I received this tidbit yesterday. Proof-positive that whereas statistics don't lie, people can lie with statistics.
"Guns don't kill people, doctors kill people!
"According to the U.S. Department of Health and Human Services, there are 700,000 physicians in the United States. The number of accidental patient deaths per year is 120,000. Therefore, accidental deaths per physician is 0.171.
"According to the F.B.I., there are 80,000,000 gun owners in the United States. The number of accidental gun deaths per year is 1,500. The number of accidental deaths per gun owner is 0.000188
"Statistically, doctors are approximately 9,000 times more dangerous than gun owners.
"NOT everyone has a gun, but almost everyone has at least one doctor. Please alert your friends to this alarming threat.
"Ban Doctors, Not Guns!"
Okay, so it was sent to me tongue in cheek, but many similiarly ludicrous ideas about safety are based on similiarly silly statistics.
Like this one: You're safer flying than driving because statistically there are more car crash fatalities per year than fatalities in plane crashes. Fact is, the average person travels in a car far more often than they do in an airplane, therefore the likelihood of being in a car accident is much higher. In fact, also, it is far more likely that one will survive multiple car crashes, whereas surviving an airplane crash is far less likely.
Or this one: You're safer not getting a tetanus immunization shot because statistically you're more likely to die of an anaphylatic reaction to the shot than you are of tetanus infection. Fact is, the reason more people die from the shot than from tetanus is not because the shot is more dangerous, but because tetanus infection is rare due to widespread immunization. However, the likelihood of surviving anaphylatic reactions is far greater than surviving tetanus, which, if you get it, has a survival rate of almost 0%.
And if one more person tells me that you're safer in a rollover accident without your seatbelt on because you're less likely to get stuck in your crushed or burning vehicle...
Thursday, January 31, 2008
Saturday, January 26, 2008
Types of Patients IX: "Bad Babies"
A touchy subject.
Yesterday, I accepted the care of a 53 day old female with respiratory distress. There is nothing more frightening to me as a parent and as an ER nurse than a baby that can't breathe or isn't breathing well.
As a parent, I recall a time when my infant son choked on a small cracker, and how the minutes he did not seem to be able to breathe shortened my life, I'm convinced, by years.
I recall, too, the several times I have had to resuscitate him when he did not regain spontaneous breathing after having seizures.
There is nothing worse than a child who will not breathe!
As a nurse, flashes of parents' hopes for their child as I care for him or her rush through my head and I realize that I am somewhat the keeper of these. I also become entrusted by the parents as easily, it seems, as one would entrust their poorly running car to a mechanic. I do not want this responsibility, but by virtue of my training and career, I have tacitly agreed to accept it.
Okay. ABCs.
A. Baby's airway was patent but compromised by mucous and secretions from what we suspected was respiratory syncytial virus (RSV), a viral infection of the lungs and airways of children primarily less than 1 year old. It is a common source of bronchial infection and pneumonia in infants.
Attend to positioning, initiate suctioning, both with a bulb syringe and wall-mounted vacuum suction via a Delee suction device, stimulates baby to breath as well as helps keeps baby's airway clear. Check.
B. As already noted, baby's breathing and oxygenation were poor. Respiratory rate was in the 80s-90s (normal values are in the 40s-50s) and oxygen saturation (a less than completely accurate measure of tissue perfusion, i.e., how much life-sustaining oxygen is getting to the organs and tissues) was approximately 88% (normal is 97%-100%).
Provide supplemental oxygen. But for a small infant this isn't the easiest intervention. Nasal cannulas and infant oxygen masks are notoriously less than effective. What is needed is an environment completely rich in oxygen, like in an incubator. We don't have this technology in the ER.
Thanks to our Respiratory Therapist (RT), a infant "hood"--a plastic dome, sort of like an astronaut's helmet, with a cut-out for the neck and sliding access panels--was placed over the baby's head as she laid on the pad of the baby warmer, a special device for infants that is no more than a treatment table with a warming light over it and oxygen tanks and suction canisters attached.
Check.
