Monday, September 14, 2015

An emergency physician stops at a roadside accident. He finds out he's not needed.

This blog post was carried in The Health Care Blog. THCB is the oldest, most active #hcsm blog. It features outstanding blogs and is produced by KevinMD

Although Dr. Edwin Leap posits he is not needed at these accident scenes, in my  opinion he has a skewed point of view, as an emergency physician somewhat jaundiced and perhaps naturally 'burned out' after a long successful and ongoing career in emergency medicine.

Let me tell you a story. On a long stretch of highway in a desert I happened upon a catastrophic accident involving three vehicles in the middle lane of the I-10 freeway. I was with my family, my wife and three sons (ages 10-15).   Traffic was speeding through the area at about 80-90 miles/hours. We were the first to arrive on the scene. The actual accident was visible to us as it occured.  I quickly intellectualized events and objectively decided to not stop and go on to our destination.

My  spouse who used to be a nurse confronted me and said 'Stop and see what you can do". Under threat of being divorced I complied. She, a nurse, and is a much better 'caregiver' than I could ever be. Nurses really do care, not just how to care or be a caregiver. She has a need to 'care'  As a physician I have a need to diagnose and treat (only one half the equation of a true healer).

Fortunately I listened to her.

I stopped and realized I was a 'first responder'.  From the side of the freeway I could see three bodies in the middle of the freeway. It was a dangerous situation for anyone.  I stood there on the side of the freeway waiting for a break in traffic. I immediately called 911

The EMT's arrived in less than 4 minutes. Fortunately although we were in a relatively isolated stretch of freeway a regional California  Higway Patrol Station was less than two miles away. It included as squadron of fireman/emt's.

As they arrived they cut off traffic (3 police cruisers, roar onto the freeway and get ahead of the cars coming down the road.

One proceeded ahead to the accident scene to coordinate their plan.  I was duly impressed, and glad I did not run into the freeway to help ( A dead me couldn't  do much)

There were three people on the highway.  Going from best to worst was a very pregnant (full term)  woman who was concious but drifting in and out of conciousness.  The second was an elderly gentleman who had been thrown out of a vehicle landing on the side of the road.  The third person lay in the median divider, crumpled head and neck twisted 180 degrees, large gash from front to back on the top of her skull, blood coming out her ears, nose and  mouth.  Her chest was crushed, she had no vital signs or reflexes with fixed, dilated pupils.

The police and EMT's asked if they should begin CPR.

The unfortunate lady was dead and the chances of a successful resusication were meager.  Besides the severitiy of blunt traume, a nearly open skull wound, and full cardiac arrest compounded her no chance of survival.

I instructed them to forget her and be attentive to the pregnant lady and the roadside victim. My assessment was she had a living baby, her vital signs were good...she had not yet gone into shock, and she had a live baby (  I happened to have my stethoscope in my car)  The uterus was quite tense....labor had begun.

I hailed down one of the on the scene highway patrol officers and told them to get a helicopter immediately....Again good fortune. The CHP station was about 1 minute from the accident site, and the helicopter was there.  Both sides of the freeway by now were closed down.  As the helicopter descended they asked me what hospital to take her to. There were three in the area, and having been on the staff at all three I chose the level 3 emergency department.  She was at the emergency department in about five minutes.

What did I do ? Nothing and everything.

By  the way I am an ophthalmologist for the past 25 years. I was a general medical officer in the Navy from 1969-1971 during the  height of the Vietnam conflict about the time of the 'Tet Offensive. You millenials will have to 'google' that one.

I ran a Navy MASH unit and I knew how to does Dr. Leap.  I did general practice for five years prior to specializing. This scene brought me back to that time.  While I did not physically perform I was able to triage and organize priorities which gave confidence to the first responders who do not have authority to make life and death decisions about CPR, administering oxygen. There immediate response is to treat unless told otherwise by a licensed M.D.

I think it was 'The perfect storm'......a good one with incredible timing and combination of EMTs police, and perhaps me, although I won't claim it.

Had I been five seconds earlier I would have missed it and been unable to respond at all.

I am not at all critical of Dr. Leap. He is far more qualified than I in the subject of emergency care.

No one can second guess these situations. There is no 'preferred practice pattern'..

As for me, my 3 kids were in the car.....they saw it all, and came to their own conclusions about the accident.  They were late to the birthday party, but will never forget what happened, and that I did stop to render aid.

I still don't really know what they thought at the time. None of them chose to follow in my footsteps as a physician.....their career now is computer science and engineering.

How the world changes !

An emergency physician stops at a roadside accident. He finds out he's not needed.
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