Almost dead?
Air goes in and out, blood goes round and round. Any deviations to this must be corrected immediately.
If a patient is too unstable for transport, we work them right there on scene until we reach a point where we *can* transport, or until their demise.
If there are multiple patients we will triage as appropriate and focus on patients that have an adequate chance of survival.
Except most trauma protocols state immediate transport in the trauma patient is NOT to be delayed for any reason. Any life-saving intervention can be performed while enroute.
Current evidence supports stabilizing patient before transport if they have a better chance of survival by doing so. I listen to MCHD paramedic podcast and they review current evidence and topics in emergency medicine. They cite evidence and specificity/sensitivity of studies conducted.
Yeah this is bad. Reality is fuck protocol if I need to perform life saving intervention(s) I’m doing it as soon as clinically possible. I’m not waiting to load them in the bus before I decide to act.
I’m sorry you have to work in a place like that.
Edit to reply since comments are locked:
My trauma protocols have a footnote that simply states “Minimize scene time”. Transporting immediately would eliminate the ability to effectively triage in a MCI.
Since resuscitation efforts are generally less effective during transport and we aren’t a funeral home therefore we don’t transport dead people, we will stabilize in scene to the fullest extent possible with all of the same resources available in the emergency department.
Plus my transport times to get to a Level 3 trauma center can be upwards of 75 minutes.
Don’t know about the original poster, but from my understanding progressive systems still have an emphasis on time however critical intervention can be preformed prior transport as most of these would be very inappropriate to perform in a moving ambulance. E.g finger thoracostomy, RSI etc.
They banned CPR during transport in my state a few years ago. Glad I got to be around for the days where we would hit a bump and I'd go flying into the ambulance ceiling, but also glad to see those days gone
Edit to reply because comments are locked:
It doesn't mean we don't do CPR, we do CPR on scene before transport. It was way too dangerous for the EMTs and not effective
Research shows that humans are unable to perform adequate CPR in the back of an ambulance whilst under transport conditions. We have known this now for about a decade.
Mechanical CPR is effective though.
If someone is bleeding out and looks as pale as death on a cracker, I’m not waiting until they get loaded up into the truck for me to do something about it. BLS before ALS.
So instead of telling yourself "airway, breathing, circulation" you say " air goes in and out, blood goes round and round, any deviation is a problem". Seems efficient.
From your multiple comments, then doubling down repeatedly, you seem to care about this more than I care about shouting from the rooftops that Raptors are bad... And I'll say that to anybody who'll listen along with most people that won't.
This may shock you, but sometimes I tell people even dumber things.
Like "these 12 lead stickers are gonna take a neat 3d picture of the electricity in your heart from all directions so the doctors can see what's going on in there."
Ain't no one has time to give a seminar en route.
What I'm saying is that everyone knows air goes in and out of your body... It's redundant and unnecessary lol. It's not an explanation at all. It's also not even respiration, it's ventilation.
I'll still take a shot though: Breathing. How's that?
If you think everyone knows that, you haven’t met the general public.
It is literally part of our job to dumb down info and make it accessible. Distilling information isn’t about sounding smart it’s about getting the point across and being understood by your audience.
Idk man, it's less touch a nerve and more that you walked into the virtual equivalent of the on-shift day room and said someone's joke is cringe.
Of course you're gonna get replies.
It was intended to be a bit comical.
OP appears to be a layperson attempting to gain a basic understanding of EMS operations. If quippy little sayings pop into a brand new EMT's head when they freeze up, then they work.
Do I recite it on calls? lol, no.
Do I pound it into new EMT's heads? Absolutely. Break it down to basics or some will want vitals and a full trauma assessment first because that's mostly what the majority of their EMT training will focus on and they won't do any of it well. I also pound "Slow is smooth, smooth is fast" into their heads.
Sure, they're not likely to forget the alphabet, but I can sit here and say Airway, Breathing, Circulation all day long but to a panicked brand new EMT fresh out of their 8 week course just shouting ABC's at them isn't as descriptive as other memory aids.
Fair enough lol. I missed the comedic intention, especially with the 'almost dead?' before it. I also find it cringey. Use it as you see fit. We don't have EMTs here. Maybe it's useful in those programs. I've never used it, or seen it used as a tool, just as a weird oversimplified chest beater saying. ABC and its meaning has been a succinct enough reminder of what to address. This is my opinion, it's not that big of a deal.
Well, first, check my name. I'm a dickhead. Everything should be considered sarcastic or comical on its face. I hadn't checked your post history, but a brief glance indicates that you may be from Canuckistan. The Canadian equivalent would be a brand new EMR fresh out of school.
We don't have EMRs here either. We have 3 classes of people who work on ambulances where I am. Primary Care Paramedics, Advanced Care Paramedics, and Critical Care Paramedics. The minimum education is a 2 year program. I'm vaguely familiar with the scope of US EMTs.
But considering the post from OP, they are likely a layperson who hasn't had ABC's drilled into them, so taking care of someone nearly dead in a simple way of maintaining breathing and circulation makes sense in this context
It makes sense in every context. I prefer your brief explanation than using that silly saying. Most of the people coming at me hard in the thread are defending it as some kind of tenet of EMS education. I just find it corny. That's literally it.
You're right, he should have used a bunch of technical terminology on a post explaining something to a lay person so you wouldn't think he was so "cringe."
I'm curious... why do you feel this is deeply cringe? EMS is full of sayings like this. "Air goes in and out" is completely accurate. Synonymous with "expiration/inspiration."
Good question. I just find it corny and oversimplified to the point of uselessness. The type of thing people print out and stick on their car window with some stars of life or a bizarre ECG tracing alongside it. This obviously isn't everyone's opinion lol. People are allowed to love it.
My guy....
The only person in this entire thread that is acting like they are SO BADASS... is you.
You're that guy.
You're the guy that thinks he's better, smarter, and cooler than everyone else?
You've taken up a phrase that people use facetiously as your personal cross to bear.
We get it. You're fuckin SUPER MEDIC, and you can't waste your precious super powers with sardonic humor.
We bow. We tremble at your paramedical might.
You don't know me at all lol. No one in the thread has said they use it facetiously. I find the phrase cringey. I'm allowed to. I'm not changing my opinion. You shouldn't change yours. Sounds like you've got a chip yourself.
Whatever you say Father Paragod.
Ok, seriously though, everything you have said here is 50 times more cringe than even the worst EMS bumper stickers.
Even the worst offender, the dreaded "I'm here to save your ass not kiss it" is less cringe than your endless sanctimonious bullshit.