C. The baby's heart rate was in the 180s (normal is 130-140s). Increased heart rate is, in part, a compensatory response to poor oxygenation and dehydration, a condition that increases when babies are sick. If tissues aren't receiving enough oxygen, the body will attempt to increase oxygen supply by passing more blood through the tissues. To do this, the brain stimulates the heart to beat faster. However, when the heart beats faster, more oxygen is consumed by the heart and the muscle begins to tire. And so, a vicious cycle ensues.
If intervention is too slow or inadequate, baby will literally wear herself out. With a heart rate of 180 and oxygenation of 88%, we were already "behind the eight ball" as a popular expression goes.
Supplemental oxygen is a good first step. Next, intravenous fluid boluses to increase the volume of fluid in the blood stream to off-set the effects of dehydration. Intravenous access also allows for easier drug administration.
Thanks to a Family Birth Center nurse, IV access was achieved within the hour of baby's arrival in the ER. Why didn't I do it? For the same reason I don't change the oil in my car...I can do it, but there are people who specialize in this sort of thing. Part of being an ER nurse is the wisdom and foresight for judicious use of resources. FBC was my resource in this case!
Circulation, check.
There is a D as well (ABC,D): Differential Diagnosis.
We suspected RSV but other conditions could cause what we were seeing. Cold-stress is another possibility. Hypothermia forces a baby to increase heart rate and breathing in order to maintain body temperature. Assessment: In fact, baby's initial rectal temp was 95.4 (normal is, of course, 98.6). Intervention: warm baby up. Using the baby warmer is standard. Warmed IV fluids helps. A special infant chemical-warming pad was also used.
Hypoglycemia is also suspected. Low blood sugar reduces metabolism; reduced metabolism decreases body temperature. No fuel for the fire. Assessment: Baby's heel stick blood sugar was 66, normal. Intervention: IV glucose (if necessary).
Check.
For three hours, we (RT, the FBC nurse, and I) attempted to improve baby's breathing, all of us, baby included, suffering through pronounced and prolonged apneic periods during which baby would stop breathing for up to 7 and 8 seconds at a time. I began to wonder from which episode baby would not recover, requiring a resuscitation effort, the survival rate of which is low.
I don't pray, but I have wishes. I wished that it wouldn't come to this.
Eventually, we transported baby via helicopter to a pediatric emergency room and, I assume, NICU (Newborn Intensive Care Unit) at the nearest large hospital. Although I haven't heard, I assumed baby's prognosis is good.
I would be lying if I denied being relieved and happy that baby was gone and out of my ER. I know my nursing limits. Baby's condition was pushing and, in some ways, surpassing them. I'm not embarrassed to admit it.
We often joke among ourselves concerning triage that there are two categories of infants: good babies and bad babies. Nearly 97-99% of babies brought in by parents are of the former category. Most of these suffer from what we call PPP, piss-poor parenting. It's the other 1% or so that scare me.
My "bad baby" experience reminds me that, no matter what my demons, I need to be ever-mindful of my skills and abilities and the limits to these, and to swallow my pride when it comes to the health of a infant. I hope I did and will always do the right thing.
Yesterday, I accepted the care of a 53 day old female with respiratory distress. There is nothing more frightening to me as a parent and as an ER nurse than a baby that can't breathe or isn't breathing well.
As a parent, I recall a time when my infant son choked on a small cracker, and how the minutes he did not seem to be able to breathe shortened my life, I'm convinced, by years.
I recall, too, the several times I have had to resuscitate him when he did not regain spontaneous breathing after having seizures.
There is nothing worse than a child who will not breathe!
As a nurse, flashes of parents' hopes for their child as I care for him or her rush through my head and I realize that I am somewhat the keeper of these. I also become entrusted by the parents as easily, it seems, as one would entrust their poorly running car to a mechanic. I do not want this responsibility, but by virtue of my training and career, I have tacitly agreed to accept it.
Okay. ABCs.
A. Baby's airway was patent but compromised by mucous and secretions from what we suspected was respiratory syncytial virus (RSV), a viral infection of the lungs and airways of children primarily less than 1 year old. It is a common source of bronchial infection and pneumonia in infants.
Attend to positioning, initiate suctioning, both with a bulb syringe and wall-mounted vacuum suction via a Delee suction device, stimulates baby to breath as well as helps keeps baby's airway clear. Check.
