pre-hospital C-section

Mon Aug 28 20:11:26 BST 2006

David,

First, read the very first line of the post, where I start by including us - us docs who have no clue what y'all do on the street - with you, the guys who do all in the streets.  I guess my ego falsely allowed me to promote myself to the level of street medic.  So sorry, man.    

Now, lets once again compare biceps, shall we?  Yes, I am a doc who works in a hospital all day long....mostly.  Please forgive me for that.  I shall not recount the extrications that I have done, for although I have indeed done many, having flown many, many missions in both the civilian and military realm, I have no doubt that they will never number up to yours.  And I have no doubt that your field experience is far broader than mine .  So we won't talk about the in-field medical care that I have had the privilege of giving to our kids with some of the best medics in the world under combat conditions, 'cause I have no doubt that you have done more.  OK - I give.  In short, I guess my skin is far thicker than yours, for I didn't feel the need to be insulted by your comments.  I do what I have to do, and move on when needed. 

Your comment "but I feel in these types of cases, there should be something that can be done, other than extrication and transport" says it all....."I FEEL".  I don't care what you feel, no more than you should care about what I feel.  What separates us from the rest of the lay public is that we are capable (or at least should be) of putting our feelings aside when facts dictate something contrary to what we feel!  Where is the medical indication - other than the way you feel?  What is the accepted indication, other than you feel or I feel.  That is how we are supposed to practice.  This is not football, where your risk taken just might be someone else's loss rather than reward.  This is medicine, and people far smarter than you and me have condemned the concept, let alone the practice, of providing medical care by the seat of our pants because we FEEL like we need to do something else.  Frankly, you have forgotten all of the folks that are standing around watching this fruitless procedure being done on a dead mother, only to deliver a dead fetus under the worst of conditions, with the worst of lighting and inadequate or no appropriate equipment and assistance.  If you do not think you have in any way harmed those folks, then I fear for us all, for the people left there after you leave will have to deal with the images you have burdened them with for a very long time..... 

"To infer that street medics have an ego problem is without merit."  Please, you must be kidding.  If you didn't have egos, you couldn't do what you do, just as I couldn't do what I do; it is that very ego that makes us strive to do better every time we take a patient under our care.  It is that ego that prohibits us from doing nothing less that the very best that we know how to do all of the time, regardless of how we feel.  It is when you or I - the street medic or doc with no ego problems  - allow our egos to take over so as  allow us to step out of our field of expertise that our egos have trumped common sense and good old fashion clinical judgement - and have permitted us to do the wrong thing.....and it will be wrong long after you forgot how you felt at that moment in time.

"Good judgement comes from experience.  Experience comes from bad judgement."

Ron

>>> David Sullivan <fpcems at yahoo.com> 8/28/2006 2:28 PM >>>
Ron, 

  Im going to make an assumption here, that you are a MD that works in a hospital all day long. Our job and your job have differences that we cannot ignore and we (as an EMS system) need each other to survive. I certainly do not stroke my ego, by landing a tough ETT ect..., and in fact I am highly insulted that you would think that about some the providers that provide ALS care are egomanics that are out there like cowboys with needles. Our job isnt easy in the least bit; when was the last time that you rescued a teenager from an MVA, delieved a baby stuck in traffic, not that Im trying to start a pissing contest here, but to infer that "street medics" have an ego problem has "no merit" 
   we have a scope of practice, and protocols, and they are there for the pre-hospital provider to operate between, but in this instance, at least in my state, there is no protocol to refer too. 
  After posting this topic i agree that this procedure has little merit and rarely successful, but if the mother is already in traumatic arrest, what are we harming? A great football coach said once, "with great risks comes great reward" I certianly wouldnt do anything to make me feel better, but I feel in these types of cases, there should be something that can be done, other than extrication and transport 
  Any flight docs out there with an opinion on this topic? or to field amputation and indications?

Ronald Gross <Rgross at harthosp.org> wrote:
  Anthony,

Your/our job is to treat the patient, NOT our egos by doing something
that is (1) of no merit, and (2) assured to fail. In short, we are to
alleviate pain and suffering and DO NO FURTHER HARM!

What worries me is your statement: "So when it comes to staying within
the scope of practice I'm all for it. I have gone above and beyond what
my job calls for to do the right thing for my patients, at times." 
Exactly how do you want it? Scope of practice is scope of practice,
and that predetermined scope of practice is not for you or me or anyone
else to change on a whim or because our ego or emotion tells us that we
want to do something else to make us feel better.

In-field C-section? Give me a break. Please refer back to Dr.
Mattox's comments for some reality testing.

Ron

>>> "Anthony Caruso" 8/28/2006 1:35 PM >>>
Ouch! Well Dave, I totally agree with you. Yes they have a less then
one
percent of chance in living and yes were here to help them. The line
has to
be drawn somewhere though. I like to think of myself as a medic that
would
do that cardioversion that some medic's "feels uncomfortable". So when
it
comes to staying within the scope of practice I'm all for it. I have
gone
above and beyond what my job calls for to do the right thing for my
patients, at times. I could understand if we did attend rounds with
the L&D
physicians and had further training and testing. (like an R.S.I
project,
retavaise waiver) Then I'm all for it. To give that little life a
chance
of survival. (by the way I'm expecting my 1st baby in November) So
having
said this and wanting the best care possible for my patients I would
rather
walk away from a situation saying to myself the injuries were just to
severe
for her to survive. Than not having a job in the end! Oh, and by the
way
will till "docrickfry" hears about this one. Lets just say he's been
a
staunch opponent of some of my ideas with other subjects. Sincerely, 
Anthony M. Caruso NREMT-P 
Town Of Natick Fire Department, 
Natick, Massachusetts. 

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Parrish, Richard
Sent: Monday, August 28, 2006 1:06 PM
To: 'Trauma & Critical Care mailing list'
Subject: RE: pre-hospital C-section

A Jersey City NJ Medic did this a few years ago. Medical control gave
the
go ahead and talked the medic through the process. The MD was censured
and
the Medic lost his certificate.

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