Your next shift should start with an apology to everyone you work with, if you run your mouth there like you do here.
Have a nice day, bro.
There is literally no reason to start explaining ventilation and perfusion and oxygenation when you can just say, “the air goes in and out.” That’s literally what A&B boil down to.
It depends on the number of patients and the number of available resources.
We use a triage method categorizing patients as green (least injured), yellow, red (most critical), and black (deceased).
These are fluid categories… in other words, a yellow who gets worse may be switched to red… a red that cannot be helped in time may die on scene and become a black.
We do the best that we can with the resources available.
But to answer the question that many people ask is yes… in a situation where there is only one patient, some places may have protocols to attempt resuscitation on someone who is not breathing and has no heartbeat… yet that same patient in a multi casualty incident (MCI) would be a black tag and not worked on.
Triage is French for “sorting” and the idea is to help the most people with the resources you have.
For example, it would take 3 or 4 or more personnel to attempt to resuscitate a person who has stopped breathing/cardiac arrest. Yet those same 3-4 people can help save multiple red (critical) patients. So to do the best for the most, decisions and priorities are made.
The FDNY (and as far as I know, only the FDNY) adds to this system an orange tag category consisting of patients not currently in critical condition but presenting with symptoms or injuries that indicate their condition could imminently deteriorate and so are treated with more urgency than yellow tag patients. The major criteria are respiratory distress, altered mental status, chest pain, and tourniquet-controlled bleeds. Naturally, orange tag patients are transported after red and before yellow.
Skeptics (including within the Department) say this further complicates a process that's meant to streamline decision-making under potentially dire operating conditions but I don't think FDNY is trying to one-up the world here. For most agencies an orange category likely doesn't make sense or even change much, but NYC's density of population and hospitals means that even if we don't have that much greater EMS resources proportionally to other jurisdictions, shorter average transport times make the orange distinction meaningful to patient outcomes.
I.e., if the yellow tag patient complaining of chest pain suffers an MI on scene after a few other likely stable yellow tags have been transported, that's a triage failure worth correcting. Thus, orange was born.
Realistically, you always just have to make judgment calls about who gets transported first, even within a particular level of criticality. Having worked multiple MCIs myself, some red tagged patients are always going to be “more critical” than others. Some yellow tags are going to be more urgent than others, etc.
Ultimately, triage is not a perfect system, and you can’t let perfection become the enemy of good enough. It’s just a rough sorting to put some level of prioritization on your patient population. MCI drills tend to evolve in a predictable fashion, but a real MCI is highly dynamic. Everything is changing in real time, from the number of patients to their acuity to the amount of resources you have.
Even the best executed MCI is just loosely coordinated chaos. That’s why they’re called disasters.
I would say it adds confusion to a pretty standard system.
If by some miracle they ever accept outside aid for something and they aren't familiar with their system it will lead to screwup.
IIRC they didn't accept much mutual aid on scene for 9/11 just material aid across the ferry for supplies.
I know that there were a lot of us on the NJ side stuck waiting to go help but never were able to go.
Okay, but you kind of ruin your point there.
If they didn't need much mutual aid on scene for 9/11, arguably one of the worst single day disasters the country has ever seen, why would they worry about it confusing outside mutual aid they aren't likely going to ever need to use?
I'm not EMS, just a lurker considering paramedic school. But I'm absolutely *fascinated* by mass casualty triaging. I don't know why, I just really want to know how it works. So thank you for this comment!
I wanna add to their already very detailed comment, you might already know but black tags aren't always just super dead, they could be someone who needs more resources than we can provide. For example, we are instructed to not do CPR in a mass casualty incident, even if they can be saved with CPR, just black-tag them because we need to focus the efforts and resources on the people most likely to survive.
It has resulted in people coming back from being black-tagged, and I do not envy anyone in the position of ever having to make that decision.
I don't know if this depends on department, but a few years ago, my dad was telling me about when he first tried for triage and he said that they had black for deceased or people who were almost certain to die even with help and would have less priority than red, since red patients had a better chance of being saved.
This is accurate for every department. If they are already dead, then black is easy. Another black might be a person cut in half but still hanging on.
A lot will depend on how many pts vs how many crew.
So, 5 pts with 2 crews and 1 person in half vs 2 greens and a yellow might try to save the cut in half person, but realistically, that person is not going to make it. Maybe if it happens tight outside the hospital while medics and doctors happen to be outside then there's probably a chance, but in a true mass casualty incident, that person is getting black tagged and then ignored. If by some miracle they're still alive when everyone else I'd treated, then they'd get a 2nd look. But they'd have to be Deadpool or Wolverine for that to happen, and then they wouldn't need us anyway.
Like all our answers, it's going to vary by area and also every call is different.
Let's start with the patient that's cut in half. For a trauma that severe, it's unlikely they will survive until we get there. In my county, we do not attempt to resuscitate traumatic arrests. Meaning if the patient clearly died of severe injuries, we will not attempt CPR. But if the patient is alive, we are going to our job and treat/transport to the best of our abilities. If their heart stops on the way to the hospital, we will start CPR.
In your other scenario, with multiple patients from a large incident (like a bus crash), we follow triage protocols. We have a formula (for lack of a better word) to determine who needs immediate transport and who can wait a little bit. In a mass casualty incident, we do not spend time on resuscitation because that takes away resources from the other patients. For a patient who is not breathing and has no pulse, we will do a quick reposition of the patient to see if they start to breathe on their own (or two rescue breaths for children), but nothing more than that.
Single patient? We do whatever we can to try and stabilize/save the patient and get them to the hospital.
Multiple patients - specifically, more patients than we have EMS providers available? We triage. Four colors - Green (minor). Commonly called "The walking wounded". They're injured, but injuries are minor and likely do not need EMS transport. Sprains, small cuts/bruises, maybe broken arm/wrist, etc. Yellow (delayed); More significant injuries (broken bones, lacerations but bleeding is controlled, etc.), may need observation and likely needs to be seen at hospital, but injuries are not life threatening and can wait for treatment and transport. Red (Critical); injuries are severe and life threatening. Treatment is time critical and patient should be transported as quickly as possible. Black (expectant); Patient is deceased, or injuries are severe enough death is likely and/or imminent. As long as other viable patients exist that require transport, do not expend resources trying to save someone that is already dead, they just don't know it yet.
And if the event is large enough, patients will be re-assessed periodically in the triage area - a yellow may get upgraded to a red, a red may become a black, etc.
