One of the comments to a recent post was from Henrick, who wrote: “Maybe I´ve misunderstood your post ( english isn´t my first language)and so this could be a reallt stupid question… But I have to ask! Do you really schock people who are awake and talking?”
The answer of course is yes, we do, if we can’t avoid it. If we think we have time and we think that it will work we can give a round of medicine. If we don’t, we shock away.
This all set me to thinking.
What would I want if I were the patient?
I would want medicine first if there was time. And I would want a seasoned medic taking care of me. I would want a medic who had gone to a good medic program and who was subject to a rigorous QI program, a medic who got a lot of continuing education every year. And I would want a little luck and good fortune. I would want the medicine to work.
And then I thought, what else would I want if I were a patient in the 911 system?
I would want:
Morphine if I broke my leg or arm or hip, or cut my fingers off with a snow blower or spilled boiling water on myself or had kidney stones, or even abdominal pain of unknown origin, provided I was hemodynamically stable.
A pillow and enough blankets if I was cold. Working air-conditioning in the summer.
A smooth easy ride, a rig with good shocks, a smooth experienced driver, and no lights and sirens unless I was dying of a correctable cause.
A paramedic or EMT who was nice and asked my name and told me what they were doing before they did it.
Amiodarone instead of lidocaine.
A family member sitting in the back with me unless I was out-of-control or I required much active care by a medic on each side of me and one at the head.
Phenergan if I was nauseous.
Here’s what I wouldn’t want:
Ten people from three different services: EMS, fire, police, coming charging into my house (unless I was in cardiac arrest).
Drugs down my tube.
RSI if I could be bagged, or if I was conscious.
C-spined unless I couldn’t move my neck due to the pain.
An IV unless it was necessary to give me fluid or medicine (same goes for the hospital) or unless I was really sick. (Same goes for in-hospital).
To be flown in a helicopter if I could just as easily go by ground.
An EMT who answered his cell phone while treating me.
And finally CPR if I was dead.
I’m sure there is more, but that’s what immediately comes to my mind. Some of what I would want, conflicts with what I would want to provide my own patients, but not much of it.