What would you have done in this emergency situation?

[Caboose]

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So I'm downtown, at a club that I've never been to before. Sort of one of those places you keep a low profile in until you win the trust of the regulars. It's not the safest place in the world, but I know a few people there.

A guy flies out of nowhere at top speed dropping about 8 feet onto his head to the concrete. I'm a wall flower at this point, so I watch his limp body for a while with great angst because I'm not 'one of them' so to speak. (Imagine a hardcore biker bar.) He didn't move.

Everyone just stood there. One guy shook his body a little to try to get him to come to. I hear some girl say "Well... gee whiz... I might call an ambulance... should I call an ambulance? Hold on..." For God's sake. So I call 911 and get some broad who obviously didn't understand my role in the situation. Could have gotten my ass kicked for calling any type of authority.

I made my way through the crowd thinking that since I am a medical student and know something I have the responsibility to do something. Of course, the only thing I really feel confident in is CPR. They had rolled him up to a sitting, semi-conscious slump by the time I got there. Dispatch Debbie's yelling at me the whole time to get him to say he needs an ambulance, hundreds of eyes watched as some random chick (me) kneels at his side with my phone and tries to appease dispatch. The victim, of course, was sweaty, completely disoriented, didn't know his name or where he was and couldn't really do more than mumble anyway.

Q1: Is it a billing issue that implored her to continue to yell at me to make him say something coherent when I had clearly stated he was not oriented?

Had I not had her harping on me I may have been able to do something... but then I realized that I got nothin'. What am I going to do, go through my PQRST with him? Listen to his heart? (I actually had my steth in my bag) "So, when did this start?" No - I have no clue what to do with serious head trauma except send him to the hospital, which was not on the agenda as this sort of injury happens in that club from time to time. I could have assessed his cervicals, confirmed that he had a concussion, looked for wounds, but then:

Q2: As a medical student, am I allowed to do anything at all in an emergency and be exempt from the 'practicing without a license' rule?

I tried to ask if he needed an ambulance, but a more dominant local looked at me and said something like, "I'm trying to figure out if he's one of our boys. Shut the f*@# up." ...I don't know how being one the the boys would affect medical attention, but apparently he thought so.

In this scenario, the ambulance showed up shortly after I walked away realizing that I was just an extra body while dispatched told me what a waste of time I was dt my lack of information supply. If I wasn't being recorded... Turns out he lives in his car and is in no position to desire transport - he'd probably rather have a lethal hemorrhage. It took a while for them to leave and I assume it's because the boys resisted long enough for the guy to say no. The crowd grumbled about someone calling the ambulance because things happen and that's the way it is. Unless he had started going into convulsions, no one would have called for help.

I wanted so badly to help him. I don't take emergency medicine until spring, but even then, can I do anything? I feel like I'm walking on thin ice being a medical student - I can do much less for people now than I could have if I was someone's cousin looking up things online. If I had pulled out my gloves and started to have a look before the paramedics came, would I be in trouble? I don't know where the line is.

God, I'm impatient to know everything. What a crappy ***** birthday.

Caboose.

 

[USArmyDoc]

I didn't read the whole thing but did you stabilize his C-spine? From the way you describe it sounds like a very violent fall. If so, you would want to stabilize his C-Spine and then start your ABC's.

 

[njbmd]

So I'm downtown, at a club that I've never been to before. Sort of one of those places you keep a low profile in until you win the trust of the regulars. It's not the safest place in the world, but I know a few people there.

A guy flies out of nowhere at top speed dropping about 8 feet onto his head to the concrete. I'm a wall flower at this point, so I watch his limp body for a while with great angst because I'm not 'one of them' so to speak. (Imagine a hardcore biker bar.) He didn't move.

Everyone just stood there. One guy shook his body a little to try to get him to come to. I hear some girl say "Well... gee whiz... I might call an ambulance... should I call an ambulance? Hold on..." For God's sake. So I call 911 and get some broad who obviously didn't understand my role in the situation. Could have gotten my ass kicked for calling any type of authority.