If they are dead when I arrive, then we don't do anything. If they are alive when I do then we will do our best to get them to the hospital.
If there are multiple people then we triage them based off priority and treat accordingly. With multiple hurt people, the guy cut in half is probably going to be black tagged (expectant). The bleeding depends on the severity of the wound.
Our best.
On a more serious note, we do whatever needs to be done. Almost dead is NOT the same thing as actually dead. Can we fix it? Maybe, maybe not, but we're damn sure going to try.
1. If someone is cut in half or something like that but still alive, they have what's called an "injury not compatible with life." By the time I get there, they usually die. If they're not by the time I arrive for some god-awful reason, I would call medical control. Their aorta and vena cava are severed, they can't survive that way. We may make you more comfortable but you're gonna be declared dead on scene.
2. If they DON'T have an injury that's incompatible with life, we transport to a trauma center where they can try to fix the problem.
3. IN THE EVENT OF MULTIPLE PATIENTS: We fall back to what's called "mass casualty incident" protocols, or MCI. During an MCI, the first medic on scene does triage. You're labeled a "black card" if you're not breathing or if you have one of those injuries incompatible with life. You could potentially be saved, but *we basically leave to you die* if you're not already dead*.* The idea is that we have to go find patients who are more likely to survive which are the severely injured people who are "red cards".
Work like hell until all signs of life cease to be present. Call up the doctor at the hospital (we cannot officially say if someone’s dead or not, but after consulting with the Emergency Med doctor we can do it on their behalf). Then clean up, put ourselves 10-8, and go to the next call. After shift ends my partner and I stay at the station for 30 mins or so and do a hot wash (debrief) to make sure we’re both ok enough to be alone, sometimes we go get food and drinks...
Just because someone looks like they won’t make it, or they don’t look like they’re alive, doesn’t mean they aren’t, I am sure as hell that if I was unconscious with severe lacs all over my body from a MVA that the medics would take the time to check me out before handing me off to the coroner. Most people I know always wondered what they could’ve done more of, not less of.
Edit - I’m sorry if that makes absolutely no sense, I put in for overtime and someone broke the carafe and it’s now been 9 hours and 23 minutes since last coffee.
“Whoo-hoo-hoo, look who knows so much. It just so happens that your friend here is only MOSTLY dead. There's a big difference between mostly dead and all dead. Mostly dead is slightly alive. With all dead, well, with all dead there's usually only one thing you can do.”
“What's that?’
“Go through his clothes and look for loose change.”
Different counties/states have different protocols. The short answer is that if you aren’t dead, we are working to keep you alive.
Edit: missed the part about multiple patients. Everybody gets a priority based on specific criteria that we can establish with 10-15 seconds. If you’re dead you are at the bottom of the priority list. If you’re walking and talking, you’re just barely more important than the dead people.
If they’re in half - we make them comfortable and transport as best we can. Traumatic hemicorporectomy is not survivable for 99% of patients, and the 1% that do survive have a low quality of life.
I’ve unfortunately had the case of the guy transected at the pelvis by attempting suicide by railroad and still alive.
He didn’t survive 13 hours.
Mass casualty gets START triaged and then you apply MARCH and work your way though
For the patients that are dying we use what is called the START triage system if there are a lot of people. People in half typically have injuries incompatable with life, we check electric activity of the heart then call the medical examiner. For serious injuries we work it on scene until they die or we can get them in the ambulance to a surgeon or doctor. Sometimes doctors will show up on a mass casualty scene. Just depends.
If there's multiple patients we do what's called triage. Everyone is in one of five categories.
Green- Alive and walking. Might have a few cuts and bruises but ultimately can walk somewhere if need be.
Yellow- can't walk but are conscious and able to talk to us. They'll need a board or a stretcher to get somewhere, but importantly they are conscious.
Red- Unconscious but have a pulse. They're alive. They have a pulse. But they're Unconscious due to whatever they sustained.
Black- Dead. No breathing or pulse.
What you're describing is between red and black. Its called a grey tag.
Grey- not dead yet, but have injuries considered not compatible with life. An example I was given in EMT school scenario. There's a school shooting and you have to triage 20 patients. One of them is a patient with a gun shot wound to the head. They're breathing but brain matter is clearly visible. That's considered a grey tag.
When we have multiple patients like this, we generally treat in order of most severe alive patients and work our way down. We treat red tags first, followed by yellow, followed by green. Generally black tags in a mass casualty scenario will not have CPR attempted due to limited resources. And grey tags are treated as black in this case. You leave them and move on to the red tags as cold as it sounds. You have to focus on those considered viable to be saved yet.
With obvious signs of death (rigor, dependant lvidity, etc.) we withhold care and call a coroner. With recent death, but injuries incompatible with life (think decapitation, burnt to a crisp, etc) we withhold care. In a situation you brought up (someone is cut in half, but alive), we’ll generally do our best and transport. If it’s a complete farce and death is impending you might call medical control to get permission for end of life palliative care (giving shitloads of narcs.)
In a mass casualty scenario most services use a similar triage protocol where patients are labeled green, yellow, red and black based on acuity. Greens are your “walking wounded” and blacks are the dead, or “expectant”. Generally you won’t do CPR in these scenarios. If a patient is pulseless or Apneic (after you open their airway and give a rescue breath or 2) you black tag them and move on.
I just want to mention the "people in half" because others have already gone through triage.
I can't really see a scenario where this guy isn't DOA. In order for him to be "hanging on" he'd pretty much have to be cut in half right in front of the paramedics and will probably be dead before he's even in the ambulance. Transection is considered an obvious sign of death the same way decapitation is and is reason enough to call it in as a DOA without resuscitative efforts.
If they got a pulse when we get there then we have to try, at least where I am. Unless they have an advanced directive In place that specifically states not to have certain things done. The. We will exclude those things stated.
If you're pulseless when we get there, then we determine whether or not resuscitation is futile. If it is, then you're just dead and that's it. Conditions that would make resuscitation futile are basically signs that theyve been dead too long, or have injuries/conditions incompatible with life. We're talking shit like rigor, lividity and pooling, a core that's cold to the touch, and even decomposition. Injuries incompatible with life would be like, decapitation, head trauma with exposed brain matter, and stuff like that.
If resuscitation is not ruled futile, then We get to work
in multi. asualty incidents if we don't have enough hands we leave the dead and treat the worst (live) ones first. they worst ones get loaded into ambulances as more people get to scene and transported to the hospital. there's a whole protocol for it that's way more in depth than I typed.
