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Old January 14, 1999, 01:50 AM   #26
Staff Emeritus
Join Date: November 23, 1998
Location: a small forest in Texas
Posts: 7,077
Hi Guys. Sorry to take so long getting back to you. Especially glad to see so many weighing in on this one.

No flame perceived here! I believe we agree more than shows here.

We agree:
- Appropriate bystander care is critical to patient survival. A heart attack patient in full arrest has, AT BEST a 43% chance of survival. No bystander care = 19%. (NSC figures.)

- The decision to help is very personal. Greater bystander expertise and performance means better chance of survival for both the patient and the rescuer.

- Good Samaritan Laws, in those states that have them, greatly reduce the threat of being sued (and further reduce the threat of losing such a suit). In my classes, everyone gets a copy of the Texas Good Samaritan Act and we discuss the first two paragraphs in depth. We also discuss: Duty to Act; Abandonment; DNR orders; Rescuer/Bystander safety, control, and assistance; Patient Confidentiality; and much more. I give a legal disclaimer, recommend seeing an attorney for "... advice you can rely on". I have had at least a dozen attorneys in my class (almost ten years) and EVERY one said I did a good job.

- It is difficult to prove negligence when the patient is dead to begin with. We discuss clinical v. biological death. I state that I never worry about being sued (for doing CPR) because I perform "by the book" - just as we all do together in class.

- Saving a life is a beautiful thing. That's why I rode the ambulance in my community for six years. (Took my own daughter to the hospital twice.) There were times, after turning my patient over to hospital personnel, I then have had to wash blood, vomit, broken glass, mud, even horse manure out of my hair, clothing, etc. (I have learned to really HATE fire ants!) I spent money, effort, and time away from my family to go to meetings, teach EMS classes, make runs all hours of the day and night (and go to work thereafter, etc.). I had 7 or 8 homes in my subdivision where I was their first level of medical care, working directly with their doctors. I also am partially disabled because of my EMS duty. I never received or asked for a single penny for this community service. Yes, I understand the value of saving a life.

- About the CDC risk assessment - I agree. I should have said, "... too little to be contagious in practical terms" - or something to that effect. Same with the AHA info.

- MOST importantly, we agree that Spectre is at low risk checking IDs or escorting folks from the bar (per his example)

Sorry you're distressed with my "preaching... biased views". ( I appreciate your gentleness.) Please relax. I use nationally-approved tapes, texts, tests, & brochures. We discuss in great depth the extremes in willingness to provide medical care (Never? Always? Where in between?). I fully explain the views of fine Paramedics who land everywhere along that continuum. Re-reading my post, I see it implies "bias". However, I was trying to preach the use of gloves and barrier devices - not the withholding of medical care.

We disagree not so much in facts as in choices:

1. My example of Monica Lewinsky is a better example for my point (concerning strangers) that your example of a date. If I were still dating, I would know enough about the lady to somewhat evaluate the risk of her general health and lifestyle. With complete strangers, in the heat of an emergency, such evaluation is MUCH more difficult. While nothing is certain, we can (and do) evaluate such risks all the time.

2. Apparently we evaluate the risks of communicable diseases differently. that's OK. If you have little or no fear of communicable diseases, I commend you for your bravery - for you know the risks. You're listed as a "medical professional" so I must believe you have seen patients die in agony from pneumonia. According to Carol Kahn (Parade Magazine, 12/20/98 pp 12-13), "Up to 3 million cases of infectious pneumonia occur annually, resulting in about 75,000 deaths." Note other communicable diseases are not included in those figures. I'm not preaching "withhold care". I'm preaching, "Use gloves & barrier devices."

3. You refer to 12 cases of HIV transmittal from patient to EMT. Again, I was discussing ALL communicable diseases. I stated my source for the 200 EMT annual deaths hoping someone could shoot it down! But as one instructor put it, "It doesn't matter how many (EMT deaths) there are. You don't need to be one of them." Food for thought...

4. We both skipped some of the obvious advice to Spectre. Such things as frequent hand-washing, don't touch your eyes, use a towel on the restroom door when you leave, etc.

5. "Reasonable is a key word." We agree 100%. I have never refused to treat a patient I thought I could help, including CPR. However, I personally consider it unreasonable NOT to use a barrier device when doing CPR on a stranger. I am being sincere when I again commend you for your bravery, but the "beautiful" lives I want to save first are my wife, my children, their children, and my mother.

If I had a part in convincing you NOT to do CPR on anyone, I did you, myself, and your potential patient a great harm. At the time, I thought my meaning was clear that I was advising you to use a barrier device. Upon re-reading my post I see Olazul's point - it seems I was trying to "scare you off". My mistake and I apologize.

As we speak, I have a small pouch on my belt with a barrier device and four gloves. The pouch is 3"x4"x1" - smaller than my handcuff case. If you have Gall's "Holiday '98" catalog, see examples on pp 151 & 160. Please contact some of your local EMS field personnel to see what they use and advocate. Ask those who serve IN THE FIELD, TODAY - their advice should be current and practical.
Stay safe. I'm sure we're with you whatever personal decision you make.
Dennis is offline  
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