you can be most effective in saving are those who have suffered critical trauma injuries -- those where you can apply direct pressure to stop bleeding, as an example. CPR is a good skill to have in these situations, but the reason is not as you'd expect -- knowing how to accurately asses a person who is down can save you from wasting resources that can be used to save another person who has a chance at life. The most life-saving knowledge you can have in a mass-casualty situation is basic first-aid, IMO.

[Edit: For clarification after reading Dr. Persoff's posts] I don't disagree with anything he's said. If you're faced with the situation where you have to choose to do or not do CPR, you're in between a rock and a hard place. Start it, and you don't have the personal authority to stop it until the person revives, you collapse, or you are relieved by someone with equal or better training than you. Don't start it, and you may be wasting the person's one chance at survival. A compromise -- if you know CPR, you can teach someone the basics very quickly -- "push his chest this far, several times every 10 seconds, and don't worry about breathing for him. Keep doing it until you're relieved or he revives." Once you have enlisted someone else to do it, you can continue to help others.

Okay, now I feel like I'm going in circles...mass casualty triage is one of those things that's not easy to explain to a general audience, and no matter what decision you make, IMO you'll find something you did (or didn't do) to regret. I've never had to make the decision not to treat someone, but I imagine it would be one of the hardest of my life.

 

[John Diel]

Lightning striking a person to the point of cardiac depolarization happens anywhere between 30% and 70% of all strikes. The cardiac dysrythmia commonly seen is either Ventricular Fibrillation (VF) or Asystole (AS). The VF may be cardioverted via electric counter shock such as those provided by AED's. Asystole can not. However, Proper CPR may restore a "shockable" cardiac rythym or even restore a heartbeat well enough to support life. It has to be immediate though. Often times VF or AS convert themselves very shortly after the initial shock as the myocardium attempts to repolarize. Then the problem becomes respiratory arrest caused by the thoracic and diaphram muscles being spasmed by the lightning.

AED's will pick up on the VF or VT if present. They will not pick up on AS. AS is generally treated with Atropine, Epinephrine and another drug (name doesn't come to mind) via IV Bolus, and continued CPR. Cardioversion is not recommended unless it's a last resort.

AED's are really pretty limited in what they interpret and what they will actually attempt to cardiovert. So they are of limited value. I don't think they are cheap to buy either. However, My only experience was with early models several years ago. I would bet the technology has changed quite a bit since then and they are probably better than they used to be.

Triage, or at least the version being spoken of here, of a bit tougher. However, given the circumstances (using this last episode as an example) there would not be much reason to not attempt CPR on an unresponsive victim. Medical help is on the way and there are varying amounts of time before they get to advanced care. I personally have done CPR for 2 hours and the victim lived. In some cases though the injuries are pretty obvious that you can't save them. Limited resources take precedence, but this is not a military battlefield and there is resonable help on it's way. The issue becomes, how long can you hold out until that help arrives. Do you have the immediate resources there to save a life. Case Scenario (I've used this in training a few times), you have 2 victims and ACLS help is 15 minutes away. Victim 1 is unresponsive, not breating and no paplable pulse. Color is good and skin temp is warm. Victim 2 is complaining of radiating chest pain and flail chest (Obvious broken ribs), multiple contusions, lacerations, and bleeding profusely.

Which one do you take care of? Remember, ACLS Unit is 15 minutes out. Let's say you have an AED available and a first aid kit.

Have fun with that one. I used to use this on drills quite a bit.

 

[Kathryn Piotrowski]

I am thrilled to see so many stormchasers becoming enlightened about the "Good Samaritan Law". I can't even imagine not helping someone in distress. We are often the first few persons on the scene after a devastating tornado has hit a community and there are so many ways in which we can help. When the F-4 ripped through Hoisington in 2001, I was just a few blocks away from the complete destruction on the west side of Hoisington. I had a search light with an extra long cord that plugged into the cigarette lighter of my car and I could hear people calling out for others in the dark. I turned that on and it helped persons make their way to the exposed basement of a neighbors home, that helped until the emergency crews arrived with larger lights and the equipment to extract the persons from the basement. Now I carry a large first aid kit, masks, extra water, a heavy duty tow rope and a container of toys (of all kinds) to drop off at the command post/shelters. For the children just to have something that they can call their own, helps so much.

I would like to see the Stormchaser community carry toys in their vehicles to drop off to the shelters...we all have limited space in our vehicles but crayons and coloring books take up very little space and kids love them.

We can help in so many ways...as I found out from Hoisington and other devastating events...just talking and letting someone talk about what they have been through is very comforting for them.

I am really proud to be a part of this great group of storm chasers who care so much about helping others in their time of need.