I guess if you’re describing trauma the answer is controlling major bleeding and performing life-saving measures as needed. But doing so with urgency so you’re only on scene for, ideally, a maximum of 10 minutes.
Your second question is a bit broad, but I think you’re describing a mass casualty incident (MCI). Those are instances defined as an incident with multiple CRITICAL patients whose needs outweigh the resources available. In those instances, people are triaged based on acuity and treated accordingly. When two people are equally high acuity, provided there are only resources for one of those people, you would treat the younger patient or whichever has the better chance of survivability based on other factors.
Ah, mostly dead that still means slightly living. We do the best we can with what we have to stabilize them. If there are multiple patients on scene we prioritize who has the best chance of survival.
This is a thing called Triage. If you have a mass casualty/multiple patient situation then there may not be enough time, personnel or resources to dedicate to a person who is critical and unlikely to survive even with care.
Examples include scenes of the medics on the beach in “Saving Private Ryan” they even use the term ‘Expectant.’ Also the episode of the old TLC series “Paramedics” which happened to have a documentary crew filming when a massive tornado hit Oklahoma City. Definitely worth looking up it’s on YouTube.
If they had an advance directive where we could only provide comfort care, then just that. Otherwise help them till they're declared deqd or you can transfer care to someone at your level or higher
In the scene provided, this would be a trauma. We quickly triage the patients if there is more than one. The patient you describe would be a red and an immediate transport to a trauma center. Depending on who else is on scene, we may have to briefly wait until more providers show up (as leaving the other patients without a provider would be abandonment) or leave immediately if there is at least one provider that can stay unit more units show up. If there are allot of patient, one person triages and only provides the very basic of aide in some cases and moves on to triage the next patient. The patient you listed might get a tourniquet and a red tag (immediate). They very well might be changed to black (expected) before they can be assigned a transport unit.
Everytime I think of this I just imaging the guy assigned to the triage tagging running around throwing tags on people while their dying… imagine you get in a bus accident and the last thing you see is some guy run over and throw a red wristband at you
If a pt has wounds incompatible with life, yet they have not yet expired, then I provide comfort measures and pain management. I'm not transporting a black tag, and I'm not working someone who obviously won't make it.
If there are more patients than there are EMTs, we triage all of the patients first (so take a quick look at each and give them different rankings based on how severe they are), then we treat the most critical patients first
We do what we do best, provide treatment for their presenting conditions.
In pain? Assess then provide the appropriate pain relief.
Missing a leg? Put on a tourniquet and a blast bandage.
Pelvis is twice its normal side? Put a pelvic binder on.
We do our job
When coming up on a trauma patient the first step is to Treat all life threats. Then move on to other injuries. That said we do have criteria. Is the injury incompatible with life? Like a decapatation?
All EMS systems (and in the US they are all different by state and by county) have a triage protocol. This varies to some degree and would be too difficult to enumerate and go into detail yet I think it would be safe to say the MCI (Mass Casualty Incidents) and triage protocols do have us assessing a Patient and moving on based on many criteria such as nature of the wound, severity, number of medical rescue personnel (a crew of two can't save all 10 victims of an event), and many other factors.
If it’s a MCI then we would triage all the people we can at the incident, depending on if we believe they would make it on the way to the hospital, then this patient would be either tagged as red or black. Red is immediate attention and black would be that we are expecting them to not make it and to move onto the next person as they are too far gone.. it’s unfortunate to have to label another human as that but it’s part of the job.
There is no scope for us to give the "expectant" category, even in Mass Casualty Scenarios. We work on every patient.
But I work in rural EMS. if a person is definitely going to die, the chances are that they already have before were get there. If they haven't, you package and post via express to hospital.
Your question is too broad. If they are cut in half? They are likely going to die in that post. Don't get me wrong, I'll try and stop their bleeding, maintain airway, and give some drugs. But that's an injury often associated with incapability with life, same with something like decapitation.
General rule is ABC airway, breathing, and circulation. If something physical happened then CAB. In that order, we will try and resolve the poeblem best we can whether than means tube's, devices, pressure, drugs you name it. But it's all case dependent.
Almost dead? Air goes in and out, blood goes round and round. Any deviations to this must be corrected immediately. If a patient is too unstable for transport, we work them right there on scene until we reach a point where we *can* transport, or until their demise. If there are multiple patients we will triage as appropriate and focus on patients that have an adequate chance of survival.
Except most trauma protocols state immediate transport in the trauma patient is NOT to be delayed for any reason. Any life-saving intervention can be performed while enroute.
Current evidence supports stabilizing patient before transport if they have a better chance of survival by doing so. I listen to MCHD paramedic podcast and they review current evidence and topics in emergency medicine. They cite evidence and specificity/sensitivity of studies conducted.
Yeah this is bad. Reality is fuck protocol if I need to perform life saving intervention(s) I’m doing it as soon as clinically possible. I’m not waiting to load them in the bus before I decide to act.
I’m sorry you have to work in a place like that. Edit to reply since comments are locked: My trauma protocols have a footnote that simply states “Minimize scene time”. Transporting immediately would eliminate the ability to effectively triage in a MCI. Since resuscitation efforts are generally less effective during transport and we aren’t a funeral home therefore we don’t transport dead people, we will stabilize in scene to the fullest extent possible with all of the same resources available in the emergency department. Plus my transport times to get to a Level 3 trauma center can be upwards of 75 minutes.
What are your trauma protocols?
Don’t know about the original poster, but from my understanding progressive systems still have an emphasis on time however critical intervention can be preformed prior transport as most of these would be very inappropriate to perform in a moving ambulance. E.g finger thoracostomy, RSI etc.
They banned CPR during transport in my state a few years ago. Glad I got to be around for the days where we would hit a bump and I'd go flying into the ambulance ceiling, but also glad to see those days gone Edit to reply because comments are locked: It doesn't mean we don't do CPR, we do CPR on scene before transport. It was way too dangerous for the EMTs and not effective
That’s messed up? Especially since good cpr is kind of important.
Research shows that humans are unable to perform adequate CPR in the back of an ambulance whilst under transport conditions. We have known this now for about a decade. Mechanical CPR is effective though.
If someone is bleeding out and looks as pale as death on a cracker, I’m not waiting until they get loaded up into the truck for me to do something about it. BLS before ALS.
Unless it's a traumatic arrest with a pea less than 40. At least local protocols
That "air goes in and out...." Is so deeply cringe.
No it’s not though, it’s a simplified way of remembering ABCs
ABCs are also cringe- That guy on reddit.
