Thursday, August 27, 2020

When No Help Is Needed

The protests in cities are heating up, and more people are bringing firearms to them. This has meant, and will mean, that people are going to get shot for doing stupid things, at stupid times, in stupid places, while with stupid people. Nothing good comes from being stupid!

I'll defer to the trained professionals on how to actually treat a gunshot wound; my medical training only covers how to help a patient get to that trained professional if possible. We've suggested several types of first aid equipment and training over the years, and I know we've covered triage procedures for when the casualties outweigh the medical staff/training/equipment available. Use the search box in the upper left corner to find the older but still relevant articles, because today I want to cover another, more unpleasant, aspect of emergency first aid: when do you not try to help?

One of the things I've noticed most first aid classes lack is a defined point of “they're gone, you can't help them any more”. Your Red Cross first aid class isn't designed to teach you how to treat injuries; it's meant to teach you how to stabilize a patient for transport to a facility where they can be treated. It takes more advanced training to cover the obvious signs of death and when it is proper not to attempt to help, as first responders are more likely to be the first on scene to find an obviously dead person.

I dug around through my training materials and several online sources, and they all agree on the basics of when to declare a patient deceased and that medical aid in not going to help them. The following is a basic outline, not an exhaustive one.

Obvious signs of death / Don't attempt to revive:
  • Decapitation: if the head is removed from the body, current medical science can't help them.
  • Incineration: firefighters are more likely to see this than an average person, but once the body has gone from “burns present” to “charred” there's nothing you can do.
  • Decomposition: obvious is obvious -- a decomposing body is not going to heal.
  • Bisection: a fancy way of saying “cut in half”.

Presumed dead but has potential for revival:
  • Unresponsive
  • Not breathing
  • Has no pulse
  • Has fixed, dilated (open) pupils

If presumed dead AND has any of the following, do not to try to revive:
  • Rigor Mortis: I covered this in one of my first articles. Shortly after death, the body goes stiff due to the chemical reactions of the onset of decomposition.
  • Lividity of lower extremities: Once the heart stops pumping blood, that blood tends to settle out in the lowest part of the body. Blood pooling under the skin will look like a massive bruise or discoloration, which is known as lividity. Rolling a patient and looking at the underside is all you need to do.
  • Massive trauma with internal organs visible: Unless you're next door to a fully equipped surgical theater, there's nothing you can do that will help.

Helping others and rendering aid are good things in my book, but you need to know when you'd just be wasting time and supplies that might be used to save someone else's life.

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