Saturday, 1 May 2010

Emergency medicine at 36,000 feet. Who would you want?


For various reasons here at ND Central we have not posted recently. The biggest cause of this is the fall out from the Icelandic volcanic ash cloud in terms of reducing bodies on the ground which only now are finding their way home from foreign shores.

An article in an obscure bit of the medical press caught our attention. If you can find it, it is on the letters page of the freebie found with the British Medical Journal called BMA News which is normally about as thick as a piece of quality toilet paper.

On their letters page there was a short letter entitled “Trust me, I’m a physio”.

The crux of the letter was that a doctor, who is an anaesthetist, volunteered to help in response to a request for inflight medical help only to be told by a steward that someone else had volunteered “who is a physiotherapist”.

What does this tell us about dumbing down?

So now if there is an acute medical emergency like a heart attack, a pneumothorax, meningititis, a cardiac arrest on an aeroplane a physio is now to be preferred over an ansaethetist? We are sure that the prompt administration of some core stabilizing exercises with some gentle mobilization and stretching will be of huge benefit for any life threatening emergency at 36,000 feet.

We do wonder what the acute medical emergency was that a physiotherapist would have been able to manage better than an anaesthetist?

Praise be to the Party for telling us all that anyone can be a doctor. It would seem like someone, somewhere, might be starting to believe them.

7 comments:

Simon said...

While you're being a bigoted old sod you might have forgotten that physiotherapists are required to know basis resus skills if they work in-hospital. Or would you rather that physio kept their mouth shut with no idea if anyone else was around and the patient died as a result?

GrumpyRN said...

"volunteered to help in response to a request for inflight medical help only to be told by a STEWARD that someone else had volunteered"

So you expect airline stewards to understand the difference between all the jobs in health care and what each one can do? No, this is grumbling and complaining for the sake of it and making a rather specious argument.
As Simon has said, physios are also trained in CPR.

In this case would you not think that the scenario was; a call goes out for help, physio responds stating who they are but do work in healthcare setting, help accepted and stewards now don't think any more help required?

the a&e charge nurse said...

Perhaps the anaesthetist who stepped forward was en route to the States so as to to avoid any awkward questions about a fatal adrenaline bolus she administered while working in the NHS?
http://www.dailymail.co.uk/news/article-1137862/Doctor-convicted-killing-intensive-care-patient-injection-adrenaline-avoids-jail.html

The judge (in this case) stated, "Arrogance has cost you your reputation" - a perennial claim that could be made against other doctors it seems?

Anonymous said...

'Quack attack', eh Northern doc!

Legally, what becomes of the physio if the patient dies?!

Q-U said...

"The judge (in this case) stated, "Arrogance has cost you your reputation" - a perennial claim that could be made against other doctors it seems?"

And practicing out of their depth HCPs including nurses?

the a&e charge nurse said...

Well, Q-U it needn't even be a health professional in certain life threatening situations.

If somebody has a VF arrest 36,000 feet in the air the most important factor would NOT be the job title of the rescuer, but the timely attachment of an automatic defibrillator - followed by delivery of a shock, a skill even cabin crews are familiar with nowadays.
http://www.virgin-atlantic.com/tridion/images/factsheet_specialassistance_tcm4-426062.pdf

Needless to say not all current ALS (advance life support providers) or indeed APLS (advance paediatric life support providers) are medics.
For example, as an ALS + APLS provider I have been been involved in over a hundred arrests (after more than a decades experience in A&E) - could a psychiatric consultant, or dermatologist say the same thing?

GrumpyRN said...

Anonymous, nothing happens to the physio. If he/she worked to the best of their abilities, knowledge and experience then that is all that is required. Even USA have good samaritan laws.

Q-U,
I once attended an arrest in a hospital kitchen, who gave me the most help? A kitchen porter who had had training, the patient survived and went home from hospital a few weeks later.

As an aside to this I was working in a DGH and we had an emergency ongoing, 3 anaesthetists appeared and took over. The senior(consultant) then quoted ATLS guidelines to me and stopped me doing what I was doing and made me hold onto the patients head to protect his airway as ATLS says A first then B and C, totally ignoring the fact that I was the only nurse present. And incidently ignoring the ATLS guidelines which say don't tie up your most senior and experienced nurse with stuff that they should have been doing. I was left to watch as they then proceeded to make a balls up of the rest of the resuscitation. For example, they were shouting for drugs - great, except they did not know where the were kept, the key was in my pocket and they did not know how to make up the drug as well as not knowing where needles and syringes were kept.

So the answer to the question "Who would you want?" is not always a doctor, it is the person most able to do the job and is not out of their comfort zone. As I have worked in the back of an ambulance, at the side of a road and even in fields then perhaps it might even be me.