B. As already noted, baby's breathing and oxygenation were poor. Respiratory rate was in the 80s-90s (normal values are in the 40s-50s) and oxygen saturation (a less than completely accurate measure of tissue perfusion, i.e., how much life-sustaining oxygen is getting to the organs and tissues) was approximately 88% (normal is 97%-100%).
Provide supplemental oxygen. But for a small infant this isn't the easiest intervention. Nasal cannulas and infant oxygen masks are notoriously less than effective. What is needed is an environment completely rich in oxygen, like in an incubator. We don't have this technology in the ER.
Thanks to our Respiratory Therapist (RT), a infant "hood"--a plastic dome, sort of like an astronaut's helmet, with a cut-out for the neck and sliding access panels--was placed over the baby's head as she laid on the pad of the baby warmer, a special device for infants that is no more than a treatment table with a warming light over it and oxygen tanks and suction canisters attached.
Check.
C. The baby's heart rate was in the 180s (normal is 130-140s). Increased heart rate is, in part, a compensatory response to poor oxygenation and dehydration, a condition that increases when babies are sick. If tissues aren't receiving enough oxygen, the body will attempt to increase oxygen supply by passing more blood through the tissues. To do this, the brain stimulates the heart to beat faster. However, when the heart beats faster, more oxygen is consumed by the heart and the muscle begins to tire. And so, a vicious cycle ensues.
If intervention is too slow or inadequate, baby will literally wear herself out. With a heart rate of 180 and oxygenation of 88%, we were already "behind the eight ball" as a popular expression goes.
Supplemental oxygen is a good first step. Next, intravenous fluid boluses to increase the volume of fluid in the blood stream to off-set the effects of dehydration. Intravenous access also allows for easier drug administration.
Thanks to a Family Birth Center nurse, IV access was achieved within the hour of baby's arrival in the ER. Why didn't I do it? For the same reason I don't change the oil in my car...I can do it, but there are people who specialize in this sort of thing. Part of being an ER nurse is the wisdom and foresight for judicious use of resources. FBC was my resource in this case!
Circulation, check.
There is a D as well (ABC,D): Differential Diagnosis.
We suspected RSV but other conditions could cause what we were seeing. Cold-stress is another possibility. Hypothermia forces a baby to increase heart rate and breathing in order to maintain body temperature. Assessment: In fact, baby's initial rectal temp was 95.4 (normal is, of course, 98.6). Intervention: warm baby up. Using the baby warmer is standard. Warmed IV fluids helps. A special infant chemical-warming pad was also used.
Hypoglycemia is also suspected. Low blood sugar reduces metabolism; reduced metabolism decreases body temperature. No fuel for the fire. Assessment: Baby's heel stick blood sugar was 66, normal. Intervention: IV glucose (if necessary).
Check.
For three hours, we (RT, the FBC nurse, and I) attempted to improve baby's breathing, all of us, baby included, suffering through pronounced and prolonged apneic periods during which baby would stop breathing for up to 7 and 8 seconds at a time. I began to wonder from which episode baby would not recover, requiring a resuscitation effort, the survival rate of which is low.
I don't pray, but I have wishes. I wished that it wouldn't come to this.
Eventually, we transported baby via helicopter to a pediatric emergency room and, I assume, NICU (Newborn Intensive Care Unit) at the nearest large hospital. Although I haven't heard, I assumed baby's prognosis is good.
I would be lying if I denied being relieved and happy that baby was gone and out of my ER. I know my nursing limits. Baby's condition was pushing and, in some ways, surpassing them. I'm not embarrassed to admit it.
We often joke among ourselves concerning triage that there are two categories of infants: good babies and bad babies. Nearly 97-99% of babies brought in by parents are of the former category. Most of these suffer from what we call PPP, piss-poor parenting. It's the other 1% or so that scare me.
My "bad baby" experience reminds me that, no matter what my demons, I need to be ever-mindful of my skills and abilities and the limits to these, and to swallow my pride when it comes to the health of a infant. I hope I did and will always do the right thing.
Wednesday, January 23, 2008
Health Care Rights (and Wrongs)
Is health care a right? Should everyone in our society have access to health care? Should this access be free? Equal? Or, should it be based upon need, or an individual's ability to pay, or some other category of restriction (e.g., the relative contributions people make to society)?
