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View Full Version : Seeking opinions on a moral dilemma of sorts



Tog
2010-Jul-16, 12:51 PM
Here's the situation. You are by yourself in a public area and you see two people struggling to move an unconscious person. From their speech and expression, you have every reason to beleive that the UC guy is a friend of theirs. They inform you that he's in that condition due to diabetes, but adamantly refuse to call an ambulance, or stop "helping" him while you do.

Their attempts to get him into a wheelchair result in dropping him on his head about half a dozen times, and he's still not in.

The correct thing to do is stop right there and call an ambulance. I know this. It's not an option, because the two guys moving him are going to continue either way. So, here is the question:

Is it more wrong to help them haul the guy off and try to reduce the chance for further injury, or to call the ambulance and watch them continue with their failing efforts to move him?

NEOWatcher
2010-Jul-16, 01:17 PM
I would say call for professional help, and get involved. But not in assisting.
Whether the guy is in a wheelchair or not at that point is moot. Leave him where he is, stop the others from inflicting harm, and only perform "emergency" type actions if he can't breath or something like that.
Let the professionals determine if he can be moved and how.

By helping them into a wheelchair, you are only going to add to the confusion which could inflict even more harm than they are causing.

Argos
2010-Jul-16, 01:29 PM
I second NEO.

Fazor
2010-Jul-16, 01:36 PM
If it's really a diabetic coma, there's no reason to put the person in a wheelchair other than to help move the person to a hospital. And if that was their goal, why not just let you call an ambulance?* You don't typically just "come out of" diabetic shock, at least to my knowledge, without getting whatever it is your body needs (depending on type of diabetes).

But anyway, "morally" I don't think there's a wrong answer; they're both moral so long as your trying to help. But importantly, call the ambulance and/or the police. Were the two friends intoxicated? Why were they struggling so much? Personally I'd be a bit suspicious of getting too involved based on their actions; they're either hiding something or stupid. If the former, then they could "go off" if they suddenly feel "the gig is up".

*MY* guess would be some sort of OD or alcohol poisoning.

*I said "no reason to not want to call an ambulance" but I do understand that some areas (probably MOST areas in the US) charge the patient for the call, and many times people can't afford the bill so refuse to call the squad. Suppose it could be that.

Swift
2010-Jul-16, 02:20 PM
Is it more wrong to help them haul the guy off and try to reduce the chance for further injury, or to call the ambulance and watch them continue with their failing efforts to move him?
Yes, it is more wrong. Call the police, call for an ambulance. These friends do not appear to know what they are doing, helping them may just compound the problem. Let the professionals sort it out. Even if the friends insist that you do not call and continue to move the guy away, call the police. For all you know they are not trying to help, but intend him harm.

Ara Pacis
2010-Jul-18, 04:05 AM
How do you know it was really their friend and not Weekend at Bernies?

Tog
2010-Jul-19, 07:28 AM
I would say call for professional help, and get involved. But not in assisting.
Whether the guy is in a wheelchair or not at that point is moot. Leave him where he is, stop the others from inflicting harm, and only perform "emergency" type actions if he can't breath or something like that.
Let the professionals determine if he can be moved and how.

By helping them into a wheelchair, you are only going to add to the confusion which could inflict even more harm than they are causing.
I agree with what you said, but it wasn't possible in the situation. The only way I could have possibly stopped them from trying to get him into the wheelchair would have been to incapacitate them. It wasn't an option.

My choices were to call for real help and watch them dribble his head off the floor some more, or try to help them. I helped, but I don't feel good about it. I wouldn't have felt good about it either way.

Fazor: They said it was diabetic shock, but my bet would have been an OD of some sort as well. They all looked a little shady. A local PD Sgt. comes in here from time to time. On his off nights, he works security at the hospital. He saw the guy come in and said they treated it like an OD.

Ara: That did cross my mind for a second, but they didn't try to hide it from me, at all. Instead they called for my help, and one was very close to a panic every time they'd drop him. The impression of them was that at the time, they were both very concerned for his well-being, but going about it in a really stupid way.

When it's me that needs medical attention, I'm very level headed and focused. When it's someone else, I seem to lock up and do dumb stuff. I just didn't see a way to stop them from hurting the guy more.

For what it's worth, the cop said I should have done it the way I did. I just hope it never comes up again.

mugaliens
2010-Jul-19, 08:38 AM
Is it more wrong to help them haul the guy off and try to reduce the chance for further injury, or to call the ambulance and watch them continue with their failing efforts to move him?

It's more wrong not to simply follow the third option: Call the ambulence, then assist them to the maximum extent possible. Or help them, then call the ambulence.

I'd help them to prevent further harm to the individual, then as soon as he was in the wheelchair, I'd perform the usual round of ABC checks (airway, breathing, circulation). If the individual was simply unconscience, I might still call an ambulence, as anyone in a state from which they cannot be roused is by definition "ill," and depending upon the illness, could be in critical or even life-threatening condition.

For me, doing nothing in this sort of situation is never an option.

Larry Jacks
2010-Jul-19, 03:23 PM
Here's the situation. You are by yourself in a public area and you see two people struggling to move an unconscious person. From their speech and expression, you have every reason to beleive that the UC guy is a friend of theirs. They inform you that he's in that condition due to diabetes, but adamantly refuse to call an ambulance, or stop "helping" him while you do.

While you may believe they're actually helping the UC man, for all you really know, they may be trying to get rid of his body. Call 911. Let the paramedics treat him if it is a medical emergency and let the police handle the situation if it's something else.

Moose
2010-Jul-19, 05:40 PM
1) Case 1: Those really are friends: Call 911. Get the paramedics and police moving as quickly as possible. The paramedics are to help the unconscious guy. The police are to get them to stop "helping" him. Since you've already verbally instructed them to stop (incompetently) (mis)handling their friend, you've exhausted your moral options. The most important thing is to get competent help on the scene ten minutes ago. Do not otherwise attempt to handle the unconscious person. If/when all heck breaks loose due to the TBI they've just given him, you want to be the witness on the scene, rather than the stranger with "deep pockets" that his insurance will be urging him to sue.

2) Case 2: Those aren't friends: Call 911. Get the police and paramedics moving as quickly as possible. The police are (at minimum) to recover the victim. The paramedics are to treat the victim. Short of vigilanteism, your moral option is clear: you are the only witness on the scene. Either way, do not attempt to handle the victim or engage the aggressors on your own. They have a hostage, and you will need assistance.

Either way, call 911, monitor the situation from a safe distance, and absolutely no touchee.

DonM435
2010-Jul-19, 06:37 PM
I'd be worried that the police or medical people would tell me that this guy' friends had everything under control, and that I had no business abusing the emeregency services.