I made my way through the crowd thinking that since I am a medical student and know something I have the responsibility to do something. Of course, the only thing I really feel confident in is CPR. They had rolled him up to a sitting, semi-conscious slump by the time I got there. Dispatch Debbie's yelling at me the whole time to get him to say he needs an ambulance, hundreds of eyes watched as some random chick (me) kneels at his side with my phone and tries to appease dispatch. The victim, of course, was sweaty, completely disoriented, didn't know his name or where he was and couldn't really do more than mumble anyway.

Q1: Is it a billing issue that implored her to continue to yell at me to make him say something coherent when I had clearly stated he was not oriented?

Had I not had her harping on me I may have been able to do something... but then I realized that I got nothin'. What am I going to do, go through my PQRST with him? Listen to his heart? (I actually had my steth in my bag) "So, when did this start?" No - I have no clue what to do with serious head trauma except send him to the hospital, which was not on the agenda as this sort of injury happens in that club from time to time. I could have assessed his cervicals, confirmed that he had a concussion, looked for wounds, but then:

Q2: As a medical student, am I allowed to do anything at all in an emergency and be exempt from the 'practicing without a license' rule?

I tried to ask if he needed an ambulance, but a more dominant local looked at me and said something like, "I'm trying to figure out if he's one of our boys. Shut the f*@# up." ...I don't know how being one the the boys would affect medical attention, but apparently he thought so.
In this scenario, the ambulance showed up shortly after I walked away realizing that I was just an extra body while dispatched told me what a waste of time I was dt my lack of information supply. If I wasn't being recorded... Turns out he lives in his car and is in no position to desire transport - he'd probably rather have a lethal hemorrhage. It took a while for them to leave and I assume it's because the boys resisted long enough for the guy to say no. The crowd grumbled about someone calling the ambulance because things happen and that's the way it is. Unless he had started going into convulsions, no one would have called for help.

I wanted so badly to help him. I don't take emergency medicine until spring, but even then, can I do anything? I feel like I'm walking on thin ice being a medical student - I can do much less for people now than I could have if I was someone's cousin looking up things online. If I had pulled out my gloves and started to have a look before the paramedics came, would I be in trouble? I don't know where the line is.

God, I'm impatient to know everything. What a crappy ***** birthday.

Caboose.

As a medical student at your level you know next to NOTHING. Doing something outside of your experience could be harmful. Calling the EMS (who are trained to handle these types of situations) is the best thing that you could have done. If the patient didn't need CPR (which your state that you have experience with), then you are out of bounds getting involved in this matter.

You will never KNOW everything and even if you were an experienced trauma surgeon, without your tools and equipment, you would have little role in this situation. EMS needed to get to this patient promptly and that essentially ended your role in the matter.

At your stage in training, you call 911, and give any information that you know to be true and accurate. As an attending surgeon, I would have to take any information that you gave me (because of your training level) as coming from a civilian bystander.

These types of situations are not for "cowboys" who jump in and do things that they have little experience handling. The results can end up being total paralysis for the patient and the experience of being responsible for the paralysis/death of a person because you were in over your head.

If you were a trained EMS (certified), you might have been of more use to this person but outside of that, call 911, give any information that you have and leave this to the emergency providers who are trained to assist victims in the street.

 

[fMRI]

Q2: As a medical student, am I allowed to do anything at all in an emergency and be exempt from the 'practicing without a license' rule?

Practising without a license? ROFL!

You're not there to play doctor (which you are not), you shouldn't pretent you could 'medically clear' people. But you should do everything to prevent harm. (E.g. by requesting assistance from professionals, keeping other unqualified people from moving him etc.). You should definitively worry about the so-called "Good Samarithan" law, especially as a medical student.

 

[45408]

Whoa, don't think so much. If you're in a bar, serious head trauma = don't move them or let anyone move them, and if they're not breathing = CPR. Don't take it any farther than that. And call 911. It's not like a neurosurgeon would be able to do much in that situation either.

 

[Depakote]

Whoa, don't think so much. If you're in a bar, serious head trauma = don't move them or let anyone move them, and if they're not breathing = CPR. Don't take it any farther than that. And call 911. It's not like a neurosurgeon would be able to do much in that situation either.

👍

 

[KeyzerSoze]

Ya know... that club sounds like a kind of dodgy place. Just FYI.

 

[Caboose]

Well fMRI, being a part of SDN is also a little violating, isn't it? Are you really rolling on the floor laughing? Really? Well, that's special.