These are the fundamental questions about health care that we, as a society, have not yet fully addressed. Currently, our health care system functions upon a sickly jumble of half-answers.
It is easy to say that everyone has a "right" to health care, but very few absolute rights exist. Most rights are accorded with exceptions or with responsibilities and obligations placed upon the recipient. (More about obligations and responsibilities another time.)
What are the exceptions to an individual's right to health care? In our society, most exceptions concern the nature and extent of care one can expect.
By virtue of EMTALA, all individuals regardless of ability to pay have a right (see entry of 9/3/07) to a medical screening in an emergency room of a facility that participates in the federally-funded programs of Medicare and Medicaid to determine whether or not s/he is experiencing an emergent condition requiring treatment and/or stabilization and transfer. However, one does not have a right to demand certain treatments or interventions, even if another person may receive these.
In essence, one has a right to treatment for emergencies, but one does not have a right to an MRI for a headache, or a bone scan for "brittle bones," or a heart/lung transplant for organ failure.
Just as one has a right to free speech, one cannot utilize this right wherever and however one wishes. There are restrictions and exceptions.
In the emergency room, what is prudent and customary care for the condition a patient is experiencing and not simply the patient's ideas and desires or even their ability to pay, determines the sort of care they receive. It is the right of the patient to have what is prudent and customary (sometimes called the "standard of care").
But this is not a right transferable to the private sphere of health care. Just because one has a right to such treatment in the ER doesn't mean they have the same rights at the local Family Medical Clinic, or Dr. Joe's, or even at for-profit, privatized hospitals. These services can be exceptions to the right of health care.
In fact, one of the reasons ERs are often saturated with individuals who are un- or underinsured is because physicians and other clinicians in private practice aren't obligated to fulfill an individual's right to health care. Many private practice physicians only accept patients on Medicaid as a small percentage of their overall clientele, and virtually none accept uninsured patients unless they have cash up front. This is sometimes referred to as The American Way.
What this effects is a two-tiered (actually, multi-tiered) system of health care in which privately insured individuals and those with retirement-age or disability-qualifying Medicare can usually access private health care, while poorer individuals who can't afford private insurance or don't work at jobs that are required to provide it (e.g., part-time, seasonal, small businesses, etc.) must rely on Medicaid or no insurance at all.
These latter individuals are those who the New York Times apparently has a problem with gumming up the ERs. Where else are they to go?
If health care is a right with exceptions and restrictions, then these sorts of problems are going to acutely inconvenience even those at the top of the system. However, I suspect these problems inconvenience those at the bottom more often, in fact, chronically.
Inject for-profit motives of private insurance companies, and these problems multiple precipitously. The system, the entire system, is in need of an overhaul.
These are the fundamental questions about health care that we, as a society, have not yet fully addressed. Currently, our health care system functions upon a sickly jumble of half-answers.
It is easy to say that everyone has a "right" to health care, but very few absolute rights exist. Most rights are accorded with exceptions or with responsibilities and obligations placed upon the recipient. (More about obligations and responsibilities another time.)
What are the exceptions to an individual's right to health care? In our society, most exceptions concern the nature and extent of care one can expect.
By virtue of EMTALA, all individuals regardless of ability to pay have a right (see entry of 9/3/07) to a medical screening in an emergency room of a facility that participates in the federally-funded programs of Medicare and Medicaid to determine whether or not s/he is experiencing an emergent condition requiring treatment and/or stabilization and transfer. However, one does not have a right to demand certain treatments or interventions, even if another person may receive these.
In essence, one has a right to treatment for emergencies, but one does not have a right to an MRI for a headache, or a bone scan for "brittle bones," or a heart/lung transplant for organ failure.
Just as one has a right to free speech, one cannot utilize this right wherever and however one wishes. There are restrictions and exceptions.
In the emergency room, what is prudent and customary care for the condition a patient is experiencing and not simply the patient's ideas and desires or even their ability to pay, determines the sort of care they receive. It is the right of the patient to have what is prudent and customary (sometimes called the "standard of care").
But this is not a right transferable to the private sphere of health care. Just because one has a right to such treatment in the ER doesn't mean they have the same rights at the local Family Medical Clinic, or Dr. Joe's, or even at for-profit, privatized hospitals. These services can be exceptions to the right of health care.