Kathryn Piotrowski

 

[Warren Faidley]

I might suggest that Tim, or the moderators set up a new forum just for "Chase Medical" or something like that. There are a host of discussions that might be helpful to chasers regarding this subject -- as witnessed herein. Just a suggestion.

Warren
EMT-B

 

[Willie Dines]

I might suggest that Tim, or the moderators set up a new forum just for "Chase Medical" or something like that. There are a host of discussions that might be helpful to chasers regarding this subject -- as witnessed herein. Just a suggestion.

Warren
EMT-B

I second that suggestion wholeheartedly, as it would be great for new and lesser experienced chasers to be able to get the correct info and to learn a few basic medical skills, to be able to help people out, in more ways, than many people are still not quite aware of

Nice one Warren

Willie

 

[Mike Peregrine]

Just to add to the good ideas so far for things to take with you ... in addition to the first aid stuff, I carry a chargeable spotlight that can plug into the cig lighter ... 1,000,000 candles of light can do a lot to illuminate piles of debris in the dark. Also I carry jumper cables, a good tow rope, tools (including a hatchet, etc.), a couple of thermal emergency blankets, emergency candles, bottled water, and make sure your own car has a spare, extra fluids (including emergency gas) and the things you might need in a tight spot. It makes for a load to haul around all the time in addition to the camera gear, but it's definitely worth it to have.

 

[John Diel]

I have to add a word of caution to the medical thread. Do not attempt ANY of this, unless you are qualified to do it. Just reading about it from someone who knows something about it does not qualify you.

The best of all worlds Would be to have EMT training and certification at at least National Registry Basic level. EMT- 1st Responder or simply 1st Responder would do well too.

At a minimum, Red Cross First Aid or Advanced First Aid (do they still offer those levels?) and 1 rescuer CPR training and certification. I stress CERTIFICATION. Here's why. Just going through the course and not getting your certification will put you at risk if called on to utilize those skills.

You stop at a home where someone flagged you down. 90 year Grandma has had a heart attack and you perform CPR and she doesn't make it. 3 months later you get a summons to appear in courst because someone says you killed her in performing the CPR incorrectly. You're being sued.

Even though the burden of proof is on the person sueing, a Certification (the so called "piece of paper") will go a long way in showing that you did indeed perform CPR correctly and fall under the Good Samaritan Act. If you do't have the certification, then you have acted outside your scope of training and are now liable for that action. That's pretty simplified, but in today's society, it's a very real possiblity. It's also one reason I will continue past an accident if there is Law Enforcement on the scene or and Ambulance. I may slow down to offer help, but generally at that point, I'm turned away.

I'm not trying to scare anyone, just make people aware of what can happen, even in the very friendly midwest.

What ever you do, don't attempt a crycothyrodomoty (a movie favorite, the old pen through the throat scene to get someone to breath). Just don't even think it!

 

[Jason Persoff]

This is rapidly degenerating into a medical discourse ...great to see.

***AEDs and non-VF rhythms. The basic AED will only shock verified VF/VT. It is true that they won't shock asystole. However, many of us in resuscitation research have argued that the analysis should include asystole since very careful catheter experiments show that asystole occurs as one of two entities: true flatline (dead) and fine VF (potentially shockable/curable). Given this binary nature to asystole, in fact we may see subsequent software/firmware upgrades that allow AS to be shocked (something I support).


***The drugs John mentions above are actually in reference to two other classes of arrest: asystole and PEA (pulseless electrical activity). In asystole there has NEVER been a consistently documented drug or tx that results in survival except for CPR. Some newer data support possibly using vasopressin, but I'm pretty underwhelmed with the data there. For PEA, the only drugs that seem to work are epinephrine, IV fluids, and possibly bicarbonate. Will skip the rationale why these are the drugs o' choice. However, when in doubt, do CPR.

***A brief comment on triage in lightning strikes. LS victims are actually supposed to be treated in "reverse order". In other words, the more "dead" they look, the more resources should be focused on them. This is because the first minute or so after a strike, proper CPR will likely regain the pt's cardiac, pulmonary, and cerebral circulation sufficiently to prevent long-term damage. In non-electrical injury mass casualty incidents, those that look dead are left dead; but no in lightning.

***Mike's comment about light is critical as is all of the "survival" gear he lists. May I also recommend: a spare set of prescription glasses, alcohol sanitizer, and a box of big trash bags for throwing the nasty stuff (blood and guts) into something other than the road.

