Aesop, of The Raconteur Report, recently had an exchange with “B”, the proprietor of the “In The Middle Of The Right” blog
“B” had opined that the advice provided by Sumdood, a “Newspaper Doctor”, quoted in The Daily Mail, was wrong. He then elaborated upon his perspective why, in his area, waiting for their version of EMS was more likely wrong, than not (outside of specific outlier circumstances).
Aesop, who has been an ED RN for many years, presented a contrary appraisal, suggesting an action plan wherein in nearly every single case, calling EMS, and awaiting their arrival was more likely to be a superior plan, than any “snatch ’em up and boogie to the hospital” alternative plan of action. He then enumerates his concerns with that get-up-and-go course of action.
“B” responded, citing his rural setting and the assertion that he, “B”, a civilian, could make the trip in his personal vehicle in an estimated 16 minute trip, compared to his estimate of EMS responding in around 15 minutes, and an estimate time-to-ER adding up to something like 35 minutes. He opines that contrary views seem ”..let us say, city-centric”.
I responded as follows, edited for typos:
“You do make some good points. OTOH, having lived in a rural county (our hospital was the only one in two counties this away, or three counties, thataway), I, as a former medic, can authoritatively state that having your partner drive the ambulance, is orders of magnitude better, from a patient care perspective, than you barreling yonder to your local hospital. There are, of course, exceptions. If you have the expertise to differentiate A from B, or G, then feel free to make that determination. As I told my daughter ref her wheezing child, do you know CPR? Can you perform same in a moving automobile? What’s your notification plan, to warn the hospital that you’re coming in hot with a critical child?
One Weird Trick? Your local medics, at whatever level of licensure, CAN do those things, DO have those capabilities. Yes you likely can phone whoever, WHILE driving essentially “Code 1”, AND wondering how you’re gonna provide care, while simultaneously driving, navigating, communicating, and assessing your patient.
Reflect on the deleterious effects of task stacking, on each one of those mission critical tasks, while under stress that most of us will never have experienced in our lives.
Which one of those tasks are you willing to compromise?
So, yeah, there will be occasions wherein scoop-and-go is reasonable and prudent. In my experience on thousands of EMS runs, and decades as ER RN those are uncommon.
Like, use-a-tourniquet-as-a-civilian uncommon. “
Mr. “B” replied, citing his assessment that his local EMS “was only a transport service”. He asserted that “...even heart attack victims...” received this level of care. Again I responded.
“TBH, field care of an MI or an ischemic/hemorrhagic stroke is, at best, ongoing assessment, supplemental oxygen. Again, every fraction of a second you are watching traffic is another fraction of a second you are NOT assessing your patient. Conversely, every fraction of a second you glance at your patient, is a fraction of a second for some kid to run into traffic/some granny to bust a red light/other trip stopping additional calamity.
But, you are correct. Aesop’s years in ER, my 2+ GENERATIONS of EMS and ED experience mean nothing, because “city”. Or something.
You indeed DO know your AO better than I do. You, indeed, know the risks you are willing to undertake, better than I do. And, finally (in both senses of that word), you know the risks that you are willing for your loved ones to assume, in this hypothetical situation.
My 2 cents worth of advice, is worth exactly what you paid me for it.
I’ll E-mail you, your change.
I genuinely hope that you never need to field trial your plans. Just as I pray that I never again have to field trial my own plans.”
Another exchange, with my response:
(“B” observes:) “THEN a 16-18 minute drive to the ER (close to 35 minutes) is better than a 16-18 (or even less, yeah, I am that good of a driver with the equipment to match, even under the stress you refer to…I’ve done it once before) minute trip to the ER for a real medical professional to treat is the better option? ”
(Reltney McFee responds) Well a coupla things: in my experience, folks who are in arrest, generally have measurably better outcomes (even if any outcome from an arrest trends toward “dismal”), should they receive, say “16-18 minutes…” of, say, cardiopulmonary resuscitation. Hell, taking your numbers, even 45 minutes of CPR is more likely to produce a “good” outcome (for whatever value of “good” you select) than 16 minutes of anoxic cardiac arrest.
Again, your circus, and you ought to organize your monkees in the manner that you think is best.
Aesop and I are presenting alternate viewpoints, that’s all. In my case, since around 1988, I have been in rural areas as EMT, ER RN, and midlevel provider. Again, in my case, I have carried a pager for my local fire department exactly so that SOMEBODY would show up at someone’s house, who was having the worst day of their lives, in order to attempt to mitigate same.
My opinion derives from 2 generations in the sick people business, in rural areas. No, not Four-Corners-Of Arizona rural, but Upper-Midwest rural.
Should a summary be worthwhile, my baseline is to encourage everybody to become an EMT, at least at the basic level. It’s around a semester at Lansing Community College (to select a venue near to my “neighbor”, Eaton Rapids Joe, aka ERJ), and should you find yourself in hard circumstances, you will NEVER EVER think, “Gosh, I sure wish I had known less about that problem!”
If you have read ERJ’s thought experiments formulated as tales, you have narratives of scenarios wherein basic EMT skills might be life saving. Hell, if you listen to “B” from In The Middle Of The Right, you will hear him describe living in an area where, should YOU! Have basic EMT skills, your family will for a fact be measurably safer than if you do not.
As with anything I tell y’all, (hell, for that matter, with anything I tell my patients!), none of you are in my chain of command. You are, however, in my “chain of nag”, so, consider yourselves nagged to train up. Hard times are looming, and whatever form that they take, you will not ever think “Dammit! I wish I had not known how to respond to that!”, when “that” threatens your child, or spouse, or neighbor.