He’s calm, funny and likable. I can imagine that in moments of emergency, he can stay really focused and rational. Just shows that some people truly find their professions and purpose in life!
Agreed. I was floored when he caught the mistake of lifting the motorcycle over the guy's head. He must've had something like that happen to him or his team.
@Brett Why are you floored by something that anyone should have caught? It's a 350-450 lb or more hunk of metal, plastic, rubber, etc, and you're going to lift it up and over an individuals head? Moving it with manpower alone is risky as it is, but moving it over his head is flat-out dangerous.
I had to do chest compressions on a woman a couple months ago. I've had training in the past that made me "certified" but it was years ago. It was the 911 operator that got me doing them. He had a metronome I could hear to keep pace with. I couldn't believe how tiring it was. I kept slowing down and the 911 guy kept me going at the right rate. I remembered how far you had to compress on the dummy and after only a minute, I felt her sternum break. I told the the 911 guy about it and he said that's ok, keep going. A decade or so ago, the woman had open heart surgery where they broke (cut?) The sternum to get in. I imagine that was the weak point that broke. Anyway, I must've done something right. I was doing the compressions for about 10 minutes and the woman is alive and kicking today.
Good job!! Glad you weren't afraid to step in and help! That's an awesome story! Even in people without a 'zipper', it's very common to break ribs doing CPR. Specifically with elderly folks.
I had a cardiac arrest , luckily in the back of an ambo and I ended up with numerous broken ribs. The fact that I was in pain meant they did it right and I was grateful for being alive to feel the pain.
@@chrisdixon299 lol idk, man, as a veterinary technician myself, I very often have a stethoscope around my neck, trust me with your pets, absolutely 100%, i treat every pet like their my own, but trust me otherwise? Not sure if that's a great idea 🤣
More than what he does know, I'm impressed with this man's ability to admit when he doesn't know, and I appreciate that. As a patient, I appreciate it when my PCP admits to not knowing something and works to get me to someone who might. I've had plenty of professionals try to skirt around their ignorance rather than accept it, and it always fills me with unease. I've always respect healthcare workers who are honest. This gent seems like the reliable, honest sort.
I really liked this expert. Loved his knowledge, how he analyzed the scenes, explaining the reasoning. Plus his reactions really felt genuine and were hilarious, like "Yep, that's called murder. He stabbed her!". I would love for him to come back and make another batch of ratings!
I had the Ukrainian-American version of him for my mentor back in the day. You gotta appreciate medics like them, totally committed, great demeanor, and super-knowledgeable! Those are the medics I would easily trust with my life if crap ever hit the fan!
Finally an episode from a Paramedic’s pre-hospital point of view. As a registered Paramedic in the UK, it’s interesting the differences between the skills and equipment we use in the UK, compared to the US. It’s also interesting how many similarities there are, from clinical interventions, and administrations of medication. Next episode, get a clinician to review ‘Bringing Back the Dead’ with Nicholas Cage.
I’ve received a few messages from UK medics over the years and have done competitions with you guys. I like the differences and similarities too! A big little EMS world!
Scope of practice also range widely in US, for example my protocol in Washington States allow simple thoracostomy, pericardiocentesis and blood transfusion(if provided)
I shattered my hip and broke nine vertebrae last February. And some ribs. Those fine paramedics in Flagstaff gave me fentanyl in the ambulance twice, and I didn't even ask. Thanks guys, for all that you do with people having their worst moments.
Lucky. I had broken ribs, a collapsed lung and the other on the verge of collapse. They didn’t give me a damn thing until I started flipping out at the hospital and tearing at my bandages because of the pain. I don’t remember much because eventually I was given fentanyl. I could barely speak or breathe.