Larry Jacks
2010-Jul-19, 06:47 PM
I'd be worried that the police or medical people would tell me that this guy' friends had everything under control, and that I had no business abusing the emeregency services.

If they're literally dropping the guy on his head, it'd be hard to say they had everything under control. In the best case, their "act of kindness" is likely making the man's medical condition worse, both by the delay in getting professional help and by their ineptitude. In the worst case, you may be witnessing a crime and shouldn't become an accomplice however unwittingly.

Fazor
2010-Jul-19, 06:56 PM
I'd be worried that the police or medical people would tell me that this guy' friends had everything under control, and that I had no business abusing the emeregency services.
If you're calling because of something you perceive as a valid medical emergency, it doesn't matter if you're right or wrong. According to the paramedics (firefighters) I know, the majority of their medical runs turn out to be nothing even remotely serious.

I see a lot of posts saying "The moral decision is to [help the 'friends' / not help the 'friends']"; am I the only one that differentiates "moral" actions from "correct / incorrect" actions? I think you can still make a "morally sound" decision and do the wrong thing; in my humble opinion, as long as you do what you believe you should be doing, it's moral. At least barring some kind of psychopathology.

grant hutchison
2010-Jul-19, 07:38 PM
If I couldn't get them to leave him alone in a safe horizontal position (which sounds like it wasn't something they were willing to do), I'd have phoned the emergency services (police and ambulance) while sitting in the wheelchair to abort their efforts to commit manslaughter. If they objected to this, I'd have run away with the wheelchair. A wheelchair is a ridiculously dangerous place to put an unconscious person.

Grant Hutchison

Salty
2010-Jul-19, 11:06 PM
I think NEOwatcher and Moose have hit the nail on the head.

Sitting in the wheelchair and/or running away with it goes from a provocation of the two actors or to out and out theft, which is not moral. That wheelchair is not your property to do with as you please.

This comment comes from my experience working as an uniformed security guard at three different hospitals with two different security companies.

grant hutchison
2010-Jul-20, 12:18 AM
Sitting in the wheelchair and/or running away with it goes from a provocation of the two actors or to out and out theft, which is not moral. That wheelchair is not your property to do with as you please.There is, however, an overriding moral imperative to prevent further injury to the unconscious casualty. If his alleged friends can't be persuaded to stop their attempts to put him into the wheelchair, they should be prevented. I wasn't joking when I used the word "manslaughter": if these guys were trying to feed him into a wood-chipper, I doubt if a concerned bystander would worry that the machine was not their property.

I once rescued an unconscious elderly lady from a wheelchair, into which she had been wedged by two (sorry Salty, this is a horrible coincidence) security guards in a shopping mall. She'd had a simple faint, but had almost immediately been propped upright by these two large worried men. As a result, her brain wasn't perfusing at all well. When I happened by, she was having a seizure in the chair while the two guys struggled to hold her in a sitting position. Something that could have been managed perfectly well in a horizontal position had turned into a near-death experience upright. She would have died, and in not many more minutes, if she hadn't been extracted from the wheelchair. Unconscious people frequently do not do well if you sit them up.

Grant Hutchison

Swift
2010-Jul-20, 02:25 AM
I'd be worried that the police or medical people would tell me that this guy' friends had everything under control, and that I had no business abusing the emeregency services.
I worked 5 years as an Emergency Medical Technician (and thus also interacted with the Police a lot), I taught CPR & First Aid for about 10 years, and still keep my CPR and First Aid up to date and interact with the rangers at the park system I volunteer with. While I can not say that such a thing would be completely impossible (cops do bad things sometimes), it is very highly unlikely, and it would be completely against all kinds of rules. Even if you misinterpreted the situation and everything was under control, you had reasonable grounds to assume otherwise and contacting the emergency services not only would not be abuse, but would be the proper thing to do.

DonM435
2010-Jul-20, 03:38 AM
Of course, I would hope that officials involved in emergency response would be grateful to people who provide information, and would treat them with reasonable respect, confidentiality and all that. It's just that my experiences with voluntarily getting involved in something just to be a good citizen haven't been so. I'm not talking about life-or-death situations, just things like reporting a parked car with a flat tire or its lights on, a broken elevator, just situations that looked kind of weird. I usually got pumped for identification, for more information, get told to do this or that or to wait around until it was all settled and such. It makes me think twice before sticking my nose in.

NickW
2010-Jul-20, 07:27 AM
I usually got pumped for identification, for more information, get told to do this or that or to wait around until it was all settled and such. It makes me think twice before sticking my nose in.

With the work I have done with police, they usually like as much information as can possibly be given to them. But usually in a situation as stated in the OP, you aren't dealing the police but a 911 dispatcher. That is where being a passive observer comes in handy. If you are worried about becoming involved you try to take in as much information about the incident as you can and report it to the dispatcher, that way the dispatcher can actually dispatch the proper people for the job. Of course it will almost always entail the police, which in this circumstance would probably be a good idea.

mugaliens
2010-Jul-20, 08:36 AM
1) Case 1: Those really are friends: Call 911. Get the paramedics and police moving as quickly as possible. The paramedics are to help the unconscious guy. The police are to get them to stop "helping" him. Since you've already verbally instructed them to stop (incompetently) (mis)handling their friend, you've exhausted your moral options. The most important thing is to get competent help on the scene ten minutes ago. Do not otherwise attempt to handle the unconscious person. If/when all heck breaks loose due to the TBI they've just given him, you want to be the witness on the scene, rather than the stranger with "deep pockets" that his insurance will be urging him to sue.

...

Either way, call 911, monitor the situation from a safe distance, and absolutely no touchee.

With respect to Case 1, if you call 911, but do nothing to help and they further injure their friend, you're morally culpable for negligence for having not rendered aid when you could have. Perhaps not legally so in some (most?) states, but certainly morally so, as per the "moral dilemma" portion of the title of this thread.

On the other hand, if you're sure you're not legally liable by refusing to render aid (other than calling 911), you're protecting your legal backside.

But at what expense? This thread isn't about legality. It's about morality. The expense would be the individual's health, perhaps his life. Would that be a morally acceptable thing to do, to safeguard your legal culpability while by means of legalized negligence allowing further harm to come to the individual when you could have done something to prevent it?

That's not morally acceptible in my book.

geonuc
2010-Jul-20, 08:37 AM
There is, however, an overriding moral imperative to prevent further injury to the unconscious casualty. If his alleged friends can't be persuaded to stop their attempts to put him into the wheelchair, they should be prevented. I wasn't joking when I used the word "manslaughter": if these guys were trying to feed him into a wood-chipper, I doubt if a concerned bystander would worry that the machine was not their property.