I did call 911 and I didn't touch him.

One more time:
I did call 911 and I didn't touch him.

There was no gun slinging and I don't see this as a useless question as no one likes to feel helpless. I've been told that saying "I'm a medical student" and doing something - including instructing people - is not o.k. It's emphasized, as reinforced here, that I am uneducated and can't even tape an ankle anymore with student status, else I'll be sued, raped and beaten.

It was obvious that the paramedics were not welcome there, (I actually felt a little on edge for them walking in), so what if I would have stayed after the gang kicked them out? Would it be wrong to tell him if he has worsening headache he should really reconsider getting help? Would it be wrong to monitor him in any way after EMS was sent away (assuming they let me stay)? In general, if someone sends them away OR if 911 is not an option, am I truly not allowed to do anything in the situation even the week before I graduate?

Anyway, I'm not into playing doctor so I can feel all important when I am clearly not a neurosurgeon - not even a PCP. I recognize that my clinical education is not valuable in an acute TBI and I also realize that me and my assessments are a little more than a nuisance to EMTs.

Honestly, I also wanted to hear that there was nothing more that I could have done in this situation, even if I know, logically, that there was not. So thanks for reinforcing the notion that I did the right thing and for taking the time to read/respond.

Caboose.

 

[Dwindlin]

Q1: Is it a billing issue that implored her to continue to yell at me to make him say something coherent when I had clearly stated he was not oriented?

If your still curious about this part then I can help you here. No, there was no billing reason to keep you on the phone. Dispatchers try to gather as much information as possible for the responding crews often from less than ideal sources. So the many that I worked with (I wasn't a dispatcher but one of the responders) just answered the calls with the assumption that who they were talking to knew less than nothing both both medicine or what actually happened.

 

[Caboose]

thx, atkinsje.

 

[howelljolly]

Caboose,

you did a nice job.

If you were in New York City, you did the right thing by not touching the patient. Not only does the good samaritan law do nothing for you (it actually makes you obligated to not touch the patient), additionally the Nonsolcited Medical Intervention Protocol in NYC says that you are not supposed to intervene in the care of the patient. Especially once paramedics arrive. All you can do is walk away and call 911.

The 911 dispatcher probably wanted specific information from you, which you may have been overthinking, since you know something about medicine. The dispatcher needs to know if the patient needs EMTs or if they need Paramedics (theres a difference). They also need to know if any additional support is needed (police, rescue, etc). They have scripted queestions, and are looking for basic answers. In your case, it seemed like they wanted to know if the patent was responsive to verbal stimuli, or if they had an appropriate verbal response. Theyre trying to get a vague idea of the Level of Consciousness and the Glasgow Coma Score.

Knowing that, in the future, you can keep your distance. Stay calm. Call 911, and play dumb. But understand that the dispatcher is trying to decide if the patient needs an ambulance or if they need a mobile intensive care unit, without seeing the patient. Just answer the questions as they are asked, to the best of your knowledge from were you stand.

In this case, if you just said "hes only making incoherent sounds", without trying to assess the patient's actual response yourself, the maximum GCS he can have is 12 out of 15. Also insist that he is not making any spontaneous movements, and youve knocked his his GCS down to 7. You've also just got your patient a ride on an MICU with paramedics. Just so you have an idea of how it works.

I do not suggest you try this finagling to upgrade your ticket to the ER when you stub you toe.

But anyway. Nice job. Being powerless to help the patient is a horrible feeling. You'll have that feeling any time you are a witness to an accident, or even in the hospital for a patient you dont know how to help. You'll get used to it.

 

[Engineer2MD]

Caboose - not sure if you want to hear from me - I'm an M0 starting in the fall, but I had a similar situation not long ago.

We hired a guy to build horse stalls in our barn. I was out with him on a nice Saturday afternoon helping. Out of nowhere, he starts vomiting. He got very sick, very fast. There was a nasty stomach virus going around, so I kind of assumed that's what was wrong. He kept saying he was fine, but pretty quickly asked if I would call his wife to come and get him and take him home.

I said sure and I called her and she headed out our way. I got him a drink of water and a wash cloth for his face. When I got back outside, he was laying in the bed of his truck. I asked how he felt. He said his left elbow hurt and he felt sick at his stomach and like something was laying on him keeping him from breathing.