As bad a reputation as it has, fentanyl is common in medical treatment for the simple reason that it works, but it should only be prescribed for things like surgical anaesthesia (personally had it twice in the last three years for knee surgeries) or emergencies, and not things like chronic pain where the constant dosing means the risk of physical reliance and addiction becomes higher. Medical grade fentanyl is also unlike the street drugs that're often badly made or contaminated, which is a big cause of deaths and big reason why it has a bad rep. Also, while the OP's story sounds positive, l have issues over the fact that they administered the drug without asking. I don't know what the laws of consent are in the US, but here in Australia if you are even remotely aware and sensible they cannot administer any drug or treatment without first getting your consent. This can be as simple as verbalising what they're about to do ("l'm going to give you some fentanyl, it'll help with the pain") and as long as you don't resist, that equates to consent, so in a way it's asking without asking. If that's what happened with the OP then l have no problem with that, because technically they did "ask". If they just quietly did it and you only found out later it was fentanyl, that's a consent violation. You have to give the patient every chance to refuse a treatment, no matter for good or bad reasons, because there's always a chance they can reveal something that means that treatment might be unsuitable; a person with a history of recent opioid addiction, for instance, might object to being treated with fentanyl and if they're aware/sensible enough to communicate that you would want to find that out and give them a non-opioid instead.
I just got home from EMT class, what a perfectly timed video upload! It's a great feeling now to have the knowledge to recognize something is wrong before he even says anything.
When I got my EMT cert 2 years ago, we were taught to do chest compressions to the beat of the song “Stayin Alive”, which comes out to 100-120 reps per min. If you’ve ever conducted chest compressions , you know that it will take every single ounce of energy you have in just a few short minutes when done properly.
12:35 great point. While traveling in a bus for a European tour Metallica's bus veered off the road (debatable what caused it ) Cliff Burton the bass player ended up being trapped beneath the bus and it slipped and fell when they attempted to move it landing on top of him for a second time. No one knows if he was already deceased at the time and that's always bothered me. There's a chance he was alive and perhaps he could've survived. But we'll never know. Tragic 😥 RIP Cliff Burton 🤘🏻😤🤘🏻
@@fastkarr8256 not necessarily. I've worked as a firefighter and an EMT and now in Nursing and you would be surprised what the human body can withstand. That's why I said there was a chance and that we'll never know.
He was definitely dead at that point. He didn't just "get trapped", he fell from the bus window and the bus fell on him. Sure it added insult to injury to drop the bus on him again, but he definitely was already dead
@@myfaceismyshield5963 I don't speak in absolutes just experience. We got dispatched to an 18 wheeler rollover with a female under it and she survived after rescue. All I was saying was it can happen. I wasn't there so I can't say DEFINITELY either way.
I wonder how long he was “trapped” under the bus in the first place and how exactly his body was positioned under it. Could be Acute Compartment or Crush Syndrome, especially if unrealized at the point of rescue. It’s been shown that even one hour could lead to such severe consequences, not to mention hypovolemic shock to begin with, both which should be treated with fluid overload. I would think that the only substantial prehospital difference between the two would be how careful the fluids should be managed and if bicarb should be considered if within local protocol. Other than that there’s not too much that could be done at the prehospital level.
During basic training in the Marines a recruit in my platoon started choking while we were in the "chow hall." Our DI walked over, stood the kid up and gave him the Heimlich maneuver, calm as ever. Then screamed at us to hurry the F up and eat! Good times!
It's interesting to me what we "know" from movies/TV. We "know" that defibrillator paddles are used when someone flatlines, so movies/TV continue to depict this, even though it's inaccurate. According to this expert (and other videos), in reality, paddles are no longer used and if someone flatlines, it's too late for a defibrillator or anything else to work. This isn't a big deal with silly stuff (no, you can't shoot off a lock), but when it comes to emergency situations a person might actually experience, then Hollywood should aim to be accurate.
I love shooting off the lock, I can not get into this, ok lets make sure we wont be able to , shoot it , hopefully its a cheap lock and not going to richochet directly into us LOL
@@literalantifaterrorist4673 in Germany you find defibrillators in every public building. I rented my local community centre and it came with a defibrillator. So we were all laymen. Glad we didn't have to use it.