I once rescued an unconscious elderly lady from a wheelchair, into which she had been wedged by two (sorry Salty, this is a horrible coincidence) security guards in a shopping mall. She'd had a simple faint, but had almost immediately been propped upright by these two large worried men. As a result, her brain wasn't perfusing at all well. When I happened by, she was having a seizure in the chair while the two guys struggled to hold her in a sitting position. Something that could have been managed perfectly well in a horizontal position had turned into a near-death experience upright. She would have died, and in not many more minutes, if she hadn't been extracted from the wheelchair. Unconscious people frequently do not do well if you sit them up.

Grant Hutchison

Good post, Grant.

Salty
2010-Jul-20, 09:18 AM
There is, however, an overriding moral imperative to prevent further injury to the unconscious casualty. If his alleged friends can't be persuaded to stop their attempts to put him into the wheelchair, they should be prevented. I wasn't joking when I used the word "manslaughter": if these guys were trying to feed him into a wood-chipper, I doubt if a concerned bystander would worry that the machine was not their property.

I once rescued an unconscious elderly lady from a wheelchair, into which she had been wedged by two (sorry Salty, this is a horrible coincidence) security guards in a shopping mall. She'd had a simple faint, but had almost immediately been propped upright by these two large worried men. As a result, her brain wasn't perfusing at all well. When I happened by, she was having a seizure in the chair while the two guys struggled to hold her in a sitting position. Something that could have been managed perfectly well in a horizontal position had turned into a near-death experience upright. She would have died, and in not many more minutes, if she hadn't been extracted from the wheelchair. Unconscious people frequently do not do well if you sit them up.

Grant Hutchison


Ooops.

My response was with the ignorance about the danger of the upright position viz prone on the ground. Yes, the head should be at body or lower than body level.

Well, with the intention of returning the wheelchair after the authorities arrived, you could take it away...but that could distract them from the woman and bring them after you to do harm to you. You also have a moral duty to protect yourself from harm.

Me, I'd get on a phone and call 911. I'm too old to fight two other men.

Moose
2010-Jul-20, 10:07 AM
With respect to Case 1, if you call 911, but do nothing to help and they further injure their friend, you're morally culpable for negligence for having not rendered aid when you could have.

No. I've already rendered the best aid possible by calling 911 immediately and reporting the situation. The diabetic coma itself is the priority and the only life-threatening issue in the scenario. Diabetic coma is (clearly) not treatable by anybody on the scene. Focusing on anything else delays life-saving treatment. The immediate priority is to get the paramedics (and police) moving and guide them in as quickly as possible. That requires you to stay on the phone and describe/describe/describe until help arrives.

Sticking one's nose into it further, without any support at all, increases the risk to the only competent observer/guide on site, and to the victim if the two "helpers" decide in their judgment (either impaired or malefic) to resist my attempts to stop them from hurting the victim further. The first moral duty of a rescuer (and every CPR/First Aid course I've ever taken has hammered this as point number one) is to not make the situation worse by yourself becoming a victim needing rescue.

grant hutchison
2010-Jul-20, 12:49 PM
Well, with the intention of returning the wheelchair after the authorities arrived, you could take it away...but that could distract them from the woman and bring them after you to do harm to you. You also have a moral duty to protect yourself from harm.

Me, I'd get on a phone and call 911. I'm too old to fight two other men.My previous response to this seems to have vanished into the ether. Let me see if I can reconstruct it succinctly.
Moose's point about ensuring your own safety is well taken. So you need to make a judgement about the risks to yourself, and your ability to deal with and limit those risks. Tog's description conjures up a pretty familiar picture for me, of disorganized incompetents whose own state of consciousness is not currently running on its factory settings. But of course one would need to be there to assess that with any degree of confidence.
One's moral obligation also scales with the perceived risk to the casualty, and one's ability to offer assistance. Certainly in my country, the law and relevant professional bodies recognize this, and apply different standards to medically trained people than to untrained people.

So: I'm highly trained to deal with unconscious people, I have clearly identified a large risk associated with the wheelchair, and I have some training and experience in identifying and dealing with people who have rendered themselves pharmacologically stupid. I have a moral duty to get involved, specifically to thwart the wheelchair thing until the emergency services arrive.
In other situations, and for other people, the balance may go a different way: if you can't offer much assistance to the casualty, if you don't see an immediate risk to the casualty, and if you're uncertain about approaching these guys safely, then standing back to monitor the situation until the emergency services arrive may be morally more appropriate.

Grant Hutchison

DonM435
2010-Jul-20, 01:19 PM
With respect to Case 1, if you call 911, but do nothing to help and they further injure their friend, you're morally culpable for negligence for having not rendered aid when you could have. Perhaps not legally so in some (most?) states, but certainly morally so, as per the "moral dilemma" portion of the title of this thread.

On the other hand, if you're sure you're not legally liable by refusing to render aid (other than calling 911), you're protecting your legal backside.

But at what expense? This thread isn't about legality. It's about morality. The expense would be the individual's health, perhaps his life. Would that be a morally acceptable thing to do, to safeguard your legal culpability while by means of legalized negligence allowing further harm to come to the individual when you could have done something to prevent it?

That's not morally acceptible in my book.

Those are all good points. I'd add that those who create these legalistic obstacles that get in the way of needed assistance are morally culpable thousands of times over.

NEOWatcher
2010-Jul-20, 03:11 PM
No. I've already rendered the best aid possible by calling 911 immediately and reporting the situation. The diabetic coma itself is the priority and the only life-threatening issue in the scenario. Diabetic coma is (clearly) not treatable by anybody on the scene. Focusing on anything else delays life-saving treatment. The immediate priority is to get the paramedics (and police) moving and guide them in as quickly as possible. That requires you to stay on the phone and describe/describe/describe until help arrives.
I was going to mention something like that. But; I would also like to add that it's still possible that you could help at the instructions of 911 which also relieves the liability.

Moose
2010-Jul-20, 03:31 PM
Actually, the good Samaritan laws in the states are pretty clear (and Canada's are similar). If you're acting in good faith, within your area of knowledge, you're safe from prosecution. If the person were having, say, a seizure, I'd be safe from legal issues if I were to intervene. Diabetic coma, on the other hand, is not within the umbrella of (typical) first aid certification.

grant hutchison
2010-Jul-20, 03:53 PM
Actually, the good Samaritan laws in the states are pretty clear (and Canada's are similar). If you're acting in good faith, within your area of knowledge, you're safe from prosecution. If the person were having, say, a seizure, I'd be safe from legal issues if I were to intervene. Diabetic coma, on the other hand, is not within the umbrella of (typical) first aid certification.Generalized care of the unconscious patient may well be part of your first-aid certification, though, so any intervention aimed at keeping the casualty flat and maintaining the airway while waiting for expert assistance would be defensible under any reasonable Good Samaritan laws. An expert in diabetic management would (and could) probably do little more than that without specialist equipment, apart from perhaps being able to get enough history and examination to brief the paramedics on arrival.