I - no joke - thought "Well, you climbed into the bed of your truck and probably hit your funny bone. You're throwing up, so obviously you don't feel well."

When his wife got there, we got him up and into her car. All of the color drained out of his face and he started to pass out. She yelled "Oh no! You're having another heart attack!"

me: HUH?!?!?

At that point, she wouldn't let me call 911 and laid rubber down my driveway. She drove the 30 min to the nearest ER. He was indeed having a heart attack and later that day had a quadruple bypass.

To this day, the guy credits me with "saving his life" - but as I point out repeatedly, all I did was call his wife. It never even occurred to me that he might be in serious trouble.

My husband likes to tease me about it with the "You want to be a doctor? really?" jokes.... but seriously, live and learn. I feel horrible but there wasn't much else I could do not knowing anything. Except - Next time I'll call 911 if I even SUSPECT something is wrong. Better safe than sorry.

I think you did the right thing. 🙂 And I don't think there was anything else you could've done under the circumstances.

(Quit going to that bar! hehe)

 

[Caboose]

Thanks guys! That makes me feel a lot better. It's kind of amazing I hadn't gone through this process yet. ...and I'm not sure, but I'm thinking I won't be all that welcome at that club. It might put my friends who brought me there in a weird spot if I just strolled on in. "Anyone need an ambulance? I have a phone right here..."

Caboose.

p.s. it was interesting to find that a lot of people aren't aware you can refuse transit.

 

[david713]

Being a medical student means absolutely nothing in treating a patient. The janitor in the bar has more medical experience.

First, remember that one of the best ways to get Hep C or AIDS is by blood or saliva contact. If you don't have adequate protection, don't touch.

If you have gloves, stabilize the spine and don't move the patient. Arrest blood loss. Clear the trachea. Unless you want to spend a considerable amount of time in the hospital, don't do mouth to mouth unless you know the person.

Once EMT is present, you do not have a role. No matter who you are. You give them any relivent information. If you don't know what that is, you don't have a place any where near the area.

You are covered by the law for rescue actions unless they are really stupid or interferring with the EMT.

 

[silas2642]

Never do anything outside the realm of your expertise; you did the right thing by calling 911 and then essentially doing nothing.

 

[SoCuteMD]

It was obvious that the paramedics were not welcome there, (I actually felt a little on edge for them walking in), so what if I would have stayed after the gang kicked them out? Would it be wrong to tell him if he has worsening headache he should really reconsider getting help? Would it be wrong to monitor him in any way after EMS was sent away (assuming they let me stay)? In general, if someone sends them away OR if 911 is not an option, am I truly not allowed to do anything in the situation even the week before I graduate?

No, you are truly not allowed to do anything the week before you graduate. Nor should you do anything the week AFTER you graduate.

Just FYI - I'm an intern in an emergency medicine residency. We work closely with EMTs and medics and spend a significant amount of time riding alone during our first two years of residency. We are not allowed to provide medical direction to the medics until our second year. If we, as emergency medicine residents, can't even provide medical direction until R2 year then no medical student should be attempting to provide care in the field.

 

[45408]

No, you are truly not allowed to do anything the week before you graduate. Nor should you do anything the week AFTER you graduate.

Just FYI - I'm an intern in an emergency medicine residency. We work closely with EMTs and medics and spend a significant amount of time riding alone during our first two years of residency. We are not allowed to provide medical direction to the medics until our second year. If we, as emergency medicine residents, can't even provide medical direction until R2 year then no medical student should be attempting to provide care in the field.

You guys are giving EMTs/paramedics way too much credit, and not enough credit for what a med student actually knows. I used to work on an ambulance, and if you haven't learned more in 4 years of med school than somebody did in a one-semester class....

That said, don't do much, because you're in a bar.

 

[ZagDoc]

Whoa, don't think so much. If you're in a bar, serious head trauma = don't move them or let anyone move them, and if they're not breathing = CPR. Don't take it any farther than that. And call 911. It's not like a neurosurgeon would be able to do much in that situation either.

Agreed. Good Samaritan laws cover CPR, but that's about it. You're not licensed yet, so you don't get to play doctor in the situation. You could be (technically) prosecuted for assault for providing intervention beyond CPR.