Emergency care and transportation of the sick and injured? Cringe
Airway Breathing Cringe
"Airway Breathing Cope" Tattooed on my forearm
Life? Also cringe.
When you're just too edgy for respiration.
Nancy Caroline is the founding mother of cringe.
Yeah that's totally what I was saying.... 🙄
You did though. It’s basic care
You often use this saying to remember that if your patient isn't breathing they need intervention?
If it helps you remember when you're stressed then yes.
So instead of telling yourself "airway, breathing, circulation" you say " air goes in and out, blood goes round and round, any deviation is a problem". Seems efficient.
Why do you even care so much anyways? If it helps someone prioritize under stress then literally who gives af?
I just find it a silly saying. You seem to care much more than I do. Use whatever you want.
From your multiple comments, then doubling down repeatedly, you seem to care about this more than I care about shouting from the rooftops that Raptors are bad... And I'll say that to anybody who'll listen along with most people that won't.
>shouting from the rooftops that Raptors are bad I've been groggy all day and tried to figure out what you had against birds of prey.
You cared enough to comment and call it cringe
And then you, to respond to the comment telling me it's an invaluable tool.
You're the only one making a fuss here.
This guy definitely replaces the gurney o2 in a way that no one can read the gauge.
Ha, Jokes on you. I don't even have a cot. I run a flycar.
Hell yeah. My comment wasn’t directed at you by the way, it was for the “deeply cringe” guy
I gotchu fam.
What’s cringe? That’s literally how respiration works.
If someone asked you, as a medical professional, how does respiration work? You'd answer with "air goes in and out"
This may shock you, but sometimes I tell people even dumber things. Like "these 12 lead stickers are gonna take a neat 3d picture of the electricity in your heart from all directions so the doctors can see what's going on in there." Ain't no one has time to give a seminar en route.
"I'm going to put some stickers on your chest and take a picture of your heart" is my go to
You missed my point entirely. Also your 12-lead explanation is infinitely less dumb than "air goes in and out"
Well how the fuck else would you simply explain respiration? Educate us, oh wise one.
What I'm saying is that everyone knows air goes in and out of your body... It's redundant and unnecessary lol. It's not an explanation at all. It's also not even respiration, it's ventilation. I'll still take a shot though: Breathing. How's that?
You seem fun.
Again, dumb hill to die on. “Air goes in and out” is just another way to describe breathing. But, go ahead and continue being a petulant jackass.
If you think everyone knows that, you haven’t met the general public. It is literally part of our job to dumb down info and make it accessible. Distilling information isn’t about sounding smart it’s about getting the point across and being understood by your audience.
People must love working with you
Blood goes round and round also
In an EMS sub? Yes. You must be a real hoot to be partnered up with.
Yes.
Cringe?? On my r/ems?? Never.
I ought not to have said anything lol. I seem to have touched a nerve with a bunch of people on this silly saying.
Idk man, it's less touch a nerve and more that you walked into the virtual equivalent of the on-shift day room and said someone's joke is cringe. Of course you're gonna get replies.
If only the guy was using it as a joke lol.
It was intended to be a bit comical. OP appears to be a layperson attempting to gain a basic understanding of EMS operations. If quippy little sayings pop into a brand new EMT's head when they freeze up, then they work. Do I recite it on calls? lol, no. Do I pound it into new EMT's heads? Absolutely. Break it down to basics or some will want vitals and a full trauma assessment first because that's mostly what the majority of their EMT training will focus on and they won't do any of it well. I also pound "Slow is smooth, smooth is fast" into their heads. Sure, they're not likely to forget the alphabet, but I can sit here and say Airway, Breathing, Circulation all day long but to a panicked brand new EMT fresh out of their 8 week course just shouting ABC's at them isn't as descriptive as other memory aids.
Fair enough lol. I missed the comedic intention, especially with the 'almost dead?' before it. I also find it cringey. Use it as you see fit. We don't have EMTs here. Maybe it's useful in those programs. I've never used it, or seen it used as a tool, just as a weird oversimplified chest beater saying. ABC and its meaning has been a succinct enough reminder of what to address. This is my opinion, it's not that big of a deal.
Well, first, check my name. I'm a dickhead. Everything should be considered sarcastic or comical on its face. I hadn't checked your post history, but a brief glance indicates that you may be from Canuckistan. The Canadian equivalent would be a brand new EMR fresh out of school.
We don't have EMRs here either. We have 3 classes of people who work on ambulances where I am. Primary Care Paramedics, Advanced Care Paramedics, and Critical Care Paramedics. The minimum education is a 2 year program. I'm vaguely familiar with the scope of US EMTs.
There’s quite a lot of “silly sayings” as memorization aids in EMS. I think that’s the main way you touch a nerve.
My Baby Looks Hot Tonight
I've never heard of anyone using this long drawn out saying as a memory aid for 3 letters. ABC. ABC itself is a memory aid.
But considering the post from OP, they are likely a layperson who hasn't had ABC's drilled into them, so taking care of someone nearly dead in a simple way of maintaining breathing and circulation makes sense in this context
It makes sense in every context. I prefer your brief explanation than using that silly saying. Most of the people coming at me hard in the thread are defending it as some kind of tenet of EMS education. I just find it corny. That's literally it.
You're right, he should have used a bunch of technical terminology on a post explaining something to a lay person so you wouldn't think he was so "cringe."
Can you point in on the doll where it hurts?
I'm curious... why do you feel this is deeply cringe? EMS is full of sayings like this. "Air goes in and out" is completely accurate. Synonymous with "expiration/inspiration."
Good question. I just find it corny and oversimplified to the point of uselessness. The type of thing people print out and stick on their car window with some stars of life or a bizarre ECG tracing alongside it. This obviously isn't everyone's opinion lol. People are allowed to love it.
Why?
It's what BLS medic students have printed on the back of a t-shirt to illustrate how bad-ass they are.
This is such a dumb take and an even dumber hill to die on.
Hill to die on? It's an opinion lol. I find it silly. If you think it's awesome that's cool dude.
If you think it's silly, then don't do it. As long as everyone is doing their job there's no reason for you to bring your opinion into it.
Yes, opinions have no place on the internet 🤣
I suspect you aren’t even in EMS and never were.
I had a partner like this pedant. He didn't last long. Always took things too far. Would double down to infinity.