Grant Hutchison

Ara Pacis
2010-Jul-21, 05:31 AM
A legal versus a moral dilema? Well, the issue here seems clear. The primary moral responsibility is to self-preservation. The secondary moral responsibility is to help those in need, but it was not evident if he who was in need was, in fact, in need or beyond help. In that case, call in the cavalry. Prudence is the better part of valor. And perhaps you could find a phone where you could call in anonymously if you do not wish to be identified.

As for myself, I would only be a Dudley Do-Right if I were skilled enough to "do right". Sadly, my limited military training did not include learning how to fight off two men in hand-to-hand combat while simultaneously using a cell phone and rendering medical aid.

mugaliens
2010-Jul-21, 08:43 AM
No. I've already rendered the best aid possible by calling 911 immediately and reporting the situation. The diabetic coma itself is the priority and the only life-threatening issue in the scenario.

So brain injury from them repeatedly dropping him isn't?


Actually, the good Samaritan laws in the states are pretty clear (and Canada's are similar). If you're acting in good faith, within your area of knowledge, you're safe from prosecution. If the person were having, say, a seizure, I'd be safe from legal issues if I were to intervene. Diabetic coma, on the other hand, is not within the umbrella of (typical) first aid certification.

Does one require specialized training to help two friends (case 1) avoid dropping their friend's head onto the pavement?

No. So after dialing 911, render aid to that effect. The act of rendering aid doesn't imply you're addressing the most complicated factor. Simply covering an unconscience person when it's cold is rendering aid, regardless of whatever other medical conditions the person may be experiencing.


A legal versus a moral dilema? Well, the issue here seems clear. The primary moral responsibility is to self-preservation.

:question: Self-preservation isn't a moral issue. Morals are concerned with responsibilities towards and the effects of your actions on others, not one's self.


The secondary moral responsibility is to help those in need...

It's the first moral responsibility, and is actually towards society in general, beginning with one's family, then neighbors, community, etc.


...but it was not evident if he who was in need was, in fact, in need or beyond help. In that case, call in the cavalry.

By all means call in the cavalry! Then render what aid you can within the limits of your training.


Prudence is the better part of valor.

It's "Discretion is the better part of valor," and that's with respect to whether or not one should fight today or live to fight tomorrow.


And perhaps you could find a phone where you could call in anonymously if you do not wish to be identified.

:question:


As for myself, I would only be a Dudley Do-Right if I were skilled enough to "do right". Sadly, my limited military training did not include learning how to fight off two men in hand-to-hand combat while simultaneously using a cell phone and rendering medical aid.

Assuming Case 1, Steps:

1. Call 911, hit speakerphone, and lay phone next to victim.

2. Ask the victim's friends if they know what's up. If they do and they're positive it's diabetic coma and need to rush him to the hospital, offer to assist them in helping the victim into the wheelchair.

3. If they don't, advise them to leave the victim where he is to avoid further injury, that you've dialed 911, and that help is on the way.

4. Regardless, render first aid to the best of your ability and/or limit of your training.

Assuming Case 2, it will become readily apparent soon enough whether they're the victim's friends or not, but if you don't at least try, how in the world are you going to know?

Some people live only for themselves. Some live for themselves, family, friends and neighbors, community, their nation, etc. Of the latter, "no greater love..." That's why we call them heroes. There's absolutely no reason to wind up a dead hero, though, as prudence dictates a quick, but careful assessment of the situation i.e. whether or not you're dealing with Case 1 or Case 2, and acting accordingly. Obviously, if the guy's getting rolled, a hands-off approach may very well be the more prudent approach!

While I would certainly be careful, I personally would not assume a Case 2 scenario and choose to do nothing while means were available (conversation, experience, judgement of character/demeanor) to ascertain if it were a Case 1 scenario or a Case 2 scenario. And if I were wrong? Oh, well - life itself is inherently risky. I'd rather go out attempting to do something right than die at a ripe old age not having acted when I could/should have.

But that's me. It's a decision everyone has to make for themselves.

Moose
2010-Jul-21, 09:15 AM
So brain injury from them repeatedly dropping him isn't?

My reference to TBI was lightly sarcastic. The more likely worst case for physical-injury-by-misadventure is concussion. Still not good, but not life threatening enough to risk exposing the victim to an escalation. The diabetic coma is still the priority.

If they're smacking him around hard enough for there to be a credible risk of TBI or death, then I'd assume malefic intent and prioritize accordingly.

Moose
2010-Jul-21, 09:21 AM
Assuming Case 2, it will become readily apparent soon enough whether they're the victim's friends or not, but if you don't at least try, how in the world are you going to know?

The problem with finding out definitively is that they're now loading your own bleeding carcass on the wheelchair too. (In for a penny...)

grant hutchison
2010-Jul-21, 09:24 AM
Well, the issue here seems clear. The primary moral responsibility is to self-preservation. The secondary moral responsibility is to help those in need ...That looks a little like the first and second Laws of Moral Robotics. :)
We seem to have an assumption that these two incompetents will inevitably and immediately attack anyone who interferes with their "plan", and that this attack will put the potential rescuer at such hazard that it will undo any possible moral benefit from aiding the casualty.
Moral philosophers tend to sneak up on these things sideways, and will wonder if you might risk a hangnail in order to save a thousand people from certain death. How about a certain hangnail to save one person from possible death? There's a spectrum of personal risk and risk to the casualty, and we all end up drawing our line somewhere on the spectrum, according to our perception of risk and benefit.

Another thing we haven't explored is that this is described as playing out in a public place. Can we enlist the aid of other bystanders? Performances like the one described usually attract a bit of a crowd.

Grant Hutchison

Tog
2010-Jul-21, 10:38 AM
Another thing we haven't explored is that this is described as playing out in a public place. Can we enlist the aid of other bystanders? Performances like the one described usually attract a bit of a crowd.

The public place was the lobby of a hotel at 4:15 AM. It's public in that there could be someone there at any time, not that it is usually actively populated at the time. When it happened, there were a total of four people around. Myself, the two guys, and the UC guy. The only other people would be those that might have come out of their rooms if we started yelling. My response would have been much different had I seen this happen in the dark parking lot across the street.

I've been staying out of this discussion mostly out of embarrassment. I handled it very poorly, and even though I can honestly say I knew better at the time (except the unconscious person in the wheelchair bit; that was new information), as it was happening, I could only realistically see those two choices. For me, this wasn't a hypothetical thing, and I'm still bothered by how I handled it.

I should have been more forceful about getting them to stop. My impression of the two men was that the smaller one would have followed whoever was most in charge. The bigger bald guy was doing most of the instructing and is the only one that I think might have gotten physical with me if I called or tried to stop him.