 

[Angie Norris]

As an old trauma nurse with field experience, I'd strongly advocate a basic first aid class and CPR training. CPR is not that useful for mass casualty incidents because the living take priority...if someone doesn't have a pulse or is not breathing, you go on to the next person. It does sound cold and heartless (and yes, it is extremely difficult to do), but in a mass casuality incident, you don't have manpower or time to spend on someone who is to the point of dying...the available resources go to the persons who have the highest chance of survival. Now CPR for a lightning strike victim, especially if the strike has just occurred, or you have actually witnessed the strike, then you are that person's best chance at life.
You don't really have to carry a mini-ER in your car (even though I admit back in my younger days I did do that)...just some basic bandaging supplies, bottled water and some blankets would do nicely.
I think Kathryn is onto something with some small toys for kids. I'm not sure about the practicality of crayons (hot trunk and thingys made out of wax don't really seem to go together), but some small stuffed animals go a long way in providing some comfort and I don't think it would be out of place to offer to adults, either. The animal lover in me would also be inclined to maybe have some dry food available for the four legged survivors.

 

[Linda Kitchen]

What would you put in a small fist aid kit? My chase partner and I fly out and never have much room, because of all our equipment. I do think it's a good idea to have a kit, so what would be the most important things to pack? Angie, good idea about the dog food. I carry a bag here in AZ as the reservations always have a large number of stray dogs. When I see one, I pull over and feed it. I know it doesn't help much but at least the dog goes to sleep with a full belly one night.

 

[Dan Robinson]

I have mixed feelings about me taking action in a tornado-ravaged town. The main reason is that with me having no medical or first responder training, I may end up at the least being in the way and at the worst doing something wrong that would aggravate the problem or cause someone to get hurt worse.

I have been one of the first people on the scene of a couple of serious auto accidents in past years. One of them was an SUV rollover on the interstate with a man trapped inside. I felt anxious about being there and yet not doing anything, but there was not anything I felt that I could/should do other than call 911. If the car was on fire and it was clear that the occupant must be pulled out immediately in order to survive, than yes, it would be a no-brainer that I should attempt to do something. But EMS and police were on their way, and there was no sign that I needed to be the one to perform a rescue or other medical procedure.

In the case of Greensburg, I naturally wanted to try to get into town to see if there was anything I could do. The power lines down across the road on 183 stopped me. But I have a feeling I would have got up there and had no idea what to do in the midst of the chaos. If I had found someone trapped, I probably would have felt it best to wait for trained rescue personnel to perform the extrication, that is, unless there was some factor such as imminent fire or gas that would make my involvement neccessary. I feel like it might be better for that trapped person to wait for trained and prepared rescue personnel instead of me, an untrained and unprepared person, attempting to do something that I know little or nothing about. It seems the latter is the more riskier than a victim simply waiting 30 more minutes. What if I moved a board and caused heavier debris to fall on the victim? What if I sparked a gas explosion? I've thought a lot about that night, and really all I could see myself being able to do is offer my two flashlights, tools, cold drinks in the cooler and space in my car. Would that be worth me taking up the valuable space on the road that the emergency workers needed? Again, I just don't know. My gut instinct is to want to help, but the last thing I want is to be an obstacle.

This thread is a good start, but short of all chasers getting fully certified in search & rescue and basic EMT training, I'd like to see a guide that suggests things that we should and should not do when a Greensburg situation arises, hopefully with input from police, fire and EMS personnel themselves. It seems they would know exactly how we could be of greatest assistance. What should be have in the vehicle, what should we do if first on the scene, etc. Or, should we even be on the scene at all.

 

[Randy Denzer]

Triage, Anytime the patients outnumber the responders......

We started Triaging the moment we arrived in Greensberg. We met Chief Cain of the Greensberg FD on the outskirts of town and we offered our help as firefighters. He led us into the town and we were stunned at the magnitude of the event. We had serious injuries in a semi truck that was turned over right on the west side of town. We litterally had hundreds of walking wounded coming to us and only 1 trauma bag. We decided to NOT treat on the west side of town and to move more central and set up a triage area at the grocery store. The hardest thing to do as a firefighter is to walk away from those who need your help. Sometimes you have to do it for the benefit of the masses. Nancy Boes set up and ran the triage area while the non firefighters directed incoming injured people to the area. She did an outstanding job running the area on her own as we went out to do search and rescue.

Triage is hard to do. It takes alot of training to be able to to it effectively. AND it takes willpower to actually do it because it means walking away from some people who need your help.

I can give a triage link but I truely think it is a more advanced practice and needs to be left to those in the first response profession.

As far as a good first aid kit?
Start off with a AHA heartsaver class! If you live in Texas let me know and I can hook you up.
I would only put things in your kit that you are trained (or know how to) to use. A good basic kit can be purchased at most medical supply stores for less than $75.00.
If you are serious about all of this then I suggest you go find an EMT class. You will never know the reward of being able to do something for someone who needs your help!! EMT B (basic) classes are sometimes provided at night to fit around a regular work schedule.
I teach EMT classes in central Texas at multiple fire academies that allow extra seats for civilians to take these excellent classes. Email me personally if you need any help finding a class.

Randy
[email protected]