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RE: Dealing Responsibly with Injured People

Yes, Beth is 100% correct.  When a person has been injured and is acting
stange that person can not make the judgement of turning down med. care.  In
law enforcement if there is any sign of injury we call the EMS and let the
fire and EMT's make the call.  The "ball" is now in their court and they are
much better able to deal with injuries than we are.  If the victim objects,
too bad!  So the rule is if the person can not take care of him/her self
then call 911.  Then they have no choice, they will get treatment.  The
EMT's and Fire personnel will take over.  

-----Original Message-----
From: beth glover []
Sent: Thursday, October 18, 2001 9:27 AM
Subject: RC: Dealing Responsibly with Injured People

Hi Linda; I am gonna approach your question from a medical/nursing point of
view.  Remember I went to that ride and a kid got hit on the street after
the ride as I drove home. I got out and helped, and that kid was thrashing
around and moving in a way that could have resulted in his paralysis if he
had an unstable neck injury. (which he didn't)  I was very insistant that he
lay still until the paramedics got there, and he was somewhat uncooperative.
The first thing the paramedics did was put a cervical collar on him and
duct-tape him to a back board, in case of broken bones that nobody could
visualize without x-rays. That is not unusual, they always use duct tape.
(Duct tape is a woman's friend) 

  Anyway, in the instance of the woman's injury...I would have called the
paramedics whether she liked it or not. In your assessment of her behavior,
she was acting strangely. That could have indicated a mild concussion or a
slow intracranial bleed.  People with brain bleeds often times act
aggressively, and beligerently. I have seen folks with head injurys exhibit
almost superhuman strength. I took care of a girl with a head injury once
who moved her bed back and forth across the room while she was in it, in
locked leather restraints!   If you call the paramedics, they can assess the
person, they can contact the nurses at the emergency room via radio, who are
working in conjunction with a MD. They can make the decision, and take it
out of your hands. It takes the liability and responsibility away from you.
The person can also sign a form waiving medical treatment, but usually they
finally agree to treatment, when confronted with a bevy of handsome param! !
edics!    In any case, this woman's judgement was impaired, like a drunk,
and she was also risking the lives of the horses, possibly other passengers,
and of course other drivers on the road. She could have fallen unconscious,
or had a seizure while driving.  In addition, if she had possible fractured
ribs, she could have developed a collapsed lung and suffered respiratory
problems, up to and including respiratory arrest, and shock. She would have
found herself alone, and without help at that time. Injury victims can
deteriorate in wierd ways within an hour after the accident.  

  In the future, my advice to you or any other manager in this dilemma would
be follow your  good instincts!  Go ahead and call the paramedics, don't
even tell the person about it if they are acting up, and if they don't like
it, "tough shit".  If it is unnecessary , then you erred on the side of
caution.  It is the ethical thing to do. 

Thanks for bringing up an important issue!   Beth Glover

>From: "Linda B. Merims" 
>Subject: RC: Dealing Responsibly with Injured People 
>Date: Thu, 18 Oct 2001 09:17:49 -0400 
>I had the most serious responsibility of ride management come up and 
>whack me on the head at my ride last Sunday, making me embarrasingly 
>aware of how unprepared I was to deal with it realistically. 
>A woman riding with a junior had her horse flip over backwards and 
>land on her. 
>Everybody was extremely lucky: it happened just outside of camp, 
>and the woman was able to make it back to camp with her junior. 
>My basic question is: when do you overrule the expressed wishes 
>of an injured person because you think it is important for their 
>The woman made it back to her trailer and even got the two horses 
>loaded. I wasn't even aware that an accident had happened until 
>two other riders told me that they had seen it and that they thought 
>this woman REALLY NEEDED HELP. 
>The woman was sitting in her truck, trying to figure out whether she 
>was well enough to drive home. The horse had landed on her left 
>side and she thought her right side was good enough to shift and 
>use the accelerator and brake. She herself said that she suspected 
>she had broken ribs on the left side and at least a severely bruised 
>left leg if not an actual fracture. 
>She didn't want the paramedics called. (How would her horses, rig, 
>and the junior (a neighbor kid) get home? I certainly had made no 
>provision for such an eventuality.) I agreed to go along with 
>her wishes. However, half an hour later, she's still sitting in her truck. 
>This tells me that even she has serious doubts. I was wondering 
>seriously now whether I shouldn't overrule her and call the paramedics. 
>Luckily we had another rider who knew this woman and, after talking 
>with her for almost 45 minutes, persuaded her to let her call her 
>husband (this other rider's husband; the injured woman lived alone) 
>and have him drive her and her rig home. 
>In followup, I discovered that when she got home she was feeling much 
>worse and had them call 911. She's been in the hospital for two 
>days and will be going home tomorrow, but will be laid up for at 
>least a month. I havn't yet found out what her injuries actually were. 
>What should I have done? How do you ride managers deal with the 
>entire issue of injured riders? Do you have "in case of emergency" 
>numbers on entry forms? 
>Linda B. Merims 
>Massachusetts, USA 


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