I never did think it was a diabetic shock issue. I thought it was a drug overdose from the start. That's just a gut feeling based on their attitudes and appearance though. That was an opinion shared by the cop at the hospital based on his observations of the staff. He doesn't know for sure.

The hospital did call the hotel later that morning, twice, so I know he ended up there. The police have not tried to contact me, yet, so I'm guessing that he lived. The guy that went with him to the hospital was back at the hotel 90 minutes later, so they didn't arrest him. I talked to the cop that was working security that night and he remembers seeing the guy wandering around. So far, it looks like it managed to work out well enough for all, but I have no idea what the status on the victim was.

Salty
2010-Jul-23, 02:04 AM
There is, however, an overriding moral imperative to prevent further injury to the unconscious casualty. If his alleged friends can't be persuaded to stop their attempts to put him into the wheelchair, they should be prevented. I wasn't joking when I used the word "manslaughter": if these guys were trying to feed him into a wood-chipper, I doubt if a concerned bystander would worry that the machine was not their property.


I once rescued an unconscious elderly lady from a wheelchair, into which she had been wedged by two (sorry Salty, this is a horrible coincidence) security guards in a shopping mall. She'd had a simple faint, but had almost immediately been propped upright by these two large worried men. As a result, her brain wasn't perfusing at all well. When I happened by, she was having a seizure in the chair while the two guys struggled to hold her in a sitting position. Something that could have been managed perfectly well in a horizontal position had turned into a near-death experience upright. She would have died, and in not many more minutes, if she hadn't been extracted from the wheelchair. Unconscious people frequently do not do well if you sit them up.

Grant Hutchison


Well said, Grant,

However, whether on or off duty, my first moral protection is myself. If I'm the only other person there, I serve all involved's best interests by finding a phone and calling 911 (I don't carry a cell phone; but, usually when on duty had either a two way radio or a Nextel to communicate with my dispatcher) or call my dispatcher, if I had been on duty.

In either event, the odds are two to one, in the favor of two men mishandling an unconscious man. I'm not cya from legalities, but from an implicit threat of violence. Literally cya. I'll stick by no physical involvement and call 911 ASAP.

Salty
2010-Jul-23, 02:10 AM
With respect to Case 1, if you call 911, but do nothing to help and they further injure their friend, you're morally culpable for negligence for having not rendered aid when you could have. Perhaps not legally so in some (most?) states, but certainly morally so, as per the "moral dilemma" portion of the title of this thread.

On the other hand, if you're sure you're not legally liable by refusing to render aid (other than calling 911), you're protecting your legal backside.

But at what expense? This thread isn't about legality. It's about morality. The expense would be the individual's health, perhaps his life. Would that be a morally acceptable thing to do, to safeguard your legal culpability while by means of legalized negligence allowing further harm to come to the individual when you could have done something to prevent it?

That's not morally acceptible in my book.

Hi, mugaliens,

Like I wrote to Grant, I consider my first moral imperative to physically protect myself. If the two men will not respond to my suggestion to lay the person flat on the ground, or respond with verbal hostility, my best avenue, for all concerned, to call 911 ASAP.

grant hutchison
2010-Jul-23, 12:24 PM
However, whether on or off duty, my first moral protection is myself.You're the second person on this thread to state this as if it were some sort of moral imperative.
I don't criticize your decision in this scenario, since you clearly perceive a more immediate threat of violence than I do. Each of us would make our own decision when faced with a real situation.

But I confess I'm intrigued (and perhaps a little alarmed) to see "look after yourself" given such primacy in a discussion about moral issues.
Doesn't the example I gave (risk a hangnail to save a hundred people) suggest that "look after yourself" can never be considered an absolute moral duty? If you agree, then surely there is a moral balance to be struck in this scenario, too.

Grant Hutchison

Moose
2010-Jul-23, 12:52 PM
You're the second person on this thread to state this as if it were some sort of moral imperative.

Every Red Cross First Aid or CPR class that I've taken (between 1990 and this year) has made the point, prominently, up front, that not having gloves is a valid reason to avoid contact with blood or bodily fluids, that just because they teach you how to splint an arm does not mean you should attempt to do so (except in very limited circumstances). And they've hammered that you're no good to anybody if you wind up making yourself into a second victim.

Someone with first aid is a slightly educated layperson, and not a replacement for a medical professional. What they teach (although they don't come right out and say this) is to provide the minimal amount of care required to ensure the victim's survival, and leave the rest to real practitioners. Even using first aid correctly, you can still wind up doing a lot more harm to the victim than good.

The trick is knowing when to intervene and (more importantly) when not to. There are too many potential hazards and undercurrents implicit in what Tog witnessed (for both the victim and the potential responder) for me to advise attempting a response beyond getting the cops and medics there ten minutes ago. (The questions of "whose wheelchair is that, where did they get it, and where are they attempting to take the victim" come immediately to mind, dramatically increasing the likelihood of that being a crime scene.)

Tog
2010-Jul-23, 01:09 PM
The wheelchair belongs to the hotel. He came down the elevator on the floor, then the three of us moved him into the chair. It was while I was getting the chair that I heard them drop them a few more times. Then there was one more as I was steadying the chair before I felt compelled to help them move him.

grant hutchison
2010-Jul-23, 02:38 PM
Every Red Cross First Aid or CPR class that I've taken (between 1990 and this year) has made the point, prominently, up front, that not having gloves is a valid reason to avoid contact with blood or bodily fluids, that just because they teach you how to splint an arm does not mean you should attempt to do so (except in very limited circumstances). And they've hammered that you're no good to anybody if you wind up making yourself into a second victim. Yes, it's part of the "123, ABC" approach that we teach in Basic and Advanced Life Support in Europe, too, but Life Support courses are certainly not intended to teach a nuanced moral philosophy.
If someone made a decision not to help the casualty in a scenario like Tog's, because they had reason to believe or to suspect that they would be attacked by the other "rescuers", I certainly wouldn't fault them in the slightest. I just think we do need to be clear that this is not a morally cut-and-dried issue, in which "personal safety" trumps all other considerations, all the time. (I suspect we all are quite clear about that. I'm just responding with a bit of nuance to what seem to me to be rather declarative statements.)

Grant Hutchison

grant hutchison
2010-Jul-23, 02:44 PM
The wheelchair belongs to the hotel. He came down the elevator on the floor, then the three of us moved him into the chair. It was while I was getting the chair that I heard them drop them a few more times. Then there was one more as I was steadying the chair before I felt compelled to help them move him.So you were actually supplying and controlling the wheelchair?
By offering the wheelchair, were you trying to prevent a situation in which they simply carried their unconscious friend out of the hotel, intermittently dropping him?

