His mind is the ultimate weapon . . . So is yours!
This tagline from the MacGyver television show sums up a lot of how we as medical providers should look at our abilities. The tools needed to care for someone cannot be found in our ambulance or first aid kit, but rather in our mind.
For those of you too young to remember MacGyver, he was very resourceful and with a paperclip, cotton ball and two inches of Duct tape could make a working helicopter. (Okay, not really . . . it’s television). This week I’d like to cover some resourceful ways to do our job with materials not necessarily considered medical equipment.
When someone breaks a bone, we use a splint. But the splint doesn’t need to be a padded board or custom cut piece of cardboard. While quick splints, board splints or Vacu-splints work wonderful, they are not always available. When we really consider what we’re doing, we’re creating a fake bone. Bones provide stability to the body and any child older than 3 knows how bones are generally placed. . . Arms don’t bend between the elbow and wrist. Patients will generally self-splint to support the break and hold it into the position of comfort. We can create a splint with anything rigid; a magazine, stick, book or layers of clothing. Another possibility that we can use is an air-filled ziplock bag. Fill the bag and place it to support the injury and secure it into place. Air splints are quite rigid and can be slightly formed to the injury.
Fractures are definitively diagnosed using x-ray, but most of us were not born on Krypton. An effective method to determine if a bone is broken is to use a tuning fork and stethoscope. Place the vibrating tuning fork against the bone at one end and auscultate on the opposite end. With an intact bone the sound will resonate normally, but if there is a break the sound will be muffled. Listen to the bilateral bones for comparison. Sometimes in small bones, particularly in the hands and feet with many surrounding nerves, the vibration will cause a brief increase of pain. These are both signs of a break. While the tuning fork is not definitive, it is accurate in about 85% of all breaks.
Tourniquets have long ago lost favor for controlling bleeding. But recent military experiences have shown them to be quite effective at saving a life. The problem with the old tourniquets was that people would use string or other small items to constrict the area. The small contact area would create severe damage that couldn’t be repaired and many times would require amputation at the constriction point. Before applying a tourniquet, all other methods to control bleeding should be exhausted including direct pressure, elevation and pressure points. If we apply a tourniquet we are really deciding between life and loss of limb. A proper tourniquet should be at least 1 ¼ inch wide. A belt, cravat, webbing from a backpack or a blood pressure cuff can all be used to restrict arterial flow to the affected limb. Pressure should be continually applied until the bleeding becomes controllable, not necessarily stopped. After application the tourniquet must be locked down in a way that pressure will not be lost. Writing the time on the patient’s forehead has been the long established pattern to document application time. Use blood, a sharpie or other method to document the time. Limbs can go for many hours without normal blood flow before necrosis occurs.
Controlling someone’s airway is paramount! Luckily Head-Tilt or Jaw-Thrust are very effective. The most recent standards of the American Heart Association had recognized that without air, life is terminated. If we suspect cervical trauma we should try to use a jaw-thrust. If facial fractures prevent this, or for other reasons we cannot open the airway with this maneuver, AHA has published to use the head tilt-Chin Lift. While the possibility for paralysis does exist, a life in a wheelchair is better than death from lack of air. I personally would have a problem making this decision, but they are correct.
CPR has been found to save many lives and we’ve all been taught to compress at a rate of 100 per minute. Unless you happen to be a gifted musician, obtaining 100 cpm is very difficult. We’ve all been taught “Staying Alive” or “Another One Bites the Dust” (Don’t sing this one out loud), but while these will get you close can still both be sung at different rates. As an aside, after a long code either of these songs will stick in your head like the small world ride at Disney. Consider using a metronome. Many of us do not have these but there are many free apps for your smart phone that will suffice for this purpose. Set it at a rate of 100 and keep up. For advanced providers in the group 100 bpm at 13/4 time will give you a unique beat every 13 beats which is the optimal time for bagging during arrest with an advanced airway.
This one from the Boy Scouts of many years ago, hypothermia can be treated by placing two people into a single sleeping bag. The literature of the time called for skin to skin contact, but if the clothing is light heat will still be radiated and captured by the bag. For obvious reason the skin contact was removed from the Boy Scouts and unfortunately they dumped the whole method. Heat packs made with warmed water in bottles, drinking warmed fluid and getting them out of the elements are effective and important, but cuddling can also rewarm someone effectively.
Moving patients without proper equipment can be challenging, unless you’re willing to think outside the box. Two large poles (or strong branches) can be placed parallel over a blanket. The ends of the blanket are folded over one branch to the other and reversed. The overlap will be held tight by the patient’s weight allowing the blanket and branches to be used as a litter. If you don’t have a blanket, two jackets can also be used. . . place the branches from the bottom through one arm each, and place the second jacket around the opposite ends of the branches. The two jackets will be inverted from each other but will provide support needed if we are moving without concern for cervical spine.
Backpack frames, while they can never be used to completely immobilize the patient can be used in conjunction with tape to secure a potential spine issue. Professionally we have KED extraction devices which are essential ½ longboard that is secured around the patient until better immobilization can be obtained. The pack frame can provide the same support to the spine with creative taping. A rolled jacket, blanket or towel can be used as a cervical collar and CID Blocks.
While I understand that this is a scientific survey of 1 incident. A few years ago, I was out with some kids when one was stung by a bee. He started to have difficulty breathing due to an unknown allergy. We had no epi pens to help him through this. I started screaming at him to get his own body to kick adrenaline (the same thing as epinephrine). The kid is still a bit freaked by me and I had some explaining to do, but the story started with “Your son is alive.” This may not work in all instances, or even any more beyond this one, but in this case the adrenaline that his own body could release, with some encouragement, saved his life.
There have been many jokes about Swiss Army knives and some have been created that are beyond useful for their size. But as a medical tool a Swiss Army knife (or knockoff) is worth more than its weight in gold. Attachments include tweezers, knives, saws, awls, hooks and scissors. I would strongly recommend that everyone not only have one in their first aid kit, but their pocket . . . every day.
While specifically developed medical equipment has many benefits, and I’m not suggesting these materials over their use, they are not always available. All devices were created through trial and error to be more efficient but, while effective, are not always the easiest to use. With some common sense and knowledge we can find ways to make many bad situations better.
The most important thing that my ambulance delivers to any scene is my brain. Even with all of the fancy medical equipment that we have, we still improvise base on the scene presented. Knowing of some of these basic treatments can help us out of a jam. Prehospital providers are sometimes having to perform in the “wild wild west” and need to be ready to care for an injured patient with only the equipment in reach. OEC specializes in wilderness medicine and encourages us to treat people that may have delayed definitive care. Hopefully some of these suggestions may help you when you’re not traveling prepared like a Boy Scout . . . or MacGyver.