 

[Knicks]

You guys are giving EMTs/paramedics way too much credit, and not enough credit for what a med student actually knows. I used to work on an ambulance, and if you haven't learned more in 4 years of med school than somebody did in a one-semester class....

That said, don't do much, because you're in a bar.

👍

 

[Shosha]

Being a medical student means absolutely nothing in treating a patient. The janitor in the bar has more medical experience.

First, remember that one of the best ways to get Hep C or AIDS is by blood or saliva contact. If you don't have adequate protection, don't touch.

If you have gloves, stabilize the spine and don't move the patient. Arrest blood loss. Clear the trachea. Unless you want to spend a considerable amount of time in the hospital, don't do mouth to mouth unless you know the person.

Once EMT is present, you do not have a role. No matter who you are. You give them any relivent information. If you don't know what that is, you don't have a place any where near the area.

You are covered by the law for rescue actions unless they are really stupid or interferring with the EMT.

I am guided by the wise words of Socrates daily: "I only know the fact of my own ignorance." I have never been found lacking in humility. Nonetheless, I find your pronouncement that a 3rd year medical student, who has 6+ years of post-secondary education (possibly more if she's pursued a graduate degree prior to entering med school) 2+ of which have been spent at a school of medicine has less medical experience than the janitor at the bar insulting.

I think I may understand the source of your urge to use hyperbole. I realize that as an attending you may see many students who do not have enough humility to recognize their own shortcomings and who do not comprehend the extent of their own incompetence. Some of these student, with their bravado and inflated egos, may even put patients in your care at risk. Nonetheless, I humbly suggest that swinging the pendulum as far in the other direction as you have with your statement, and denigrating all students with such words, is not constructive.

Other than that, thank you for the very helpful list of things to do and not to do. This thread has definitely provided some sensible guidelines.

 

[howelljolly]

I am guided by the wise words of Socrates daily: "I only know the fact of my own ignorance." I have never been found lacking in humility. Nonetheless, I find your pronouncement that a 3rd year medical student, who has 6+ years of post-secondary education (possibly more if she's pursued a graduate degree prior to entering med school) 2+ of which have been spent at a school of medicine has less medical experience than the janitor at the bar insulting.

I think I may understand the source of your urge to use hyperbole. I realize that as an attending you may see many students who do not have enough humility to recognize their own shortcomings and who do not comprehend the extent of their own incompetence. Some of these student, with their bravado and inflated egos, may even put patients in your care at risk. Nonetheless, I humbly suggest that swinging the pendulum as far in the other direction as you have with your statement, and denigrating all students with such words, is not constructive.

Other than that, thank you for the very helpful list of things to do and not to do. This thread has definitely provided some sensible guidelines.

Its not just an issue of humility. A little learning is a dangerous thing. And yes, the janitor is more useful than a medical student in this situation.

The Red Cross and AHA train lay-people how to act in these sorts of emergency situations, and they do a decent job. They teach simple reflex or common sense responses to a basic assessment of the situation, just a bit more than what the janitor would come up with on his own. Once you know anything about medicine, you'll respond more slowly, apprehensively, perhaps wrongly.

An example of this is Caboose sitting there pondering about c-spine or closed head injury, when all she needed to do was tell the dispatcher that all he can do is mumble. The janitor would have done that easily, because he would have done exactly what the dispatcher said... not wondered about what sort of assessment to do. Im not picking on Caboose, Im just making a point.

Most non-EMS medical professionals are useless and dangerous in these situations. This is one of the reasons that New York has the Nonsolicited Medical Intervention Protocol.

A little learning is a dangerous thing.

 

[howelljolly]

You guys are giving EMTs/paramedics way too much credit, and not enough credit for what a med student actually knows. I used to work on an ambulance, and if you haven't learned more in 4 years of med school than somebody did in a one-semester class....

That said, don't do much, because you're in a bar.

Paramedic school isn't one semester.

Maybe youve learned more in 4 years, but what you've learned doesnt do the patient any good. The streamlined assesment based treatment that an EMT learns in 6 months does.

Who's better at fixing your car? A PhD in mechanical engeneering, or the guy that took a 6 month technical certificate course?