@@1IGG Yeah, same here in America, but those are automatic defibrillators. The difference is that with manual defibrillators, you have a screen showing you the patient's heart rhythm and you choose whether to give them a shock or not. With an automatic one, the machine analyzes it for you. You'll only find manual defibrillators in hospitals and ambulances really.
0:29 The Mrs Doubtfire one....if I remember correctly, Stu said no pepper because he was allergic and Daniel dressed as Mrs Doubtfire snuck back and put a crapload of it on there before they brought the food out. So I'm not sure if he was choking because of anaphylaxis due to the throat narrowing and thus unable to swallow it or if he genuinely started choking unrelated to the pepper that Daniel put on.
The two are completely seperate processes, but if someone goes into anaphylactic shock then it’s safe to say that is what you should be treating for, and ensuring the airway is clear is part of the care process regardless if he just choked or not. In this case anaphylaxis should set in almost immediately, but I think he was “just” choking and not in anaphylactic shock. Had he been, clearing the airway probably wouldn’t do very much as the shock needs to be reversed or it will just continually to worsen access to the PTs airway. I’m not a medical professional or anything, so this is mostly just by speculation
@@NoobOfShame pretty spot on actually. Bonus info: let’s suppose someone was choking AND had their airway close. It’d be pretty difficult to get the obstruction out so some medics can do a cricothyroidotomy.
As an ex ER Nurse, Retrieval Nurse (who did primary retrievals) and PHTLS instructor- loved it, couldn't fault it, great episode! I was once first on scene (as a civilian) at a single vehicle accident in rural Australia. The driver was critical with an obvious head injury, GCS3 (deeply unconscious) and obvious major chest trauma. I called the retrieval medical coordinator (benefits of working in the system) and when I described the guy's chest injury and signs, she got the impression he had a tension pneumothorax (TPX) and asked if anyone on scene had a knife so I could do an open thoracostomy (basically make a hole in the chest wall and in to the pleural cavity big enough to release pressure and not close over again- big time out of my scope of practice). Fortunately she was receptive to my explanations as to why I didn't think he had a TPX (he wasn't tachycardic and wasn't deteriorating). Ultimately, after a paramedic arrived (single officer, not advanced trained), the guy did develop a TPX and I successfully decompressed his tension as described by Capt. Li. Sadly, not long after the chopper arrived with a full medical retrieval team the patient arrested and despite our best efforts (intubation, bilateral chest decompressions and even chest tubes), he passed away by the roadside. As an emergency nurse, it was an amazing experience working in the prehospital setting with absolutely no medical tools available (we did have gloves from an off duty cop who also stopped) through to having all the bells and whistles of a medical retrieval team. Still, a sad outcome 😞
Randy is the man!!! A great Paramedic full of so much knowledge and experience. He’s super professional and overall a great person! Awesome seeing him on Insider!!!
Common misconception about TXA's function is that is causes increased clotting formation in the case of trauma. It actually prevents the breakdown of current clot formations. Other than that super minor nit pick, thanks for representing the profession very well. 10/10 would trust you to take care of me or my family.
Great video. Would absolutely let this guy save me. However; Max is living in not only the post apocalypse, but in Australia. Imperitor Furiosa is lucky enough not to have Larry and Barry. A knife, a bone needle, and a field transfusion are the best she's gonna get in the wasteland.
