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Mon Aug 28 21:42:07 BST 2006

Once again, I will be using some of Pret's remarks in my next OB Emergencies
presentation to EMS.

Oh to be as eloquent as Pret.

Andrew
----- Original Message ----- 
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Monday, August 28, 2006 3:30 PM
Subject: RE: pre-hospital C-section

The only "human condition" in play here is our collective primal
inclination, in the face of fate or failure, to do something pointless
-- or even boldly stupid -- in an empty and undeniably vain attempt to
not do nothing.

It's tough to make surrender feel proper, much less heroic; but it's
curiously easy for some of us to think of gutting a corpse as "going
above and beyond."

Even if we forgive the inanity of extemporaneous EMS Caesarean section,
it's nothing short of shocking to hear suggestions that we devote
resources, manpower, and training to developing, disseminating, and
normalizing a process for it.  According to the metaanalysis cited by
Dr. Mauritz (Katz, et al, Perimortem cesarean delivery: were our
assumptions correct?  Am J Obstet Gynecol. 2005 Jun; 192(6):1916-20;
discussion 1920-1), we're talking about (at most) EIGHT APPLICABLE CASES
with (at best) SIX SURVIVORS over (at least) TWENTY YEARS, divided
evenly among tens of thousands of providers.

How many paramedics do we train in emergency obstetrical surgery, and at
what cost, for a virtually zero-yield endeavor?  How much time do we
devote to protocol development?  To medical control?  To performance
review?  Broadly implementing this pointless windmill-tilting might
easily cost millions of dollars.  Me, I'd rather buy new tires for fifty
or sixty thousand ambulances, or train a few million grade-schoolers in
basic first aid and BLS.

My heartless fiscal conservatism notwithstanding, how many patients
might this process cause to be preferentially undertriaged in favor of
an almost certainly non-viable fetus?  How many providers might injure
or infect themselves in the frantic fillet-fest?  How many families and
bystanders will be asked to endure the image and the memory of a young
woman cut apart and fished within, for nothing more than the assurance
of an extra casket at her funeral?

Worst of all is the reflexive tendency of professional groups (in this
case, prehospital providers), to interpret the deflation of a dumb idea
as a broad assault on their professional self-worth.  Whether or not
it's intentional, it is manipulative, self-pitiful, and an insult to
both sides of an otherwise reasonable debate.

Folks, this thread is a stinker.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of David Sullivan
Sent: Monday, August 28, 2006 2:13 PM
To: Trauma &amp, Critical Care mailing list
Subject: RE: pre-hospital C-section

Anthony,

  I totally agree, I think that this is one of those area's where
protocols and the human condition dont really see eye to eye. I agree we
have to operate within our scope of practice, and we shouldnt deiviate
from that. I regularly attend the EMS rounds, but we should be looking
to do round maybe with an ICU/CCU should be offered to us, but the
bosses in Boston wouldnt go for it....to "progressive" shhhhhh I think
we all want the best care. I think the scenerio is charged not for the
medicine, but for the emotion that can be felt by going through a call
like that. a good movie qoute reminds me of this situation "sometimes
doing the right thing, aint doing the right thing"  Congrats on the new
addition, I have a 3 yr old, going on 30!!
  stay safe out there!!

  dave sullivan BA NREMT-P

Anthony Caruso <Medic541 at hotmail.com> wrote:
  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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