In fact, one of the reasons ERs are often saturated with individuals who are un- or underinsured is because physicians and other clinicians in private practice aren't obligated to fulfill an individual's right to health care. Many private practice physicians only accept patients on Medicaid as a small percentage of their overall clientele, and virtually none accept uninsured patients unless they have cash up front. This is sometimes referred to as The American Way.
What this effects is a two-tiered (actually, multi-tiered) system of health care in which privately insured individuals and those with retirement-age or disability-qualifying Medicare can usually access private health care, while poorer individuals who can't afford private insurance or don't work at jobs that are required to provide it (e.g., part-time, seasonal, small businesses, etc.) must rely on Medicaid or no insurance at all.
These latter individuals are those who the New York Times apparently has a problem with gumming up the ERs. Where else are they to go?
If health care is a right with exceptions and restrictions, then these sorts of problems are going to acutely inconvenience even those at the top of the system. However, I suspect these problems inconvenience those at the bottom more often, in fact, chronically.
Inject for-profit motives of private insurance companies, and these problems multiple precipitously. The system, the entire system, is in need of an overhaul.
Tuesday, January 22, 2008
Roe V. Wade V. Bush
On this day in 1973, the supreme court issued a ruling that stated first trimester elective abortions were indeed legal.
On this day in 2001, President G.W. Bush signed an a "memorandum reinstating full abortion restrictions on U.S. overseas aid" (NYTimes). In other words, according to Bush, abortions were not permitted in countries receiving U.S. aid.
What was I saying about inequality when it comes to the U.S.-style "health" care?
On this day in 2001, President G.W. Bush signed an a "memorandum reinstating full abortion restrictions on U.S. overseas aid" (NYTimes). In other words, according to Bush, abortions were not permitted in countries receiving U.S. aid.
What was I saying about inequality when it comes to the U.S.-style "health" care?
What's in a Name (of a Disease)?
http://www.nytimes.com/2008/01/22/health/22dise.html?th&emc=th
Apparently, much more than the disease itself. Although I am not so sure it's a good thing to have a disease named after you, I am sure it's better than being named after a disease.
And I have not done any research on the issue, but I am sure we could find in the history of medical research and development plenty of instances in which what we know now was, in part, generated by nefarious activities of clinicians and scientists. Some of these were members of the Nazi party; some were American scientists and doctors.
The institution of medicine is not immune to the same racism and sexism that plagues society in general (no pun intended), and often this is seen in the "naming" of conditions, procedures, or remedies.
Even one of the most honorable of health-related issues is subject to this: pregnancy and childbirth.
The EDC, which so many confuse for "estimated date of conception," actually is the acronym for "Estimated Date of Confinement." In other words, that time at which the baby will likely be born and the mother will be "confined" to a hospital bed for a week. Now, we know that this rarely happens any longer, that most new mom's go home within a day or two of an uncomplicated birth. But the term persists.
With multiple miscarriages, a woman hopeful of bringing a fetus to term may be labeled an "habitual aborter"! And with each miscarriage, unless there is a known cause, the failure of a conceived pregnancy is said to be a "blighted ovum". In other words, it's the woman's fault, when in fact there is no reason to suspect the ova over the sperm. But a male-dominated medical institution would hardly want to point fingers at themselves and their kind.
What's in a name? A name. But a load of other things that may bother people.
I hold to my original statement, and I'm glad my name isn't Anna Plastic Tumor.
Apparently, much more than the disease itself. Although I am not so sure it's a good thing to have a disease named after you, I am sure it's better than being named after a disease.
And I have not done any research on the issue, but I am sure we could find in the history of medical research and development plenty of instances in which what we know now was, in part, generated by nefarious activities of clinicians and scientists. Some of these were members of the Nazi party; some were American scientists and doctors.
The institution of medicine is not immune to the same racism and sexism that plagues society in general (no pun intended), and often this is seen in the "naming" of conditions, procedures, or remedies.
Even one of the most honorable of health-related issues is subject to this: pregnancy and childbirth.