 

[Shosha]

I am more than willing to entertain the hypothesis that a sensible janitor could have acted more rationally than a jittery medical student. However, I still take issue with the statement that the janitor has more "medical knowledge" than a 3rd year medical student.

The advice David713 gave in the rest of his post regarding what to do confirmed my initial thoughts when reading the OP and all of those were based on what I have learned so far in medical school - don't move a patient with a suspected spine/head injury without proper support, clear the airways, prevent aspiration if a patient is vomiting, stop any bleeding, put any severed body parts on ice, avoid exposing yourself to bodily fluids to avoid potential infections, etc. I doubt I would know these things if I were a janitor in a seedy bar.

There is merit in the argument that someone with a little knowledge may do more harm than good. However, more than one post in this thread has attempted to reduce medical students and doctors to something close to machine-dependent automatons. If I understand correctly, even a trauma surgeon and a neurosurgeon would be helpless if they came upon this bar scene? Really? The take-home message that I am picking up from this is that after all the years of studying and training, I am going to "grow up" to be a useless little widget unless I am plugged into a hospital with 24-hour access to a CT scanner and MRI machine? Is this really true?

Sorry if my last questions are somewhat off topic, but I am really curious.

 

[RiceOwl04]

Whoa, don't think so much. If you're in a bar, serious head trauma = don't move them or let anyone move them, and if they're not breathing = CPR. Don't take it any farther than that. And call 911. It's not like a neurosurgeon would be able to do much in that situation either.

I agree! I'd be careful with the CPR as well, as mentioned earlier, protect yourself first. You don't want to contract HCV/HIV. The best thing you can do for someone in that situation is get them to a trauma center ASAP.

 

[Shosha]

The point that got lost in all of this is that it was Caboose's birthday.

Happy Birthday, Caboose! 🙂

Hope you'll be able to celebrate your next one in a much better way/place.

 

[howelljolly]

I am more than willing to entertain the hypothesis that a sensible janitor could have acted more rationally than a jittery medical student. However, I still take issue with the statement that the janitor has more "medical knowledge" than a 3rd year medical student.

The advice David713 gave in the rest of his post regarding what to do confirmed my initial thoughts when reading the OP and all of those were based on what I have learned so far in medical school - don't move a patient with a suspected spine/head injury without proper support, clear the airways, prevent aspiration if a patient is vomiting, stop any bleeding, put any severed body parts on ice, avoid exposing yourself to bodily fluids to avoid potential infections, etc. I doubt I would know these things if I were a janitor in a seedy bar.

There is merit in the argument that someone with a little knowledge may do more harm than good. However, more than one post in this thread has attempted to reduce medical students and doctors to something close to machine-dependent automatons. If I understand correctly, even a trauma surgeon and a neurosurgeon would be helpless if they came upon this bar scene? Really? The take-home message that I am picking up from this is that after all the years of studying and training, I am going to "grow up" to be a useless little widget unless I am plugged into a hospital with 24-hour access to a CT scanner and MRI machine? Is this really true?

Sorry if my last questions are somewhat off topic, but I am really curious.

Yeah, kinda.

You're going to learn to do things a certain way. You're going to learn to think in a certain way. If you are outside your element, without the resources you are used to, and without the sequence of prior patient care that you are used to having on board, you'll have problems. Likely, the more set in your ways you are, the harder it will be to get out of it.

 

[tchoupdoc]

1) happy birthday, caboose.

2) After all the time and money you have spent on your own brain, I think you should avoid places where head injuries occur regularly.

 

[howelljolly]

yeah, that too....

Caboose! What sort of a place are you hanging out in where people don't call ambulances, and the clientele have "boys"?

 

[smq123]

However, more than one post in this thread has attempted to reduce medical students and doctors to something close to machine-dependent automatons. If I understand correctly, even a trauma surgeon and a neurosurgeon would be helpless if they came upon this bar scene? Really? The take-home message that I am picking up from this is that after all the years of studying and training, I am going to "grow up" to be a useless little widget unless I am plugged into a hospital with 24-hour access to a CT scanner and MRI machine? Is this really true?

Sorry if my last questions are somewhat off topic, but I am really curious.