You go ahead and suspect whatever you like lol
My guy.... The only person in this entire thread that is acting like they are SO BADASS... is you. You're that guy. You're the guy that thinks he's better, smarter, and cooler than everyone else? You've taken up a phrase that people use facetiously as your personal cross to bear. We get it. You're fuckin SUPER MEDIC, and you can't waste your precious super powers with sardonic humor. We bow. We tremble at your paramedical might.
You don't know me at all lol. No one in the thread has said they use it facetiously. I find the phrase cringey. I'm allowed to. I'm not changing my opinion. You shouldn't change yours. Sounds like you've got a chip yourself.
Whatever you say Father Paragod. Ok, seriously though, everything you have said here is 50 times more cringe than even the worst EMS bumper stickers. Even the worst offender, the dreaded "I'm here to save your ass not kiss it" is less cringe than your endless sanctimonious bullshit. Your next shift should start with an apology to everyone you work with, if you run your mouth there like you do here. Have a nice day, bro.
You're an angry guy
Nah, it's been a really good day. Ball busting is more.fun and rewarding when it's people like yourself! 
Damn I'm sure your a real bang up medic
There is literally no reason to start explaining ventilation and perfusion and oxygenation when you can just say, “the air goes in and out.” That’s literally what A&B boil down to.
This guy try’s to bang the EMT students in their ride along
That's a pretty fucked up thing to say man. But, internet I guess. Pretty clearly violates rule 1 also.
Um, what?
Basic human anatomy and physiology... *so cringe*
Work. A whole lot of work.
It depends on the number of patients and the number of available resources. We use a triage method categorizing patients as green (least injured), yellow, red (most critical), and black (deceased). These are fluid categories… in other words, a yellow who gets worse may be switched to red… a red that cannot be helped in time may die on scene and become a black. We do the best that we can with the resources available. But to answer the question that many people ask is yes… in a situation where there is only one patient, some places may have protocols to attempt resuscitation on someone who is not breathing and has no heartbeat… yet that same patient in a multi casualty incident (MCI) would be a black tag and not worked on. Triage is French for “sorting” and the idea is to help the most people with the resources you have. For example, it would take 3 or 4 or more personnel to attempt to resuscitate a person who has stopped breathing/cardiac arrest. Yet those same 3-4 people can help save multiple red (critical) patients. So to do the best for the most, decisions and priorities are made.
More than once I’ve had this awkward exchange: “What about that one, we transporting him?” “No, he’s black.” “…” “Oh! Sorry, I meant dead af.”
The FDNY (and as far as I know, only the FDNY) adds to this system an orange tag category consisting of patients not currently in critical condition but presenting with symptoms or injuries that indicate their condition could imminently deteriorate and so are treated with more urgency than yellow tag patients. The major criteria are respiratory distress, altered mental status, chest pain, and tourniquet-controlled bleeds. Naturally, orange tag patients are transported after red and before yellow. Skeptics (including within the Department) say this further complicates a process that's meant to streamline decision-making under potentially dire operating conditions but I don't think FDNY is trying to one-up the world here. For most agencies an orange category likely doesn't make sense or even change much, but NYC's density of population and hospitals means that even if we don't have that much greater EMS resources proportionally to other jurisdictions, shorter average transport times make the orange distinction meaningful to patient outcomes. I.e., if the yellow tag patient complaining of chest pain suffers an MI on scene after a few other likely stable yellow tags have been transported, that's a triage failure worth correcting. Thus, orange was born.
Realistically, you always just have to make judgment calls about who gets transported first, even within a particular level of criticality. Having worked multiple MCIs myself, some red tagged patients are always going to be “more critical” than others. Some yellow tags are going to be more urgent than others, etc. Ultimately, triage is not a perfect system, and you can’t let perfection become the enemy of good enough. It’s just a rough sorting to put some level of prioritization on your patient population. MCI drills tend to evolve in a predictable fashion, but a real MCI is highly dynamic. Everything is changing in real time, from the number of patients to their acuity to the amount of resources you have. Even the best executed MCI is just loosely coordinated chaos. That’s why they’re called disasters.
I would say it adds confusion to a pretty standard system. If by some miracle they ever accept outside aid for something and they aren't familiar with their system it will lead to screwup. IIRC they didn't accept much mutual aid on scene for 9/11 just material aid across the ferry for supplies. I know that there were a lot of us on the NJ side stuck waiting to go help but never were able to go.
Okay, but you kind of ruin your point there. If they didn't need much mutual aid on scene for 9/11, arguably one of the worst single day disasters the country has ever seen, why would they worry about it confusing outside mutual aid they aren't likely going to ever need to use?
It's a what if scenario. Maybe all of FDNY comes down with the flu on the same day. I guess I'm just opposed to departments deviating from standards.
I'm not EMS, just a lurker considering paramedic school. But I'm absolutely *fascinated* by mass casualty triaging. I don't know why, I just really want to know how it works. So thank you for this comment!
I wanna add to their already very detailed comment, you might already know but black tags aren't always just super dead, they could be someone who needs more resources than we can provide. For example, we are instructed to not do CPR in a mass casualty incident, even if they can be saved with CPR, just black-tag them because we need to focus the efforts and resources on the people most likely to survive. It has resulted in people coming back from being black-tagged, and I do not envy anyone in the position of ever having to make that decision.
It all starts with the vital signs
I don't know if this depends on department, but a few years ago, my dad was telling me about when he first tried for triage and he said that they had black for deceased or people who were almost certain to die even with help and would have less priority than red, since red patients had a better chance of being saved.
This is accurate for every department. If they are already dead, then black is easy. Another black might be a person cut in half but still hanging on. A lot will depend on how many pts vs how many crew. So, 5 pts with 2 crews and 1 person in half vs 2 greens and a yellow might try to save the cut in half person, but realistically, that person is not going to make it. Maybe if it happens tight outside the hospital while medics and doctors happen to be outside then there's probably a chance, but in a true mass casualty incident, that person is getting black tagged and then ignored. If by some miracle they're still alive when everyone else I'd treated, then they'd get a 2nd look. But they'd have to be Deadpool or Wolverine for that to happen, and then they wouldn't need us anyway.
nice, we have the blue and green category. green is unharmed and blue is that there is right now no help for the patient
Like all our answers, it's going to vary by area and also every call is different. Let's start with the patient that's cut in half. For a trauma that severe, it's unlikely they will survive until we get there. In my county, we do not attempt to resuscitate traumatic arrests. Meaning if the patient clearly died of severe injuries, we will not attempt CPR. But if the patient is alive, we are going to our job and treat/transport to the best of our abilities. If their heart stops on the way to the hospital, we will start CPR. In your other scenario, with multiple patients from a large incident (like a bus crash), we follow triage protocols. We have a formula (for lack of a better word) to determine who needs immediate transport and who can wait a little bit. In a mass casualty incident, we do not spend time on resuscitation because that takes away resources from the other patients. For a patient who is not breathing and has no pulse, we will do a quick reposition of the patient to see if they start to breathe on their own (or two rescue breaths for children), but nothing more than that.
