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Stoopid Medicine

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EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. We don't know everything, but we do know a lot of smart people. If we need to, we'll contact just the right experts and share their advice with you. E-mail ideas to Nancy.Perry@cygnusb2b.com.

You've been up three times already, and now you find yourself flying down a raised country road in the middle of a cornfield. The only evidence of reality is what bounces back from your strobes: the flecked snapshots of corn tassels on both sides of you and the faded road ahead, aimed at a hidden horizon. Somewhere between here and there, a pickup full of kids rolled off this road. From the chatter on the radio, you know that a sheriff's deputy, a medic unit and a squad from a neighboring county have been on scene for about 10 minutes. There's a third ambulance behind you, and so far there has been no update.

The scene becomes visible from a rise in the road. The field is illuminated on the right, and there are a lot of flashlights moving around in the corn. As you pull up, you see three a d o l e s c e n t males sitting on the side of the road with boo-boos and a couple more lying in the field next to a really bent Nissan pickup. The corn is about six feet tall, so it's hard to see anything else. But all of the flashlights appear to be in the corn beyond the pickup. You and all the rescuers there, needling the chest of and pushing cardiac drugs into an 18-year-old kid in cardiac arrest. Nobody's in c-spine. You contact one of the medics, and he admits there has been no triage.

Q. These guys do this all the time. It's like they went to school on Mars. Isn't there something you can do to make them play by the rules?

A. Not in the middle of a call, obviously. And although it's 10 times harder to re-triage an incident than to triage it right in the first place, you're the re-triage officer. Better start from scratch. This is an issue for medical directors, so following the call (preferably after you've had some sleep and aren't angry), you need to document your observations and talk to your doc.

Q. What's up with the cardiac drugs on a trauma code? Isn't that kind of a waste of time, especially with limited resources and other, untriaged patients to take care of?

A. It would be interesting to know their thought process. Many agencies persist in "practicing" advanced procedures on patients' bodies before pronouncing them. They really need to stop, especially since the families will be paying the outrageous bills for all that stuff. Some of us need to start doing things for people instead of to them.

There are no choppers available, and without so much as a by-your-leave, the medics with the cardiac arrest arrest Stokes their patient up to the roadbed and initiate a 30-minute transport with CPR still in progress. It's like none of the other patients (or their caregivers) ever existed. Sure enough, when you arrive at the hospital with the last two patients, you learn that Patient #1 is deceased, and the crew is probably back in bed at the station.

Q. How about that whole concept of CPR during transport? Even on medical calls, isn't that an unnecessary risk to a crew?

A. It's one of the dumbest things we do in ALS systems. If we don't resuscitate people on scene, they die. Period. We really ought to be pronouncing them. If you're wearing a safety belt in an ambulance, you can't do decent CPR. And if you're not wearing a safety belt, you're accepting a terrible personal risk for somebody who has already taken the Big Vacation.

Remember the first rule in EMS: Never do anything you know is stupid.

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