Question: Here is a question that has been up for debate from a few paramedics I work with. If you have a penetrating trauma, either in the chest or back, the BLS states to immobilize the object and transport to the best of your ability. If the patient were to go VSA and the object was impeding CPR, either from the chest or back (not being able to do proper compressions), it was my understanding that we as paramedics are supposed to remove the object if we cannot do proper CPR instead of working around the object, which is the counter argument. What is the direction regarding this?
Great question! You are correct. The Basic Life Support Patient Care Standards (BLS PCS) in section 3 page 41 states: Stabilize an impaled object: Leave the object in place - exception: attempt removal if the object is through the cheek or obstructing the airway; if the object is in the chest and is directly interfering with the performance of CPR, attempt to change hand position.
In the circumstance you describe above, hopefully this is an extremely rare occurrence that a patient has a protruding foreign body who then suffers a cardiac arrest and you are impeded from performing adequate CPR due to the positioning of the object.
Our recommendation should you confront this scenario however would be to leave the object in situ as directed by the BLS PCS, perform CPR as best as possible and initiate rapid transport following one analysis in this unusual circumstance.