Grant Hutchison

Tog
2010-Jul-23, 03:09 PM
So you were actually supplying and controlling the wheelchair?
By offering the wheelchair, were you trying to prevent a situation in which they simply carried their unconscious friend out of the hotel, intermittently dropping him?

Grant Hutchison

Correct on the first count. And that was the thinking at the time on the second. They had already moved him from the room to the elevator, about 100 feet (30m) before I was even aware of the situation. They were on the way to the parking lot which was an additional 100 feet (to the doors), then out to a vehicle (I assumed). They were not even able to get him out of the elevator on their own because they were trying to drag him by his wrists. That worked to get him in, but they couldn't get him turned around to drag him out.

Every time the door would close, they would let go of one arm to grab hit the door bumpers and that wold result in a drop. The shoulders were far enough off the floor that the head would droop back and also be off the floor. Thinking back, his head probably only fell a few inches each time, it just looked further because his torso was elevated.

Cougar
2010-Jul-23, 03:53 PM
Thinking back, his head probably only fell a few inches each time, it just looked further because his torso was elevated.







In a most innovative experiment by Bayly et al. (2005)
human volunteers were studied using MRI to determine
momentary brain parenchymal deformation when the head
falls just 2 cm. MRIs of the brain were obtained before and
immediately after the drop, comparing the degree of brain
deformation or warping by measuring changes in fixed points
between the two scans. These movements were far below
the threshold for concussion and the authors liken this to
the type of head (and brain) acceleration when jumping
vertically a few inches and landing flat-footed. The authors
estimated that it was 10% to 15% of the acceleration of
“heading” a soccer ball. However, even with this mild impact
the brain deforms.

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome (pdf) (http://www.cassetete22.com/fichier/doc%20-TC%202010%20Bigler_JournalofINS2008.pdf) - ERIN D. BIGLER
Departments of Psychology and Neuroscience, Brigham Young University, Provo, Utah and Department of Psychiatry and the Utah Brain Institute, University of Utah, Salt Lake City, Utah - Journal of the International Neuropsychological Society (2008),

grant hutchison
2010-Jul-23, 04:13 PM
Correct on the first count. And that was the thinking at the time on the second.Fair enough. :)
The later details alter the moral landscape considerably, for me.
Your OP conjured up (for me, at least!) a couple of guys apparently trying to help a third who had collapsed (at least potentially) under the public gaze, using a wheelchair they had obtained (at least potentially) under the public gaze.
But what we've got is two guys leaving a hotel in the wee hours, dragging/carrying an unconscious third.

I can't think of any dialogue I could have with them that would dissuade me from phoning the police, so I'd go immediately to do that. The wheelchair is a moral issue if you think it will prevent harm: saving the casualty further injury while allowing these "friends" to disappear with him faster, so I can see why you did what you did. Knowing what I know about the upright posture and unconscious people, the wheelchair loses its moral ambivalence: it's bad for him and it lets them disappear faster.

Grant Hutchison

Ara Pacis
2010-Jul-24, 05:43 AM
That looks a little like the first and second Laws of Moral Robotics. :)
We seem to have an assumption that these two incompetents will inevitably and immediately attack anyone who interferes with their "plan", and that this attack will put the potential rescuer at such hazard that it will undo any possible moral benefit from aiding the casualty.
Moral philosophers tend to sneak up on these things sideways, and will wonder if you might risk a hangnail in order to save a thousand people from certain death. How about a certain hangnail to save one person from possible death? There's a spectrum of personal risk and risk to the casualty, and we all end up drawing our line somewhere on the spectrum, according to our perception of risk and benefit.

Another thing we haven't explored is that this is described as playing out in a public place. Can we enlist the aid of other bystanders? Performances like the one described usually attract a bit of a crowd.

Grant Hutchison

Well, I was thinking of the biblical "get the beam out of your own eye before getting the dust out of someone else's" or George Carlin's bit about pushing through the crowd of paniced passengers on an aircraft so that we can get outside and help others. The hangnail is a reductio ad absurdam. Most people will be able to use some form of the rational thought theorem to balance needs and wants with logic and expectations to arrive at a conclusion that is within an order of magnitude of parity.

We do see people who make mistakes all the time when it comes to rescues, but that just proves the point. It is people who think they can swim who try to rescue a drowning person, not those who know they can't swim. The same goes for people who search the wilderness to find a lost child and die themselves. It's not a case of morality, it's usually a case of misjudgement of one's own capabilities. It's one thing to give up one's life knowing you will lose it and spare anothers. It's another thing to attempt to save yourself and someone else and simply fail in some respect.

Ara Pacis
2010-Jul-24, 05:50 AM
It's "Discretion is the better part of valor," and that's with respect to whether or not one should fight today or live to fight tomorrow.Right, how'd I mess that one up? I think I either heard or formulated a corrallary, "Prudence is the better part of discretion."

As for morality, I supose it depends on your definition of morality and how self-preservation fits into it. It certainly does no one any good if one ends up dead when their continued existence might have been better for the society as a whole. That's not strictly true, but we can ignore the cynicism of reality.

grant hutchison
2010-Jul-24, 02:39 PM
Well, I was thinking of the biblical "get the beam out of your own eye before getting the dust out of someone else's" or George Carlin's bit about pushing through the crowd of paniced passengers on an aircraft so that we can get outside and help others. The hangnail is a reductio ad absurdam. Most people will be able to use some form of the rational thought theorem to balance needs and wants with logic and expectations to arrive at a conclusion that is within an order of magnitude of parity.

We do see people who make mistakes all the time when it comes to rescues, but that just proves the point. It is people who think they can swim who try to rescue a drowning person, not those who know they can't swim. The same goes for people who search the wilderness to find a lost child and die themselves. It's not a case of morality, it's usually a case of misjudgement of one's own capabilities. It's one thing to give up one's life knowing you will lose it and spare anothers. It's another thing to attempt to save yourself and someone else and simply fail in some respect.It seems we're in agreement. :)

Grant Hutchison

DonM435
2010-Jul-24, 04:10 PM
My experience with crises is that when I froze and thought for a few seconds/minutes/hours (depending upon the urgency) about what to do, things worked out okay. The times I got injured or messed something up were the times that someone was shrieking "Do something -- anything!" or words to that effect.

grant hutchison
2010-Jul-24, 04:37 PM
My experience with crises is that when I froze and thought for a few seconds/minutes/hours (depending upon the urgency) about what to do, things worked out okay. The times I got injured or messed something up were the times that someone was shrieking "Do something -- anything!" or words to that effect.The Third Law of The House of God (http://www.urbandictionary.com/define.php?term=Laws of the House of God): At a cardiac arrest, the first procedure is take your own pulse.