The EDC, which so many confuse for "estimated date of conception," actually is the acronym for "Estimated Date of Confinement." In other words, that time at which the baby will likely be born and the mother will be "confined" to a hospital bed for a week. Now, we know that this rarely happens any longer, that most new mom's go home within a day or two of an uncomplicated birth. But the term persists.
With multiple miscarriages, a woman hopeful of bringing a fetus to term may be labeled an "habitual aborter"! And with each miscarriage, unless there is a known cause, the failure of a conceived pregnancy is said to be a "blighted ovum". In other words, it's the woman's fault, when in fact there is no reason to suspect the ova over the sperm. But a male-dominated medical institution would hardly want to point fingers at themselves and their kind.
What's in a name? A name. But a load of other things that may bother people.
I hold to my original statement, and I'm glad my name isn't Anna Plastic Tumor.
Saturday, January 19, 2008
Waiting for Goddarn Doctor (Part I)
http://www.nytimes.com/2008/01/19/opinion/19sat3.html?th&emc=th
Whereas, in my opinion, the New York Times is right-on about the negative effects of two-tiered health care coverage--that emergency room wait times have increased thereby decreasing the speed with which the sickest receive necessary treatment--I disagree with the slant of the editorial, revealed in the first sentence, that these negative effects are mostly a problem because they inconvenience those who are on the top tier.
Let's face it, "insurance" is an immoral business. (It's called "protection" in the world of organized crime.) Corporations and individuals reaping huge profits from other individuals who fear illness and injury and the catastrophic costs associated with treatment. These same insurance companies more often than not hedge their investment by accepting only the healthiest clients or at least those who have the most ability to pay premiums, only to eventually deny claims for reimbursement at every turn until such a time that someone, often the court, makes them pay.
It is time for our society to eliminate the ability of a few to profit from the fear of illness or injury of the many. A single-payer, government-regulated system is the answer.
Whereas, in my opinion, the New York Times is right-on about the negative effects of two-tiered health care coverage--that emergency room wait times have increased thereby decreasing the speed with which the sickest receive necessary treatment--I disagree with the slant of the editorial, revealed in the first sentence, that these negative effects are mostly a problem because they inconvenience those who are on the top tier.
Let's face it, "insurance" is an immoral business. (It's called "protection" in the world of organized crime.) Corporations and individuals reaping huge profits from other individuals who fear illness and injury and the catastrophic costs associated with treatment. These same insurance companies more often than not hedge their investment by accepting only the healthiest clients or at least those who have the most ability to pay premiums, only to eventually deny claims for reimbursement at every turn until such a time that someone, often the court, makes them pay.
It is time for our society to eliminate the ability of a few to profit from the fear of illness or injury of the many. A single-payer, government-regulated system is the answer.
Wednesday, January 16, 2008
Dispatch Interpretations and Other EMS Debacles
Emergency Medical Service (EMS) is an important component of any community's health care system. 911 dispatchers, EMTs (Emergency Medical Technicians) and paramedics, extrication teams, etc. are the individuals who, paid or otherwise, are responsible for ensuring that your medical "emergency" is taken care of.
Why the quotes? Because "emergency" is a euphemism for whatever a 911-caller says is an emergency. It is also whatever the dispatcher thinks is an emergency. Tremendous variation exists.
It begins with the interaction between caller and "dispatch," a group of EMS individuals with limited or no medical training who answer 911 calls--usually answering with the phrase "Police and fire." Dispatchers use latitude in interpreting the emergency nature of any particular call.
In our community there are five response levels for medical emergencies based upon the nature and/or severity of the emergency. These levels indicate to EMTs, etc., what sort of problem the caller is experiencing or witnessing, how serious it may be, and what sort of personnel and equipment might be necessary for a successful intervention.
An "alpha" response is a non-immediate transport of a patient for a minor problem or illness, or the transfer of a stable patient from one medical facility (e.g., nursing home, hospital, etc.) to another.
A "bravo" response is more serious and emergent. It is used for motor vehicle accidents in which unknown injuries may have occurred or for patients with undisclosed medical emergencies, whether injury or illness.
"Charlie" designates a serious emergent illness that is potentially life-threatening (e.g., chest pain, shortness of breath, severe allergic reaction).
A "delta" response may indicate a serious accident in which there are known injuries, a serious traffic accident requiring extrication of patients from vehicles, and/or a serious medical problem like uncontrolled bleeding, etc. EMT and/or paramedic assistance is necessary as soon as possible.