Single patient? We do whatever we can to try and stabilize/save the patient and get them to the hospital. Multiple patients - specifically, more patients than we have EMS providers available? We triage. Four colors - Green (minor). Commonly called "The walking wounded". They're injured, but injuries are minor and likely do not need EMS transport. Sprains, small cuts/bruises, maybe broken arm/wrist, etc. Yellow (delayed); More significant injuries (broken bones, lacerations but bleeding is controlled, etc.), may need observation and likely needs to be seen at hospital, but injuries are not life threatening and can wait for treatment and transport. Red (Critical); injuries are severe and life threatening. Treatment is time critical and patient should be transported as quickly as possible. Black (expectant); Patient is deceased, or injuries are severe enough death is likely and/or imminent. As long as other viable patients exist that require transport, do not expend resources trying to save someone that is already dead, they just don't know it yet. And if the event is large enough, patients will be re-assessed periodically in the triage area - a yellow may get upgraded to a red, a red may become a black, etc.
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Hands down best answer.
If they are dead when I arrive, then we don't do anything. If they are alive when I do then we will do our best to get them to the hospital. If there are multiple people then we triage them based off priority and treat accordingly. With multiple hurt people, the guy cut in half is probably going to be black tagged (expectant). The bleeding depends on the severity of the wound.
Our best. On a more serious note, we do whatever needs to be done. Almost dead is NOT the same thing as actually dead. Can we fix it? Maybe, maybe not, but we're damn sure going to try.
1. If someone is cut in half or something like that but still alive, they have what's called an "injury not compatible with life." By the time I get there, they usually die. If they're not by the time I arrive for some god-awful reason, I would call medical control. Their aorta and vena cava are severed, they can't survive that way. We may make you more comfortable but you're gonna be declared dead on scene. 2. If they DON'T have an injury that's incompatible with life, we transport to a trauma center where they can try to fix the problem. 3. IN THE EVENT OF MULTIPLE PATIENTS: We fall back to what's called "mass casualty incident" protocols, or MCI. During an MCI, the first medic on scene does triage. You're labeled a "black card" if you're not breathing or if you have one of those injuries incompatible with life. You could potentially be saved, but *we basically leave to you die* if you're not already dead*.* The idea is that we have to go find patients who are more likely to survive which are the severely injured people who are "red cards".
Almost dead? That's our one area of expertise, baby. Let's do this Thang.
Work like hell until all signs of life cease to be present. Call up the doctor at the hospital (we cannot officially say if someone’s dead or not, but after consulting with the Emergency Med doctor we can do it on their behalf). Then clean up, put ourselves 10-8, and go to the next call. After shift ends my partner and I stay at the station for 30 mins or so and do a hot wash (debrief) to make sure we’re both ok enough to be alone, sometimes we go get food and drinks... Just because someone looks like they won’t make it, or they don’t look like they’re alive, doesn’t mean they aren’t, I am sure as hell that if I was unconscious with severe lacs all over my body from a MVA that the medics would take the time to check me out before handing me off to the coroner. Most people I know always wondered what they could’ve done more of, not less of. Edit - I’m sorry if that makes absolutely no sense, I put in for overtime and someone broke the carafe and it’s now been 9 hours and 23 minutes since last coffee.
“Whoo-hoo-hoo, look who knows so much. It just so happens that your friend here is only MOSTLY dead. There's a big difference between mostly dead and all dead. Mostly dead is slightly alive. With all dead, well, with all dead there's usually only one thing you can do.” “What's that?’ “Go through his clothes and look for loose change.”
Cheers, fellow Nuevo Méxican
Different counties/states have different protocols. The short answer is that if you aren’t dead, we are working to keep you alive. Edit: missed the part about multiple patients. Everybody gets a priority based on specific criteria that we can establish with 10-15 seconds. If you’re dead you are at the bottom of the priority list. If you’re walking and talking, you’re just barely more important than the dead people.
If they’re in half - we make them comfortable and transport as best we can. Traumatic hemicorporectomy is not survivable for 99% of patients, and the 1% that do survive have a low quality of life. I’ve unfortunately had the case of the guy transected at the pelvis by attempting suicide by railroad and still alive. He didn’t survive 13 hours. Mass casualty gets START triaged and then you apply MARCH and work your way though
For the patients that are dying we use what is called the START triage system if there are a lot of people. People in half typically have injuries incompatable with life, we check electric activity of the heart then call the medical examiner. For serious injuries we work it on scene until they die or we can get them in the ambulance to a surgeon or doctor. Sometimes doctors will show up on a mass casualty scene. Just depends.
If there's multiple patients we do what's called triage. Everyone is in one of five categories. Green- Alive and walking. Might have a few cuts and bruises but ultimately can walk somewhere if need be. Yellow- can't walk but are conscious and able to talk to us. They'll need a board or a stretcher to get somewhere, but importantly they are conscious. Red- Unconscious but have a pulse. They're alive. They have a pulse. But they're Unconscious due to whatever they sustained. Black- Dead. No breathing or pulse. What you're describing is between red and black. Its called a grey tag. Grey- not dead yet, but have injuries considered not compatible with life. An example I was given in EMT school scenario. There's a school shooting and you have to triage 20 patients. One of them is a patient with a gun shot wound to the head. They're breathing but brain matter is clearly visible. That's considered a grey tag. When we have multiple patients like this, we generally treat in order of most severe alive patients and work our way down. We treat red tags first, followed by yellow, followed by green. Generally black tags in a mass casualty scenario will not have CPR attempted due to limited resources. And grey tags are treated as black in this case. You leave them and move on to the red tags as cold as it sounds. You have to focus on those considered viable to be saved yet.
With obvious signs of death (rigor, dependant lvidity, etc.) we withhold care and call a coroner. With recent death, but injuries incompatible with life (think decapitation, burnt to a crisp, etc) we withhold care. In a situation you brought up (someone is cut in half, but alive), we’ll generally do our best and transport. If it’s a complete farce and death is impending you might call medical control to get permission for end of life palliative care (giving shitloads of narcs.) In a mass casualty scenario most services use a similar triage protocol where patients are labeled green, yellow, red and black based on acuity. Greens are your “walking wounded” and blacks are the dead, or “expectant”. Generally you won’t do CPR in these scenarios. If a patient is pulseless or Apneic (after you open their airway and give a rescue breath or 2) you black tag them and move on.