Grant Hutchison

Salty
2010-Jul-25, 01:57 PM
You're the second person on this thread to state this as if it were some sort of moral imperative.
I don't criticize your decision in this scenario, since you clearly perceive a more immediate threat of violence than I do. Each of us would make our own decision when faced with a real situation.

But I confess I'm intrigued (and perhaps a little alarmed) to see "look after yourself" given such primacy in a discussion about moral issues.
Doesn't the example I gave (risk a hangnail to save a hundred people) suggest that "look after yourself" can never be considered an absolute moral duty? If you agree, then surely there is a moral balance to be struck in this scenario, too.

Grant Hutchison


Good question. It wasn't until I worked with my third security company that I learned to put my safety first. In the past, and, even with the recent employer, I have calmly walked into dangerous areas to do my job. One time at night, a few years ago, in a rough apartment complex, the security street supervisor and a senior guard persuaded me away from already talking to the driver of a car which may well have contained an armed and hostile male. My years as a night cab driver were more action packed that my time in the Marines or as a night watchman for security companies.
But, eight years with my recent employer got through to me, I can't help anybody if I'm hurt and new parameters for assessing risk.

Also, modern recovery methods from different medical conditions insist on the one in recovery putting their welfare first.

mugaliens
2010-Jul-27, 01:05 AM
The problem with finding out definitively is that they're now loading your own bleeding carcass on the wheelchair too. (In for a penny...)

In all liklihood, not I, as I'm fairly adept at self-defense, whether against fists, knives, or guns.


Hi, mugaliens,

Like I wrote to Grant, I consider my first moral imperative to physically protect myself. If the two men will not respond to my suggestion to lay the person flat on the ground, or respond with verbal hostility, my best avenue, for all concerned, to call 911 ASAP.

Same here.


Every Red Cross First Aid or CPR class that I've taken ... hammered that you're no good to anybody if you wind up making yourself into a second victim.

I agree with you, here! Obviously prudence is always required in these situations.


But, eight years with my recent employer got through to me, I can't help anybody if I'm hurt and new parameters for assessing risk.

I agree with this, as well, but maintain that one can approach the situation in a manner which is helpful while maintaining due diligence. In short, while I do hold that self-preservation is a very important factor, I do not agree that it's a moral imperative. There's no way to reconcile that with voluntary military service, particularly in combat or other hostile/dangerous areas and situations. None of us approached the dangers with reckless abandon, however, and great care was taken to identify and minimize the risks, both in combat, as well as during peacetime training.

BigDon
2010-Jul-27, 10:10 AM
My own input to this thread is there were times in the service I desperately wanted skill sets I did not have. What I later found out was called "catastrophic first aid".

Those were Very Bad Days. I still find it difficult to relate the two or three times the world showed me it really doesn't care if your mother cries.

Salty
2010-Jul-27, 11:05 PM
In all liklihood, not I, as I'm fairly adept at self-defense, whether against fists, knives, or guns.



Same here.



I agree with you, here! Obviously prudence is always required in these situations.



I agree with this, as well, but maintain that one can approach the situation in a manner which is helpful while maintaining due diligence. In short, while I do hold that self-preservation is a very important factor, I do not agree that it's a moral imperative. There's no way to reconcile that with voluntary military service, particularly in combat or other hostile/dangerous areas and situations. None of us approached the dangers with reckless abandon, however, and great care was taken to identify and minimize the risks, both in combat, as well as during peacetime training.

Well, this forum doesn't allow in depth discussion of moral imperatives and I'm no longer employed so no longer owe my employer the pragmatic consideration of protecting myself first. Nevertheless, my pragmatic duty to myself does require I do exercise due caution and vigilance when approaching strange situations. A lot of times, when there's other people around, I don't even get involved.

I have only crude first aid training and skills and no cell phone. Most of my travels are walking from my house to the local store and back. Sometimes, I also ride with different friends, in their respective vehicle. So, I pretty well, thank goodness, live a safe and simple life in my retirement.

mugaliens
2010-Jul-29, 03:16 AM
I hear you, Salty.

On a related note, there's something nearly everyone can do in case one happens across one of the 310,000 cases of cardiac arrest which occurs every year. Please read this (http://news.yahoo.com/s/ap/20100728/ap_on_he_me/us_med_hands_only_cpr). Thanks.

Ara Pacis
2010-Jul-29, 07:36 AM
In short, while I do hold that self-preservation is a very important factor, I do not agree that it's a moral imperative. There's no way to reconcile that with voluntary military service, particularly in combat or other hostile/dangerous areas and situations. None of us approached the dangers with reckless abandon, however, and great care was taken to identify and minimize the risks, both in combat, as well as during peacetime training.

So, will you offer yourself up as dinner when food runs scarce so that the rest of us can eat? I think Heinlein discusses this well in his books, especially Starship Troopers. A person can subjugate their preservation of self for a preservation of progeny or even for others for whom a person has willingly taken a stake in. However, strangers in an odd and ill-defined situation do not, for many people, arise to a level of preservation wherein they can justify sacrificing themselves and, perhaps more importantly, sacrificing their obligations to those with whom they have a moral imperative (such as family, children, creditors, etc).

How would you like your tombstone to read? "He was a hero to his children until he decided to try to be a hero to someone not his child." You know what they say about Fools and Angels, right?

Salty
2010-Jul-29, 10:47 PM
I hear you, Salty.

On a related note, there's something nearly everyone can do in case one happens across one of the 310,000 cases of cardiac arrest which occurs every year. Please read this (http://news.yahoo.com/s/ap/20100728/ap_on_he_me/us_med_hands_only_cpr). Thanks.

Thank you, Mugaliens,

I went there and read that. My only problem would be in rationing 100 pushes per minute. Nevertheless, better to manage 90 or 110 than not do it at all.

Cheers,
Salty

Gillianren
2010-Jul-30, 02:43 AM
Only five to ten percent of people who receive CPR survive, just as an FYI.

HenrikOlsen
2010-Jul-30, 11:31 AM
Vs. how many who in the same medical situation don't receive CPR?
Remember that CPR is something that happens to people who are dead without it, 5-10% surviving vs none if they don't is a vast improvement.

What I was taught on heart attacks and drowning said that the chance of survival is halved or worse for every minute without CPR (or professional medical help) due to oxygen starvation of the brain and that the real purpose of CPR is to stop that clock from ticking while waiting for the ambulance.
I'm not surprised by that 5-10% number but I think it's due to people not getting to and starting on the victims until it's too late or possibly stopping before the ambulance arrives because they think they aren't helping because the victim isn't getting up and running around like in the movies.

And it's still a hell of a lot better than the chances when waiting 10 minutes without CPR for an ambulance.

