Re: Advice / Opinions

["Rob Atwater" <Flight163@toast.net>]

I can only imagine what responses this will promote.  I have been in the
situation of being a single provider in a small aircraft, and I can
sympathsize with this predicament.  One of those situations where something
bad is gonna happen, its a question of where.

Does leaving the patient at the community hosptial help?  Are you doing her
any good?  In the case of someone having an MI or a severe trauma who you
are pretty sure is gonna box at some point, sometimes its worth it to scoop
up and run like hell, and give them a chance.  Most likely they are going to
die, and you might as well give 'em a shot.  Not the best idea, at all, but
sometimes you gotta do what you gotta do.  I know there are those of you out
there who would say that this is inappropriate and bad patient care, but
sometimes you need to do such things.

Now, speaking for the situation given on the posting.  In my simple mind,
there is no way or reason to do this transport.  The deck is so stacked for
disaster with the way things are, and I don't see a way to get to your ace
in the hole.  Murphy will be along, and he will screw things up badly.  You
will find yourself delivering a 34 week kid who needs resuscitation, a mom
who then begins to bleed uncontrollably and goes into respiratory arrest and
a doc who discovers an unknown claustrphobia and motion sickness leaving him
a quivering mass in the back corner of your aircraft.  Now what do you do?

The answer is to not get yourself into the situation.  Back out while you
still can.  You have no chance of pulling this transport off safely and
successfully.  (If you could, your next step should be to get on a plane to
Vegas and place your entire savings and future income on Black 15.)

Tell this doc it simply can't be done.  Deliver the child there, and call
for more help.  The child is 34 weeks, so should be able to hold its own.
If not, so be it.  People in this industry often think that we have to
overcome every situation we find ourselves in or we have failed.  Sometimes
the deck is so stacked that there is nothing to do.  THIS IS OK.  People
die.  Sometimes we can make a difference, and I will do my best to ensure
that I do, but I refuse to get upset over it.  I will review what I did, and
try and figure out what could have been done better, but I will sleep when I
get home.

So, basically my advice is that this transport should not happen.  Maybe you
could tie her legs to the ceiling of the a/c, and maybe your pump won't fail
too.

Awaiting the s*#t storm to follow,

Rob Atwater
Flight Paramedic



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