Yeah, even with Ambulance, it isn't, like, a normal ride or anything. It's an extended hijacking with the procedure being done there and then as an absolute last resort, when there's no hope for help and no more time to wait for the hijacking to end so they can think about getting to a hospital. Obviously what they're doing there isn't what's going on in your average 2022 ride to the hospital. Like, yeah, Furiosa's impromptu blood transfusion in the truck isn't living up to modern standards, but is it incredibly unrealistic just for that reason? "The surgery scenes from The Knick are all very unrealistic. They're not at all how we perform surgery now. Realism: 1/10."
emergency thoracotomys(cutting open someone's chest in the field) are actually a thing, at least here in Europe. indication is a cardiac arrest after a penetrating trauma in the "cardiac box". emergency physicians are called to every life threatening emergency and some of them are using this procedure. an emergency physician of the Berliner Feuerwehr (Berlin fire brigade) held a very interesting and informative talk about it, which can be found on RU-vid (it's in German though)
This was spot on. I liked the way he explained WHY we do what we do and why some of the treatments we saw were completely asinine. As a former EMS provider and current medical instructor, I enjoy learning and knowing why. GREAT VIDEO.
In defense of some of the more questionable CPR techniques you see in older movies, when I took my first CPR course in the early 90s the standard procedure was 15 compressions with 2 breathing/ventilation cycles and even older procedures called for a 5 to 1 ratio. Shocking a flat line was also a legit procedure in some situations (single shock at 200J), motivated by the fact that older defibrillators could misrepresent a small wave V-fib as a false flat line (due to low resolution monitors and pad conductivity issues). Shocking a true flat line is pointless but doesn't do any harm as long as it doesn't impede other CPR procedures, so many still do it and I still hear of some occasional success despite the technical advances in modern CPR equipment.
Yep, I'm old enough to have been taught all those protocols also 😊Thank god for research which keeps us on our toe to stay current in our practice, Hollywood, not so much 😊
@@jayrose6312 Well, if I don't have a defibrillator I may still try that, as it only takes a second, doesn't do any harm and there's a tiny chance it may actually work in some cases (success rate was thought to be around 5% if I remember correctly).
@@Dr_V I still keep these things in mind because the best tool you have in any emergency is yourself! I was an AHA instructor before I retired and even CPR has a low-ish success rate when considering those who made it all the way home after their in-hospital care. I’m pretty certain you’re spot-on regarding the 5%, and that’s likely because of timing since it has to be “just right.” Now, when thinking about CPR, what is it now, 10% or 15%, but without any CPR it’s ZERO percent! The only time CPR is truly not viable is a traumatic arrest, which most protocols say to call it. Personally, when I was the lead, I told the junior guys to initiate CPR even when I knew that it wouldn’t be successful, like an obvious AAA, simply because they don’t get to practice on an actual human being very often and it may help save the next person’s life! Be well. ✌️
Captain Li is a definite asset to the profession and did an amazing job representing it! He comes across as extremely intelligent, capable, but not cocky! I’d certainly trust him with my life if crap truly ever hit the fan!
Cutting open the chest with trauma scissors is a real thing. There was a trauma surgeon where I used to work that used to say there wasn't a trauma procedure done in the ER that couldn't be done with a pair of trauma shears. As a resident doctor I never really believed him until one of his patients went into cardiac arrest getting loaded into the elevator up to the OR. He pulled the shears out of the resident doctors pocket, did a full clamshell thoracotomy, and started open cardiac massage in the 60 sec before the elevator made it to the OR on the second floor.
Since this video was posted, I actually got sent some information regarding this clamshell procedure. Pretty cool stuff. Definitely not used in my system 🤬
I love that abyss scene. Very emotional. She really was slapped over and over again and is still bitter about it to this day saying she'll never work with Cameron again
RE: pericardiocentesis. You can do the procedure blind but for obvious reasons it's usually done with ultrasound. A LONG time ago the system I used to work in allowed medics to do blind pericardiocentesis in the field. For what again I think are obvious reasons they took that out of the SOPs decades ago.