A nasty way of looking at it, with a 10% chance of surviving if given CPR and if you know CPR, then not starting doing it in the situation is equivalent to pressing a button that'll kill a person 10% of the time.

grant hutchison
2010-Jul-30, 12:39 PM
If you look at witnessed out-of-hospital cardiac arrests in a European or North American city, the casualty's chance of surviving to hospital discharge is approximately doubled by bystander CPR. If the collapse is unwitnessed, the chances of survival are pretty poor, with or without CPR (simply because of the delay before CPR starts and definitive treatment is sent for).

Your chance of survival also depends critically on the cause of your cardiac arrest, and the arrest rhythm. Which is why in-hospital cardiac arrests, promptly attended and appropriately managed, still do rather badly: they tend to present in unpleasant rhythms at the end of a period of physiological derangement which has already failed to respond to treatment.

Grant Hutchison

DonM435
2010-Jul-30, 12:55 PM
...

A nasty way of looking at it, with a 10% chance of surviving if given CPR and if you know CPR, then not starting doing it in the situation is equivalent to pressing a button that'll kill a person 10% of the time.

Don't you mean "90% of the time"?

HenrikOlsen
2010-Jul-30, 04:34 PM
Don't you mean "90% of the time"?
Nope. If my CPR could save one person in 10 I did it on, then not doing it is killing that one person out of the 10.

Gillianren
2010-Jul-30, 07:04 PM
I just don't want people to think it's perfect and can save the lives of everyone who dies of heart failure outside a hospital. (Or inside!) You should also totally ignore that e-mail you may have been sent about "self-CPR." It doesn't work.

grant hutchison
2010-Jul-30, 10:25 PM
You should also totally ignore that e-mail you may have been sent about "self-CPR." It doesn't work.I've seen it work. :)
It just doesn't work the way the e-mail suggests: but you can keep your cardiac output going through a transient dysrhythmia if someone sees the onset, immediately tells you to start coughing, and promptly does something to terminate the dysrhythmia.

But, as you say, it's not one you'll ever have the chance to try at home.

Grant Hutchison

mugaliens
2010-Aug-02, 07:31 AM
I've seen it work. :)
It just doesn't work the way the e-mail suggests: but you can keep your cardiac output going through a transient dysrhythmia if someone sees the onset, immediately tells you to start coughing, and promptly does something to terminate the dysrhythmia.

Such as electrocuting one's self? I've done that unintentionally three times with 110 V current (0 times intentionally). Not fun! I think it would be difficullt to do it intetionally, though probably not much more difficult than put one's tongue on the terminals of a 9V battery. In the case of V-fib, the response time must be very quick - less than 90 seconds, though the shorter the better. A precordial thump generates about 30 Joules of energy, but that's about 1/10th of that used in electric defibrillation.

Regardless, if the patient is unconscious and without any pulse, CPR (or CCR) will maintain a flow of oxygenated blood to the brain and the heart until the more robust medical help arrives. I'm of the opinion the low survival rate of CPR is due to the underlying medical conditions (ischaemic heart disease or trauma) which caused the heart to stop in the first place, as well as the liklihood that it was started more than a minute or two after a person's heart stops.

mugaliens
2010-Aug-02, 07:38 AM
How would you like your tombstone to read? "He was a hero to his children until he decided to try to be a hero to someone not his child." You know what they say about Fools and Angels, right?

You're talking to the wrong fellow. I served in the military for twenty years, and in a reasonably hazardous profession. During the first ten years of my career, three good friends died doing the same thing I did, in three separate incidents, so I was well aware of the risks. I did so willingly, even taking a substantial 30% paycut when I joined. I didn't serve to protect my family, but to protect the interests of our country and her allies.

Had I died in the line of duty and had the opportunity to write my own epitaph, it might have said something like: "Loving husband and father. He willingly gave his life so that others may live."

grant hutchison
2010-Aug-02, 10:52 AM
Such as electrocuting one's self?Not so much, I think. The trouble with potentially fatal electric shock is that it causes paralysis of the respiratory muscles, too. On occasion it's possible to rescue a victim of lightning strike by simple mouth-to-mouth, because the casualty has recovered a cardiac output but is unable to breathe.
Where cough "CPR" is most often used (and where I saw it working), is during coronary angiography. The occasional person can get a nasty dysrhythmia as the dye passes through the coronary artery (it's amazing that doesn't happen more often, when you think about it).


A precordial thump generates about 30 Joules of energy, but that's about 1/10th of that used in electric defibrillation. Estimates of the energy delivery from a precordial thump vary, but it's an estimate of the energy delivered to the heart itself. Whereas the setting on your defibrillator is the total energy delivered to the patient, some of which is deposited in the chest wall and mediastinal structures.
The current European recommendation is that a precordial thump is only appropriate in a witnessed and monitored cardiac arrest: that is, you must clearly identify the onset of a shockable rhythm on a monitor, as the patient collapses. Good for ventricular tachycardia, not so effective in ventricular fibrillation, and there are rare reports of an inappropriate precordial thump knocking someone out of a perfusing rhythm into a non-perfusing rhythm. So it's again not one to be used by the occasional practitioner at home.

Grant Hutchison

BigDon
2010-Aug-02, 10:48 PM
I knew a Navy medic who was put in for a medal by his command for something he did, while on leave no less. One of those medics cleared for independant assignments like remote commands.

He was trout fishing in a very cold stream and the only other person was an obese man who fell in the stream and suffered a cardiac arrest for whatever reason.

The medic did CPR for four hours until another fishing party came by. And the victim surrived. Any body else think that's worth a medal?

He said the only reason he kept at it was the victim kept regaining consiousness and would lapse again when he relaxed the pace.

He got two more medals for being on the scene of bad traffic accidents. He once had to clock a delirous father with his lifeboat medkit he kept in the trunk of his car because the guy kept pulling him off his daughter who had been ejected in a rollover accident and had a monsterous compound femoral fracture and he was trying to save her life. (He did.) Lifeboat medkits are made of teak and have a wrist lanyard for extra off label usage, like a bludgeon.

Ara Pacis
2010-Aug-03, 05:24 AM
You're talking to the wrong fellow. I served in the military for twenty years, and in a reasonably hazardous profession. During the first ten years of my career, three good friends died doing the same thing I did, in three separate incidents, so I was well aware of the risks. I did so willingly, even taking a substantial 30% paycut when I joined. I didn't serve to protect my family, but to protect the interests of our country and her allies.

Had I died in the line of duty and had the opportunity to write my own epitaph, it might have said something like: "Loving husband and father. He willingly gave his life so that others may live."

There's a sharp difference between those who volunteer and are highly trained in professions where their life is on the line or where they are required to help others, and between those who are unwitting bystanders. In an emergency, people tend not to rise to their level of expectation but fall to their level of training. If one's a member of law enforcement or emergency medical services or military police, then use your authority to intervene. If one's not so trained, then call someone who is.