There was a similar thread in the radiology forum, recently, where the OP said that one of the doubts he had about becoming a radiologist was that he might not know what to do to help if he witnessed, say, a car crash while he was on vacation. The response he got was that, honestly, outside of a hospital or an ambulance, there isn't much that a trained EMT/EM physician/trauma surgeon could do either.

I mean, think about it. If you're shopping at the mall, and someone keels over, how are you going to listen to their heart without a stethoscope? How are you going to follow ACLS without an AED or a few syringes full of adenosine in your pocket? How are you going to give them supplemental O2 without an O2 tank? And if someone really starts crumping, how would you maintain their airway without an ETT? A lot of medicine IS equipment dependent, like it or not. It's just that med school teaches you how to use that equipment.

As tkim, an EM resident, posted, "You and pocket knife will not save the day - ever."

 

[david713]

I see that my reference to the janitor got some reaction. That is good. It allows you to put your knowledge in perspective. You will have been in school for somewhere around 7 to 8 years when you get your MD. Guess what? You still know very little. You have the basics. But how do you apply them? That is the job of your post graduate training. When you finish your first year of training (intern), you will be getting the idea of how much you have to go. Enjoy medical school, it is fun. You have no responsibilities. You are allowed to read and delve into some of the most interesting information that is known to man. You can attend clinics and see some of that information put to work. But it will still take many years to get comfortable with what to do with the information, then take the big step of challenging what you know and being critical in your thinking. Don't think that you can charge in like on TV and be a wonder. You will be put down in two seconds, likely by the nurses.

As to the incident in the bar, yes the janitor can do a better job. Likely he is mid 30's or later. You are early 20's. He has been involved in many life situations that you have not. Thus he has experience that puts your knowledge to shame. The other problem is that modern medical students are not subjected to the decision making process and the hands on experiences that we had 40 years ago. By the time I finished school I had delivered 200 babies on my own, preformed a score of surgeries (appendix usually), run a high volume clinic, preformed emergency measures under fire (both from snipers and from the cops shooting up the ER), preformed CPR in a plane and so on. The students I taught would never do these things and rarely if ever read or did extra study. If is sad.

 

[Disinence2]

You had your steth in your bag at a club?

 

[maceo]

These types of situations are not for "cowboys" who jump in and do things that they have little experience handling. The results can end up being total paralysis for the patient and the experience of being responsible for the paralysis/death of a person because you we.

she would have been protected by the good samaritan law.

 

[smq123]

she would have been protected by the good samaritan law.

Not necessarily.

In some states, if you attempt to rescue or treat someone who's not in immediate danger (i.e. in a car that's engine is starting to catch fire), and you injure them in a way that causes paralysis, you're not protected. The rescued person or his/her family can still sue you and win.

http://www.latimes.com/news/opinion/editorials/la-ed-goodsam4-2009mar04,0,7160849.story

 

[howelljolly]

she would have been protected by the good samaritan law.

Not necessarily.

In some states, if you attempt to rescue or treat someone who's not in immediate danger (i.e. in a car that's engine is starting to catch fire), and you injure them in a way that causes paralysis, you're not protected. The rescued person or his/her family can still sue you and win.

http://www.latimes.com/news/opinion/editorials/la-ed-goodsam4-2009mar04,0,7160849.story

Yeah, not necessarily true. It's nowhere near that simple. Even if she is not specifically excluded from protection under the Good Sam Law because of her jurisdiction,(as i mentioned above), any lawyer can argue that she isn't protected under it, for any number of reasons.... (she's a med student, she called 911, she acted outside the direction of the Dispatcher)

 

[45408]

Paramedic school isn't one semester.

Maybe youve learned more in 4 years, but what you've learned doesnt do the patient any good. The streamlined assesment based treatment that an EMT learns in 6 months does.

Who's better at fixing your car? A PhD in mechanical engeneering, or the guy that took a 6 month technical certificate course?

EMT-Basic is one semester, and most likely, that's the only guy who's going to be coming to the bar. He's got 144 hours of training, and that's it. He'll be quite useful, because he has a C-collar, a long-board, a BP cuff, and an ambulance to race off to the hospital with.

I don't know why you think I haven't learned anything in med school that wouldn't do any good. You've never seen a trauma patient? I did a month of trauma surgery, and a month of emergency medicine, and a modified two week version of ACLS and ATLS principles. I feel like I actually know exactly what to do in the field (which is NOT MUCH).

