In case of emergency, check your ego

My wife and I were taking a vacation day in between two talks she’s giving, and we decided to stop at a local restaurant to have some food. We were eating the food, relaxing and having a good time. It was a warm, summer day, and we didn’t have a care in the world. Suddenly, one of the restaurant employees ran out and called for someone. That someone ended up being a young man whose aunt was in some sort of trouble. “Do I need to respond?” my wife asked. I told her I’d go check.

I got up and walked across the area where you order food and get your drinks to another area where people were eating. There was a group of people around a woman who was laying on a set of chairs, surrounded by people. I turned around, walked back to our table, and called my wife’s name. She bolted from her chair, handed me her bag, and went to the aid of the woman on the chairs. The woman had apparently passed out, lost control of her bladder, and was now vomiting and profusely disoriented. My wife, a physician assistant with tons of experience in urgent care and family practice, stepped in to help, but another woman there quickly announced to the entire room that she was a nurse and that she would be taking care of the woman.

I’m not going to second-guess the nurse’s actions. I’m not an expert. But I will tell you that my wife was not impressed. The nurse refused to let us put the woman on the floor. Instead, three people had to hold the woman on the narrow chair seats. Had the woman fallen to the ground, we’d have a whole other set of problems. Next, the nurse kept saying that the woman probably had a seizure. We asked the nephew if there was anything medically wrong with his aunt. He said that she had been complaining of vertigo because of the heat. Upon hearing this, I grabbed a dinner tray and started fanning the woman as hard as I could. With everyone around holding her, the air wasn’t circulating very well, and she probably had heat exhaustion or even heat stroke. Maybe she was diabetic and didn’t account for drinking fluids on a hot day when taking her medication. Finally, when the fire department arrived, the nurse called for an oxygen mask “at full blast.” Even without any emergency medicine experience, I looked at my wife in horror. Have you ever seen anyone puke into an oxygen mask?

It can get “soupy.”

The best part was that the fire department first responders, who arrived in a pick-up truck with lights and sirens and a medical go-bag, had no glucometer with them. No blood pressure cuff. No stethoscope. The paramedics arrived five minutes later, and we hoisted the woman onto a stretcher… Then we went back to eat after washing our hands. I could tell my wife was not happy. She told me that the nurse handled things in a mistaken way. I agreed with her that holding the lady on the chairs by four people in a hot room was crazy. And I agreed that the oxygen mask “at full blast” (how many liters per minute is that?) could have caused the woman to aspirate vomit if she had vomited into it.

But I have to admire my wife for stepping aside and letting the nurse do her own thing. It wasn’t a moment to start having pissing contests, but my wife was ready to step in and intervene if the nurse crossed any lines.

They say that the first rule of handling an emergency is not to panic. I think the second rule should be to know your own limitations. Then the third rule should be to be ready to step aside and let the adults handle the situation. And the fourth rule should be to get a good picture to post on Twitter. (Don’t judge me. I was just a human air fan at that point.)

I'm a doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen

2 thoughts on “In case of emergency, check your ego

  1. It rather sounds like the poor woman had nurse Killpatient working her over.
    Seriously though, putting the patient out of a risk for a fall is priority one for a breathing patient. Hence, putting the woman on the floor would have been a first priority. Indeed, it’d be rather difficult to resuscitate a patient in a chair!
    The floor has the added benefit of being rigid, should resuscitation be necessary and even abdominal thrusts are simple to perform in the case of choking.
    A quick set of basic vitals, respiration, pulse give hints. How the skin feels and looks can give hints. A simple pinch can indicate dehydration. While that close, one can smell for acetone odor or a sweet odor.

    One stinky part of responding in such a situation is crowd control, as a crowd gathers, gets in the way and as you noticed, cuts off air circulation. I’ve actually had someone treading on my feet while I was working on a patient on more than one occasion.
    I had the benefit of being in a military environment, so the patient’s M-16 was then “handed” to the one walking on my feet’s shins, with the instruction to secure the weapon.
    Worked every time. 😉

    Well, at least in this case, the EMT’s arrived and the EMT-P arrived quickly as well, getting the patient proper emergency care.
    For the record, there is no such thing as “full blast”, but 15 liters per minute is a brisk rate that EMS frequently uses on *non vomiting* patients. Well, occasionally, for oxygen deprived vomiting ones as well, we carried and knew how to use suction units.
    Wasn’t fun, but everything can be treated except dead.
    Dead can’t be treated.

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    • If the situation wasn’t so serious, I would have laughed out loud when she said, “We need some O2, please, full blast, with a non-rebreather mask.” I’ve seen people aspirate with those things on. The woman threw up about five times after the mask went on. Clearly, the nurse was in over her head.

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