Thank you Iain, that's most useful, and thanks for the pictures Martyn! My friends are always amazed when I tell them I don't stop to help at roadside accidents (where there are emergency services present). But it's a different world out there, and unless you've got your bits and pieces with you, together with some relevant experience, you won't do much good. I'll stick to being an anaerobe for the time being.
Adrian Fogarty
P.S. Thanks also to Helen; crash or collision, I don't suppose it much matters to the philosophers on the list!
> from: IDM <[log in to unmask]>
> date: Thu, 01 May 2003 12:09:46
> to: [log in to unmask]
> subject: Re: Dash roll.
>
> A dash roll is a technique used by the Firefighters to disentrap patients
> who are stuck underneath a car dash board that has come in on them when
> there has been a considerable frontal impact. Often seat and the patient
> have also been driven forward relative to the dash if the floor pan buckles
> or seat mountings shift ( a common problem is older cars and allegedly very
> common in early Ford Sierras) .
>
> It takes a while as the A post ( the front pillar of the roof) needs to be
> disengaed from the rest of the roof structure - usually through a roof
> removal.
>
> The A posts are then cut low down below the door hinges and a hydraulic ram
> or rams are then placed against the dash and a decent sold structure on the
> floor pan or against the bottom of the B post ( the post that holds up the
> middle of the roof) and smooth pressure is then applied to push the dash
> away. It is very effective in the right hands.
>
> It can also be done using a chain and a bit of brute force, with the chain
> often being attached to a fire engine which then slowly moves back pulling
> the dash away and upwards as it goes.
>
> Both techniques need careful monitoring as rams can slip and as wreckage
> moves it can impact on the patient as the car assumes a new shape! It can
> also do unfortunate things to the unwary resuer.
>
> May I recommend a book to all the hospital chaps - written by Vic Calland no
> less - he will be too modest to mention it I am sure - "Safety at Scene - A
> manual for Paramedics and Immediate Care Doctors", Vic Calland and published
> my Mosby. 2000. ISBN 0 7234 3199 X. It covers this technique and many more!
>
>
> ----- Original Message -----
> From: <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Thursday, May 01, 2003 11:45 AM
> Subject: Re: Ideas please....
>
>
> > Ah, a subtle philosophical distinction, I suppose, but valid nonetheless!
> I figure the bracing must mean the upper limb fractures which Vic has
> described, but I didn't think you'd see a Monteggia from "bracing". Surely
> bracing would produce a similar pattern to a fall on the outstretched hand?
> And judging from the other injuries, I suspect that this vehicle was truly
> "compressed", so the Monteggia was probably as a result of a direct blow on
> the dash or steering wheel, rather than a bracing injury. Still not sure
> about dash roll though!
> >
> > Adrian
> >
> > > from: Paul Bailey <[log in to unmask]>
> > > date: Thu, 01 May 2003 08:58:41
> > > to: [log in to unmask]
> > > subject: Re: Ideas please....
> > >
> > > Adrian,
> > > an MVC is a Motor Vehicle Crash. The simple fact of the matter is that
> most
> > > of them aren't 'accidents' in the true sense of the word. ie they're
> not
> > > unforseen, involuntary or lacking in intention, but mostly due to bad
> > > driving - ie excessive speed, ethanol, not obeying road rules -
> > > intentionally.......
> > >
> > > Hope this helps.
> > >
> > > Paul
> > >
> > > ----- Original Message -----
> > > From: "Adrian Fogarty" <[log in to unmask]>
> > > To: <[log in to unmask]>
> > > Sent: Thursday, May 01, 2003 3:50 PM
> > > Subject: Fw: Ideas please....
> > >
> > >
> > > > Before this thread runs out, could you translate some things for me,
> Vic,
> > > > and for all those other obligate anaerobes (hospital dwellers) on the
> > > list?
> > > >
> > > > 1 What's a dash roll?
> > > >
> > > > 2 What are bracing fractures (I've never heard of this term in
> hospital
> > > > before)?
> > > >
> > > > 3 What's an MVC (sounds like a chain of stores that sells music and
> > > > videos in this part of the world, but I presume it's a variant of MVA
> > > which
> > > > is north American for RTA)?
> > > >
> > > > Adrian
> > > >
> > > > > > -----Original Message-----
> > > > > > From: [log in to unmask]
> > > > > > [mailto:[log in to unmask]] On Behalf Of Vic Calland
> > > > > > Sent: 30 April 2003 10:54
> > > > > > To: [log in to unmask]
> > > > > > Subject: Ideas please....
> > > > > >
> > > > > > Attended a MVC last night. Driver doing a 100mph plus put his car
> > > under
> > > > > > the end of an HGV only doing 50mph. Dragged 200-300 yards down the
> > > road
> > > > > > as the driver of the lorry regained control and came to a halt.
> > > > > >
> > > > > > Driver was late twenties, physically fit but on the heavier end of
> > > > > > normal weight range. Trapped upright until the fire crew did a
> dash
> > > > > > roll. Had 8cm transverse laceration of forehead with bit of skull
> in
> > > > > > wound but amazingly had GCS of 12-13. Had bilateral bracing
> fractures;
> > > > > > left elbow was a posterior dislocation, radius & ulna a comminuted
> > > > > > compound fracture as crunchy as a bag of crisps; his right was a
> more
> > > > > > classical Monteggia apart from the fact it was compound and the
> bone
> > > was
> > > > > > protruding. He also has a fractured pelvis with a dislocation of
> the
> > > > > > left hip.
> > > > > >
> > > > > > He had breath sounds bilaterally so we didn't realise he had a
> > > ruptured
> > > > > > left hemidiaphragm until the CXR came back. At the time he wasn't
> too
> > > > > > shut down, so we splinted the arms, gave him 50mg Ketamine im and
> free
> > > > > > flow Entonox for the extrication (long board to the rear). We were
> > > only
> > > > > > 5 minutes from the hospital so we ran with him rather than
> established
> > > > > > an i.v. on scene. There they ended up with a right femoral vein
> access
> > > > > > with a "security guard" watching it.
> > > > > >
> > > > > > I'd be interested to know if anyone has clever ideas for dealing
> with
> > > > > > this kind of situation because his pain relief was not ideal by
> any
> > > > > > means.
> > > > > >
> > > > > > Vic Calland
> > > > > >
> > > > >
> > > >
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