Its not just an issue of humility. A little learning is a dangerous thing. And yes, the janitor is more useful than a medical student in this situation.

The Red Cross and AHA train lay-people how to act in these sorts of emergency situations, and they do a decent job. They teach simple reflex or common sense responses to a basic assessment of the situation, just a bit more than what the janitor would come up with on his own. Once you know anything about medicine, you'll respond more slowly, apprehensively, perhaps wrongly.

So, on the scene, somebody had already shaken his body, and someone else had sat him up. Apparently the lay people HAD NO IDEA WHAT TO DO, because they did the exact opposite thing of what they should have done, which is not move him at all.

 

[45408]

As to the incident in the bar, yes the janitor can do a better job. Likely he is mid 30's or later. You are early 20's. He has been involved in many life situations that you have not. Thus he has experience that puts your knowledge to shame.

Experience in what? The custodial sciences?

 

[Bacchus]

Experience in what? The custodial sciences?

Maybe the pudendal nerve was severed in the fall... loss of sphincter control. He could handle that.

 

[howelljolly]

EMT-Basic is one semester, and most likely, that's the only guy who's going to be coming to the bar. He's got 144 hours of training, and that's it. He'll be quite useful, because he has a C-collar, a long-board, a BP cuff, and an ambulance to race off to the hospital with.

I don't know why you think I haven't learned anything in med school that wouldn't do any good. You've never seen a trauma patient? I did a month of trauma surgery, and a month of emergency medicine, and a modified two week version of ACLS and ATLS principles. I feel like I actually know exactly what to do in the field (which is NOT MUCH).


So, on the scene, somebody had already shaken his body, and someone else had sat him up. Apparently the lay people HAD NO IDEA WHAT TO DO, because they did the exact opposite thing of what they should have done, which is not move him at all.

Im not saying you havent learned .... i actually said you/we learned a lot. Im implying that we havent learned to do much. And what we've learned to do is in a more controlled environment. Also, what this patient needs... many of us havent learned... that is, ABCs. We get used to being able to confirm these as adequate from the doorway, and often get very confused when one or more of these is in a gray area. Remember, not everyone has the same electives in med school. Not everyone can be assumed to know what theyre doing... especially right out of med school.

I used to teach BLS and ACLS to brand spankin new interns. Some of them are completely clueless... some are very good. My most savvy ACLS student 5 years ago... ill never forget.... I asked her where she learned so much.... she said from her Anesthesia month. I never did an anesthesia elective. My worst student was a Gen Surg intern.

Correct, the bystanders had no idea what to do. My argument is only that It is easier to teach a novice the basics of first aid than it is to teach an expert the basics. You cant teach an old dog new tricks... take whatever saying you want. .

 

[Caboose]

yeah, that too....

Caboose! What sort of a place are you hanging out in where people don't call ambulances, and the clientele have "boys"?

Haha - I think the correct spelling is "boyz" but I'm not sure. I think different cultures are interesting, as naive as that sounds. There are all sorts of rules and beliefs for each group/social class of people that impact the way I communicate with them in the clinical setting. They're crazy - the way no one moved to help the guy right away or call an ambulance was very eerie. Took a lot to get me up on stage... or just the disappointed dispatcher.

Um, to split hairs, I'd beg to differ on the early 20s reference. I suppose the majority of medical students, but not all. Also, it depends on which 23 year old you're talking about - I would fit the profile of being inexperienced with trauma when I was 23, but others have grown up in more tumultuous environments. I do appreciate the amount of time to be a good doctor, (and I despise the process). Betcha I'll be quicker and more confident next time something like that happens - even as a medical student.

By the smell of urine... there was no janitor present... possibly never was.

I like to grab various items and put them in my bag before I leave - staplers, hair ties, bandages, fish lours, duct tape, extension cords; whatever might turn out to be useful on any given night.

Caboose.

p.s. Thanks for the happy birthdays

 

[MonkeyNuts!]

Should have intubated him with the phallus of one of his "boyz".

That would have woken him up real fast.

 

[Caboose]

Should have intubated him with the phallus of one of his "boyz".

That would have woken him up real fast.

I'm not really into that kind of medicine...

Caboose.