ALS PALS and ossification

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Dr Mattox,

I raised the question of CPR being appropriate for trauma in my recent
update of my ALS certification. It cost me the chance to move to being an
instructor (and try and change the system from within).

If they are going to such lengths to preserve the orthodoxy that they will
disbar anyone who questions it, how long before the system becomes ossified
(if it hasn't already) and what should be done about it?

Belonging to this list is making me increasingly uncomfortable with what I
am expected to teach my staff. I have to teach CPR in trauma, 2L fluid for
hypotension, needle thoracotomy...the list goes on. Before anyone suggests
it I have jumped ship from my present post - but only before I was pushed
overboard. My temerity to question the management of cases, and decisions
that have resulted in deaths that I know elsewhere should not occur, has
resulted in senior management threatening to have me struck off.

With your seniority and experience, Dr Mattox, it is a position you are
unlikely to find yourself in. Some hospitals (doctors?) are so bound up in
their outdated beliefs that they would rather someone die than consider the
concept that junior staff or those from another specialty might just be
right. Faced with the choice of stretching my clinical abilities elsewhere
or staying silent while people die, I have made a decision. It is a
different world some of us are faced with, where the patient is well down
the list of priorities. Driving home from every shift weeping with
frustration is not something I can handle long term. I did not know what
else to do but leave.

But I still feel like a rat.

Fiona Wallace


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