One of my paramedic instructors told me a pretty funny story.
Apparently they were on shift one Saturday afternoon, when a call came through for a Code 2 (Cardiac Arrest) at a local racecourse.
Anyway, it was about 15 minutes away so they took off in a hurry, all the while receiving notes on their terminal regarding the job. Apparently it went along the lines of this:
Initial: Unknown Age, Cardiac Arrest, Racecourse etc
Update: CPR in Progress
Update: Doctor has self accounced at scene.
Update: Doctor has called patient as deceased. CPR ceased.
It took another 5 minutes for the paramedics to get to the racecourse, and they still unloaded their gear and made their way to the patient. When asking for the doctor, they found that it was actually the racecourse veterinarian who had made the call.
If I had a dollar for every time a dermatologist or podiatrist tried to be 'helpful' on an emergency scene... I could probably buy a coffee at Starbucks... The same goes for 'nurses.' If an ER nurse wants to help out, that's great. Invariably though, it's a nurse at a nursing home or dialysis center...
I don't mean to imply these folks aren't skilled professionals, but prehospital medical emergencies are generally well outside their experience, and the confusion that arises from that can be dangerous.
Unlike a podiatrist, a dermatologist went to medical school. If they're young, there's actually a good chance that they were among the very best medical students -- in the past few years, dermatology has become one of the more competitive fields in medicine because of the lifestyle (short predictable hours, high pay, minimal insurance hassles).
There are daft people in every field, but I would be delighted to have most of the derm residents and attendings I've met in an emergency (in fairness, I should note that this is a small sample, drawn from a couple top-tier hospitals, and biased towards people who do volunteer backcountry search and rescue).
Yeah, the podiatrist comment was a bit tongue-in-cheek.
Like I said, I'm not try to discredit these folks as skilled (and in many cases, extremely smart) individuals.
However, a couple weeks of a rotation through an ER during med school isn't really going to prepare you well for prehospital emergencies (SAR, on the other hand, can be great training for that). Making an assessment and clinical decisions based on fairly limited information isn't something I've found most physicians to be comfortable with, especially in an emergency setting.
My list of 'glad to see you' docs is pretty much: ER, OB, and Anesthesia.
That depends... If they start questioning my patient care decisions, I'm going to ask them to step away. Fortunately, we have preprinted cards explaining that if they want to take over patient care, they need to speak to my medical control physician (who will need to hear a _very_ compelling argument before they would be willing to hand a scene over to someone else)
Are you implying that the emergency call was for a horse/dog in cardiac arrest, or just that the racecourse vet was the 'doctor' performing on the human?
It is amazing how well morphine can work, and how utterly useless it can be at other times. I found it to be incredibly helpful during the AMI cases, especially for putting the patient as ease, especially when they understand the gravity of the STEMI that they are currently experiencing.
We went to a fractured tib/fib (Football injury) and we loaded him up with the maximum dose over the course of treatment (50 minutes or so) and it didn't even touch the sides.
Looking back we probably should have called for the IC guys and done some ketamine + realignment.
This +10. Out of the 11 out of hospital arrests that I went to as a Paramedic (in a 6 month period), only 1 of them survived.
Ironically, the one who survived was a prisoner who had cut his own throat. He had pretty much bled out by the time we got there, with a tiny little junctional on the monitor. Today he has 0 deficits, and it is like the event never occurred.
Maybe I'm missing something, but even if there's only a 10% chance of survival I'd still want somebody to give it a shot. What is the downside -- somebody has to do it for 30 minutes until the plane lands?
That's 10% for someone who had access to advanced care within a few minutes.
If CPR goes on for more than 10 minutes or so in a non-hypothermic patient (with no other interventions), your chances of survival are basically nil. This is is especially true if you have a limited number of people doing compressions. Effective compressions are extremely hard work, and rescuer fatigue is a huge issue with CPR (we switch every two minutes no matter how 'fine' the person doing compressions claims to be). I doubt you could maintain effective CPR on an aircraft for 30 minutes (I suppose you could get a couple dozen people involved, but that seems unlikely).
If I'm not back in 15 minutes, please stop... At that point enough damage has been done to my brain that I don't want to come back...
Is CPR done on people with wounds like that? I would think the chest compressions would mostly just be pushing blood out, but I guess doing that is better than doing nothing?
The new protocol (at least for military, or at least serious trauma) is to treat massive bleeding above airway/breathing/circulation. I guess what you'd do is have someone applying pressure (or strap an israeli bandage around the neck, but not tightly in a way which would cut off circulation?) while someone else does CPR and then AED. The goal is to never have more than a 10sec break in chest compressions.
Can I ask, why Flask and not Django? (Flask fan here btw)