Curious where did you work? That’s a lot of lead way to preform that blind on the bus. I remember a old medic was telling me they were doing mouth to mouth back on the 80s. Eff that 😂😂😂
@@johnlewis399 I spent most of career in the Bronx. I remember my old partner talking about the unofficial blood-letting procedure that people used to do on A.P.E. patients. So many old school procedures lol
(4:30) I've seen narcan deployed on two of my friends at different points (we were all fentanyl addicts at the time) and they do come around surprisingly fast. it's definitely not like in the movie where they shoot up immediately. But they do seem to regain consciousness, sit up, and begin talking again in anywhere from 5 to 60 seconds (not always though- and some people actually end up needing a second round of Narcan). It's really wild to see. LIke 10 seconds ago they were basically dead. Not breathing, unresponsive, drooling and gurgling. And then boom, they're up and talking to you, asking what just happened. Narcan is seriously a miracle drug. It's saved so many lives. That and CPR. I personally believe everyone should know how to do CPR. I think its teaching should be mandatory in schools (maybe in Health classes). I had to use CPR on my friend in the situation I talked about previously. I'm the one who noticed my friend was overdosing and I had to give her CPR until paramedics arrived. I don't know what shape she would have been in if I didn't start CPR immediately. In conclusion- I think everyone should learn CPR and Narcan should be more easily accessible to the public.
As a former Heroin user... we all knew what Narcan/naloxone was. We all knew how to use it in an overdose. You'd be hard pressed to find opioid addicts today that DON'T know the treatment.
He is a very astute and smart paramedic. I was a paramedic in the 1980's and a lot has changed. That shocking w/ no heart rhythm always cracks me up too. I'm a retired RN now and in my medical career, I have had to use the paddles once because there weren't any shocking pads on the crash cart. There also was no gel, so I left a nice couple of burns on the patient but she did live so... the moral of the story is, you gotta do what you gotta do. My biggest pet peeve in medical scenes is the rails aren't up on the beds or gurneys. Even ambulance gurneys have little rails. Anytime a patient is on one, the rails are supposed to be up.
💖thank you, insider 🌻this person is so kind to share the knowledge and waste their time reviewing these 4us🙈💕what a beautiful creature..saving many lives and educating many more! ✨tysm 💖
We no longer use the mid-axillary line for the second site used for needle decompression of the chest, it's now the anterior axillary line. Otherwise very nice and informative!
Methaline blue is also used in the aquarium industry as an anti fungal treatment for fish. There's quite a lot of treatments that cross over between humans and animals/fish etc. Another good example is Ivermectin. It was first produced for use in humans but now is predominantly used in veterinary medicine.
Probably, but it is better wording since it covers more scenarios. For example, if the object being removed was itself damaged, it could fall apart and cause a failure, and damage, without anyone simply dropping it.
I just had (unexpected) open heart surgery [bleeding from an A-Clip procedure]. I have also been an EMT, it was interesting and painful to experience what I have seen and done before.
@BrugadaBro Absolutely not. Most ER docs at level 1 trauma centers don’t even do them, they have trauma surgeons do them. Chances of pneumothorax, hitting the RV, puncturing/perforating nearby arteries etc are too high for the low probability of correct placement.
He's so freaking chill.. I like that.. His blood pressure is still low while he's helping someone during a gunshot! I would love to see his series, just him!! Definitely saw the guy who passed away from colloidal silver and he was blue for years like her...
This video caught my attention primarily because I have a friend who called our local 911 emergency service center for EMS. He was hospitalized and had an IV procedure, sort of similar to one performed in a clip here. Of course I love several of the films here, but only in Hollywood could most of these things happen.
I feel like he was commenting about the wrong things in 'The Ambulance' clip, he probably hasn't watched the film and only watched snippets of it that Insider prepared beforehand. All the things he comments on like how doctors on-call wouldn't be on the golf course (they weren't on call, they are surgeon friends of her boyfriend), how she shouldn't cut through body parts with the scissors and how it's ill advised to do surgery inside the ambulance etc. are irrelevant... the whole point of the movie is that the lady paramedic got kidnapped by 2 robbers and is stuck in an ambulance that is fleeing from police and can't stop and she must keep that injured guy alive.