"Echo" response is reserved for problems requiring near-instantaneous attention, like an on-going resuscitation attempt by by-standers or the need for CPR. This response usually means someone is as close to being dead, either because of illness or injury, either this side or that side of death, as they can possibly be. Needless to say, echo responses don't usually result in successful interventions.
However, the amount of interpretation dispatchers employ in translating 911 calls into responses varies.
Some examples. Recently, four patients were brought to the ER by an out-of-area ambulance after it had been dispatched to a rollover accident. Initially, all of the individuals were assessed by EMTs and refused transport. After the ambulance had returned to its station, however, a second call went out for EMS response to the the same accident. Apparently, the "victims" realized they didn't have a ride home!
A woman calls 911 because her husband is bleeding. The woman, an ICU nurse, says to dispatch, "We need an ambulance quick! My husband's cut his arm and is bleeding from an artery." Serious? Perhaps...probably. But here is how it got called out:
"EMT Ambulance, Echo response for a hemorrhage, 41 year male, attempted suicide!"
Where that last part came from, who knows? The man had been working with a metal range hood that fell on him. Clearly, what is interpreted as an emergency, and what are the circumstances of the emergency, are as much affected by who makes the 911 call as they are by the 911 dispatcher who answers.
Why the quotes? Because "emergency" is a euphemism for whatever a 911-caller says is an emergency. It is also whatever the dispatcher thinks is an emergency. Tremendous variation exists.
It begins with the interaction between caller and "dispatch," a group of EMS individuals with limited or no medical training who answer 911 calls--usually answering with the phrase "Police and fire." Dispatchers use latitude in interpreting the emergency nature of any particular call.
In our community there are five response levels for medical emergencies based upon the nature and/or severity of the emergency. These levels indicate to EMTs, etc., what sort of problem the caller is experiencing or witnessing, how serious it may be, and what sort of personnel and equipment might be necessary for a successful intervention.
An "alpha" response is a non-immediate transport of a patient for a minor problem or illness, or the transfer of a stable patient from one medical facility (e.g., nursing home, hospital, etc.) to another.
A "bravo" response is more serious and emergent. It is used for motor vehicle accidents in which unknown injuries may have occurred or for patients with undisclosed medical emergencies, whether injury or illness.
"Charlie" designates a serious emergent illness that is potentially life-threatening (e.g., chest pain, shortness of breath, severe allergic reaction).
A "delta" response may indicate a serious accident in which there are known injuries, a serious traffic accident requiring extrication of patients from vehicles, and/or a serious medical problem like uncontrolled bleeding, etc. EMT and/or paramedic assistance is necessary as soon as possible.
"Echo" response is reserved for problems requiring near-instantaneous attention, like an on-going resuscitation attempt by by-standers or the need for CPR. This response usually means someone is as close to being dead, either because of illness or injury, either this side or that side of death, as they can possibly be. Needless to say, echo responses don't usually result in successful interventions.
However, the amount of interpretation dispatchers employ in translating 911 calls into responses varies.
Some examples. Recently, four patients were brought to the ER by an out-of-area ambulance after it had been dispatched to a rollover accident. Initially, all of the individuals were assessed by EMTs and refused transport. After the ambulance had returned to its station, however, a second call went out for EMS response to the the same accident. Apparently, the "victims" realized they didn't have a ride home!
A woman calls 911 because her husband is bleeding. The woman, an ICU nurse, says to dispatch, "We need an ambulance quick! My husband's cut his arm and is bleeding from an artery." Serious? Perhaps...probably. But here is how it got called out:
"EMT Ambulance, Echo response for a hemorrhage, 41 year male, attempted suicide!"
Where that last part came from, who knows? The man had been working with a metal range hood that fell on him. Clearly, what is interpreted as an emergency, and what are the circumstances of the emergency, are as much affected by who makes the 911 call as they are by the 911 dispatcher who answers.
Tuesday, January 15, 2008
The Danger of Driving on Cell Phones
A picture is worth a thousand warnings. Please do not talk on you cell phone while driving. As the popular bumper sticker in Seattle says, "Hang Up and Drive!"
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