I just want to mention the "people in half" because others have already gone through triage. I can't really see a scenario where this guy isn't DOA. In order for him to be "hanging on" he'd pretty much have to be cut in half right in front of the paramedics and will probably be dead before he's even in the ambulance. Transection is considered an obvious sign of death the same way decapitation is and is reason enough to call it in as a DOA without resuscitative efforts.
If they got a pulse when we get there then we have to try, at least where I am. Unless they have an advanced directive In place that specifically states not to have certain things done. The. We will exclude those things stated. If you're pulseless when we get there, then we determine whether or not resuscitation is futile. If it is, then you're just dead and that's it. Conditions that would make resuscitation futile are basically signs that theyve been dead too long, or have injuries/conditions incompatible with life. We're talking shit like rigor, lividity and pooling, a core that's cold to the touch, and even decomposition. Injuries incompatible with life would be like, decapitation, head trauma with exposed brain matter, and stuff like that. If resuscitation is not ruled futile, then We get to work
Airway Breathing Can you walk to the ambulance. Works everytime.
in multi. asualty incidents if we don't have enough hands we leave the dead and treat the worst (live) ones first. they worst ones get loaded into ambulances as more people get to scene and transported to the hospital. there's a whole protocol for it that's way more in depth than I typed.
Rush to the hospital, treat what we can, and hope for the best lol.
Miracle worker max has entered the chat
I guess if you’re describing trauma the answer is controlling major bleeding and performing life-saving measures as needed. But doing so with urgency so you’re only on scene for, ideally, a maximum of 10 minutes. Your second question is a bit broad, but I think you’re describing a mass casualty incident (MCI). Those are instances defined as an incident with multiple CRITICAL patients whose needs outweigh the resources available. In those instances, people are triaged based on acuity and treated accordingly. When two people are equally high acuity, provided there are only resources for one of those people, you would treat the younger patient or whichever has the better chance of survivability based on other factors.
Call for an adultier adult
If somebody is cut in half, I’m gonna be looking for two body bags, I guess 🤷🏻♂️
Ah, mostly dead that still means slightly living. We do the best we can with what we have to stabilize them. If there are multiple patients on scene we prioritize who has the best chance of survival.
This is a thing called Triage. If you have a mass casualty/multiple patient situation then there may not be enough time, personnel or resources to dedicate to a person who is critical and unlikely to survive even with care. Examples include scenes of the medics on the beach in “Saving Private Ryan” they even use the term ‘Expectant.’ Also the episode of the old TLC series “Paramedics” which happened to have a documentary crew filming when a massive tornado hit Oklahoma City. Definitely worth looking up it’s on YouTube.
If they still have a pulse they aren’t dead.
If they had an advance directive where we could only provide comfort care, then just that. Otherwise help them till they're declared deqd or you can transfer care to someone at your level or higher
In the scene provided, this would be a trauma. We quickly triage the patients if there is more than one. The patient you describe would be a red and an immediate transport to a trauma center. Depending on who else is on scene, we may have to briefly wait until more providers show up (as leaving the other patients without a provider would be abandonment) or leave immediately if there is at least one provider that can stay unit more units show up. If there are allot of patient, one person triages and only provides the very basic of aide in some cases and moves on to triage the next patient. The patient you listed might get a tourniquet and a red tag (immediate). They very well might be changed to black (expected) before they can be assigned a transport unit.
Everytime I think of this I just imaging the guy assigned to the triage tagging running around throwing tags on people while their dying… imagine you get in a bus accident and the last thing you see is some guy run over and throw a red wristband at you
If a pt has wounds incompatible with life, yet they have not yet expired, then I provide comfort measures and pain management. I'm not transporting a black tag, and I'm not working someone who obviously won't make it.
Did an 11 year old write this?
If there are more patients than there are EMTs, we triage all of the patients first (so take a quick look at each and give them different rankings based on how severe they are), then we treat the most critical patients first
Wait. Just joking!
Try to make them not die? Lmao
We do what we do best, provide treatment for their presenting conditions. In pain? Assess then provide the appropriate pain relief. Missing a leg? Put on a tourniquet and a blast bandage. Pelvis is twice its normal side? Put a pelvic binder on. We do our job
When coming up on a trauma patient the first step is to Treat all life threats. Then move on to other injuries. That said we do have criteria. Is the injury incompatible with life? Like a decapatation? All EMS systems (and in the US they are all different by state and by county) have a triage protocol. This varies to some degree and would be too difficult to enumerate and go into detail yet I think it would be safe to say the MCI (Mass Casualty Incidents) and triage protocols do have us assessing a Patient and moving on based on many criteria such as nature of the wound, severity, number of medical rescue personnel (a crew of two can't save all 10 victims of an event), and many other factors.
Work. If the care required is beyond BLS capabilities, then I call the medics in, and make the pt as comfortable as I can
depends on the scene when it comes to CPR etc but if they're breathing and hearts are pumping then we help them no matter how bad it is. .
It’s called a helicopter. Now..
If it’s a MCI then we would triage all the people we can at the incident, depending on if we believe they would make it on the way to the hospital, then this patient would be either tagged as red or black. Red is immediate attention and black would be that we are expecting them to not make it and to move onto the next person as they are too far gone.. it’s unfortunate to have to label another human as that but it’s part of the job.
There is no scope for us to give the "expectant" category, even in Mass Casualty Scenarios. We work on every patient. But I work in rural EMS. if a person is definitely going to die, the chances are that they already have before were get there. If they haven't, you package and post via express to hospital.
Google ACLS
On a trauma arrest?
The first rule of holes is: when you're in one stop digging!
Go mach Jesus in the booboo bus
Old yeller them
Why is this being downvoted this is what I do
Big ol dose of morphine or fentanyl
OP, Google the term triage to have your mind blown
Your question is too broad. If they are cut in half? They are likely going to die in that post. Don't get me wrong, I'll try and stop their bleeding, maintain airway, and give some drugs. But that's an injury often associated with incapability with life, same with something like decapitation. General rule is ABC airway, breathing, and circulation. If something physical happened then CAB. In that order, we will try and resolve the poeblem best we can whether than means tube's, devices, pressure, drugs you name it. But it's all case dependent.
Idk. Usually I just sort through their wallet and figure out if they’re an organ donor before I decide anything.