In my last first aid course CPR was taught as 15 compessions then 2 breaths (through a special cloth) and repeat. Check every minute for pulse and respiration...
I love professional wrestling, but I actually found his insights on the Foxcatcher clip the most interesting part of this video! I'd love to see more of that
Emergency Pericardiosentsis - in the Mid 1990s we were familiarized with the procedure. Find your landmark (I honestly forget what it was, probably 5th intercostal space medial to the midaxilary line, while watching the cardiac monitor, insert the needle until you see a run of V-Tach withdrawal slightly and then aspirate the blood from the pericardial sack.
This guy was terrific. I learned a lot b/c he does such a great way of explaining procedures. I would really like to see him review more medical emergencies in movies (I don't really watch TV).
I think the context of the scenes should be explained. The Abyss, its the man’s wife. And she drowned. I see the explaining the procedures, but if the video is about scenes from a movie, I think context would be cool for the expert to know.
What I've learned from hollywood is that compressions are useless past the first 8 seconds. If they haven't coughed out fluid and revived by then, it's best to go in a crying breakdown and start flailing against their chest, hammer fisting their chest, and yell at them not to give up. This yields the best response.
yeah, his criticism of the Ambulance clip were irrelevant.. the whole point of that movie was that the lady paramedic was kidnapped by 2 robbers that are fleeing from the police in her ambulance and she had to do whatever it took to keep that injured person alive using what she had on hand inside the ambulance.
It's fun that he says the protocol they use is the 30x2 while, at the same time this video was published, we were using and still use compressions non-stop while another person is using the ambu bag. We temporarily stop CPR when the AED says so and, as an extra safety protocol, we have to put our hands in the air and yell "clear" so the person pushing the shock button knows "ok, nobody is touching the patient, I can hit the red button safely"
I'll Drive the Bus for ya anytime Capt. Li! This was great and well presented. although I'm a little surprised that they didn't do anything from bringing out the dead?
Really enlightening to learn that roughshod medical procedures done in a post-apocalyptic wasteland aren't up to the same spec as most hospitals and ambulances. Mind blown.
In the 1980's and 1990's, intracardiac injections of epinephrine were actually very common for a variety of medical emergencies, including cardiac arrest. Opiates can actually stop the heart, but mainly causes respiratory depression which is why they can be fatal. Although not ideal, adrenaline will increase heart rate and stimulate breathing. This may just save a life in the event of an opiate overdose. Also, naloxone (Narcan) was not as widely available back then and much more expensive than it is now. Epinephrine was dirt cheap comparatively and is still used today, more for serious allergic reactions than anything else. Also, back then, if you showed up to an emergency room for a drug overdose, police would be involved and you and whoever you were with would be arrested. Which is why many people were left to die. Most places have done away with that in the interest of saving lives.
Good job. Definitely should do a part 2 but group up with a West coast medic, I.E, Washington state, Oregon, Idaho. Pericardiocentesis, needle decompression, surgical cricothyrotomy, RSI, all SOP over here. Rumors coming around finger thoracostomy, blood products, central line placement, and chest tubes are coming into protocols too.
Mad Max is never going to get many points for realism if you're basing it off modern concepts of medicine. In that setting you basically do what you can with essentially nothing. I suspect it wouldn't work either way, but if there's no other option I could see someone trying it. There's no hospitals, after all. And like... one doctor that we've ever seen, and he's not there (and is a bad guy anyway).
I'll say that some systems actually prefer you to leave the helmet, especially for football, depends where you are I suppose. Probably makes it easier to place a c collar removing it.
@@RescueRandy It is easy to say until you realize you live in rural New Mexico and the nearest hospital with ambulanes is one hour drive, lights and sirens or not. Can a layperson do chest compressions for that long? And do they get any timeframe as to when help arrives? And when it is a case of cardiac arrest, they should send a medevac almost automatically (in Germany, Czech Republic or Switzerland they do), but I doubt they do.
