Blackbag MD

08/16/2026

𝐓𝐡𝐞 𝐦𝐨𝐬𝐭 𝐜𝐨𝐧𝐬𝐞𝐪𝐮𝐞𝐧𝐭𝐢𝐚𝐥 𝐢𝐧𝐭𝐞𝐫𝐯𝐞𝐧𝐭𝐢𝐨𝐧 𝐢𝐧 𝐭𝐡𝐢𝐬 𝐬𝐩𝐢𝐧𝐚𝐥 𝐜𝐨𝐫𝐝 𝐢𝐧𝐣𝐮𝐫𝐲 𝐡𝐚𝐩𝐩𝐞𝐧𝐞𝐝 𝐛𝐞𝐟𝐨𝐫𝐞 𝐄𝐌𝐒 𝐞𝐯𝐞𝐫 𝐭𝐨𝐮𝐜𝐡𝐞𝐝 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭.

A 35-year-old jumped from the ferry platform at the start of an Alcatraz triathlon. Before he surfaced, another athlete landed on his head. He was face down in 12°C water, unable to move his arms or legs, surrounded by hundreds of swimmers.

Another competitor turned him over and held his head above water.

𝐖𝐡𝐲 𝐢𝐭 𝐦𝐚𝐭𝐭𝐞𝐫𝐬: The SMR pendulum has swung hard. NAEMSP's trauma compendium found no published literature supporting spinal immobilization. But "stop collaring everyone" is not the same as "never restrict motion," and in-water trauma with obvious neurologic deficit is one of the few remaining indications in consensus guidance.

𝐁𝐲 𝐭𝐡𝐞 𝐧𝐮𝐦𝐛𝐞𝐫𝐬:
→ 17-minute scene interval, 9.4-minute transport
→ 2.4 km of manual cervical stabilization on the back of a personal watercraft
→ MRI at 1 hour 52 minutes, OR at 3 hours 41 minutes post-arrival
→ Discharged day 12, ambulating independently at six months

𝐘𝐞𝐬, 𝐛𝐮𝐭: This is an N of 1. The authors are candid that they cannot know whether SMR helped, harmed, or did nothing. His deficits were immediate at impact, not delayed.

𝐁𝐨𝐭𝐭𝐨𝐦 𝐥𝐢𝐧𝐞: Drowning was the first life threat, and the airway drove every decision that followed. The recovery was built into a medical plan approved long before race day.

If your agency covers open water events, who is trained to ask "can you move your arms and legs" before the patient reaches the boat?

Read the full study:https://media.handtevy.com/website/Open-Water-Cervical-Spine-Injury.pdf

08/15/2026

Vascular Solutions, a subsidiary of Teleflex, partnered with the Department of War and the Defense Health Agency to develop a shelf-stable product for use in locations where blood product availability or cold-chain management is not feasible or sustainable.

08/01/2026

I don’t literally mean ✨nothing✨- keep reading.

“My patient is in hemorrhagic shock and we don’t carry blood, what do I do?” This question comes up frequently, rightfully so. Often there are responses like “fluids and pressors are all we can do.”

While these situations certainly aren’t black and white, and there is a time and place for responsible use of both interventions, they are sometimes used to “feel like we’re doing something” rather than for the benefit of the patient. Doing “nothing” for a critically ill patient can be hard to stomach.

But what hemorrhagic shock patients need, truly, is blood products and an OR. These are the fixes.

In the meantime, we should be stopping any external hemorrhage. Even when internal bleeding is the major malfunction, moderate external bleeds can add up.

Keep them warm. (It matters).

Manage oxygenation and ventilation. (Don’t kill them with RSI when BP is 💩/☠️).

Assess for other causes of shock.

Consider TXA.

And skedaddle to the closest most appropriate trauma center. No lolligagging. No fu***ng around on scene with non-life-saving tasks (IVs, TXA, etc.). G**o.

Crystalloids (this includes LR) may fill the tank and make the number look better, but they don’t actually aid in perfusion given their lack of ability to carry O2.

Vasopressors may squeeze the tank and make the number look better, but…see above.

Minimal crystalloids are generally acceptable (most of us could probably benefit from a 500 mL bolus at baseline), and vasopressors are indicated when the patient is circling the drain and there’s no other option. But using these interventions aggressively to calm our own need to “do something” is not in the patient’s best interest.

(I recognize there is some theoretical benefit + limited data supporting the use of vasopressin or norepi in early hemorrhagic shock. More research needed - but the basics are still the basics).

There will never be one right answer in these situations. The best we can do is understand the physiology, recognize what the patient needs to survive, perform the basics well, and get them to definitive care as quickly as possible.

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07/27/2026

Hi!! Jody here 🙂
The office will be open at 9:00am tomorrow morning.
If you need any lab work done, need an infusion for some extra energy or immunity! Red Light Therapy is great for healing from the inside out!!Come see us! We love to help keep you healthy and happy!

07/17/2026

Need or want blood work or an infusion? We have open days on the 22nd and 28th of July.

07/08/2026

Want to learn about peptides and supplements? Come to a lunch and learn on Thursday, July 23rd at noon. Location is the Plaza Restaurant in the back room and $20. Text to 229-473-0721 your name and email so we can include you. Buffet included

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