Friday, September 30, 2005

Democrats Unveil Medical Malpractice Proposal
Now Sens. Hillary Rodham Clinton, D-N.Y., and Barack Obama, D-Ill., have introduced the "Medical Error Disclosure and Compensation Act," which would provide funding to doctors, hospitals, and health systems that put in place mechanisms to promptly disclose medical mistakes or other mishaps to patients, offer compensation if the health provider is at fault, and ensure that those mistakes are reported to experts who can analyze them and recommend system changes to avoid similar problems in the future.
The problem with this approach is who decides what constitutes a medical mistake, how much of an injury occured, how much of the injury is due to the mistake and how much should be paid to the patient? These are basically the issues we already deal with and this article doesn't address them.

Sure, claims will be down if the patient doesn't have to file one, but is compensated without the claim. And, of course, if the doctor just admits a mistake and accepts liability, costs will go down without a trial. Gee, if all the criminals we arrest would just plead guilty, look at the potential savings for the criminal justice system!! According to this plan, they should just call the DA's office and turn themselves in.

Tuesday, September 20, 2005

Though it is a long step between being disarmed and being murdered--one does not usually lead to the other--but it is nevertheless an arresting reality that not one of the principal genocides of the twentieth century, and there have been dozens, has been inflicted on a population that was armed.

Monday, September 12, 2005

As the Special Response Team (SRT) circled through the woods to a favorable location to approach the house, Dr. Mitchell waited nervously by the command post. Although he routinely trained these type of entries with the team, as the doc he was relegated to hang with the team commander in the converted motor home used by the Sheriff's Office as a command post.

He was nervous because the team, his friends, were about to attempt entry at a residence where there was a man with at least one rifle and one handgun and two hostages. As was all too often the case, the hostages were his own wife and child, a two year old boy.

The gunman hadn't made any demands and was well known to the department as a heroin junkie. He had served several jail sentences for possession.

Dr. Mitchell mentally reviewed the afternoon leading to this point. He had been at home on a rare day off, working on his newest hobby, furniture building. He wasn't very good at it, but he loved working with his hands. His wife politely allowed him to place his furniture creations, resembling some type of modern impressionist art, around the house. He didn't even notice that the house never seemed to get full, almost like these pieces were disappearing.

While in the workroom, his Nextel buzzed. Sgt Robinson. "Doc, we've got a call-out. Some hype with a gun is threatening to kill his wife and kid. He's well-known to us, but hasn't ever done anything like this before."

Running upstairs, the doc quickly changed into his bullet-proof vest and fatigues. Pulling on his tactical holster with his Glock 22, he called out to his wife, letting her know he was leaving.

He threw his tactical medical bag into the trunk of his car and jumped into the driver's seat. He was proud of his bag, having spent seized drug money to buy and equip it. He just hoped he never had to use it, but that is what he prepared and trained for.

On the way to the scene, lights flashing, he mentally prepared. He ran through scenarios, using imagery to review what equipment he had and what he would have available from EMS. He had also convinced the team members to carry certain supplies on their tactical vests.

Snapping back to the present, he watched as the team advanced behind the tactical shield, approaching the front door. No one had heard from inside the house for almost an hour, prompting the scene commander to order the tactical entry.

As the team knocked the front door off its hinges, the night lit up with sound, smoke and light as they threw flash bangs. Suddenly, multiple shots rang out, shouts came over the tactical radios and Dr. Mitchell heard his name called.

The hostage taker had barricaded in the bedroom. The team leader was unsure if they had hit him with any of their shots, but a team member was down. The doper had fired off several random shots with a handgun and one had ricocheted from the ceiling, hitting the officer in the neck.

If the scene had been controlled, Dr. Mitchell would have entered with EMS. However, this was far from a controlled scene and the EMS and rescue squad members were unavailable for assistance. He had to make his own tactical entry.

As the team was clearing the remainder of the house, two team members came out with the shield and escorted Deputy Doc, as he was known, into the living room. What he found looked as horrible as anything he would see in the ER. John Hilliard was lieing on the floor with stridorous respirations and a neck that looked enormous, even for the weight-lifter he was.

Dr. Mitchell dropped to the ground. "OK, ABC's," he muttered. The airway was definitely in danger from the expanding neck hematoma that was obvious as soon as he pulled the ballistic collar off the vest. Only a bullet coming at a down angle could have gotten past the vest and collar like this.

"Well, let's see if they got their money's worth," he thought as he pulled open the airway kit in his bag. One quick look into the hypopharynx revealed the futility of trying to intubate this way. "What a mess!" he exclaimed as he looked at the destroyed upper airway. It was obvious that the bullet had crossed the neck and there was no way he was going to be able to perform a standard intubation through this hamburger.

After pouring Betadine across the anterior neck, he isolated his landmarks and incised the front of the trachea. After creating the opening, he slid the business end of an endotracheal tube into the opening. He cut the tube shorter with bandage scissors and reinserted the adapter. Hooking up the ambu bag, a team-mate was able to provide respiratory assistance.

"All clear," came the call from the team leader. During the period of quiet before the entry, the moron doper had shot up and was now passed out.

As the paramedics packaged Hilliard for the flight to the hospital, Dr. Mitchell got to intubate the shooter as well. As angry as he was, protecting this asshole's life was the job, just as was saving his friend. Sonofabitch.

Wednesday, September 07, 2005

I mean, really, why does a cartoon squirrel have more compassion than real people?

Monday, September 05, 2005

You never know when you will be called on to do something extraordinary. The other day James Parks, a local ER doc, was driving to the YMCA to exercise. Just another routine day, about 20 minutes on the rower and hitting the weights. The best part was the sauna after the workout.

However, this was not to be just another routine day. As he crested the hill near the airport, he saw something that snapped him out of his daydream. A large tanker truck was angled across his side of the divided four-lane highway and a small car had driven up under it.

Slowing, he pulled onto the shoulder, driving past the small number of cars that had already become trapped behind the wreck. As he moved to the side behind a highway patrol car with its blue lights flashing, a sheriff's deputy approached him and began to instruct him to stay in his car. As James began to explain who he was and offer to help, the deputy recognized him and said, "Thank God you're here! We've got a really bad one!"

Dr. Parks pulled a couple of gloves out of the box in his trunk and began to approach the car. One of the rescue squad handed him a scene coat and a helmet. "You'll need these, doc, there's a gas leak and we're going to have to do an extraction."

The tanker truck was loaded with thousands of gallons of highly flammable gasoline and the car had struck a valve, bending it and causing a leak. There were four people trapped in the car, but the truck driver was OK.

As he walked up, he saw that the driver's side of the car was severely damaged, with the roof compressed so much that only a small space was open through the rear passenger window area. He couldn't see the driver at all, and could see a paramedic extended through the opening in the window. The right side of the car was wedged under the truck.

Just then, the paramedic pulled out of the car and stood up, holding an infant. Turning, she saw Dr. Parks and said, "I had to cut him out of the car seat. I didn't want to, but I wouldn't have been able to get the car seat out the window. We are in a hurry, as the gas leak is concerning."

Looking around the rear of the car, Dr. Parks saw the firefighters trying to stop the leak and scattering an absorbent material (looked like kitty litter) to soak up what was on the ground. If a fire started, everyone in the car would be lost. Obviously, rapid extraction was important.

As the paramedic handed the small boy to a rescue worker, Dr. Parks looked through the opening. He saw a young girl in the rear passenger side seat, crying loudly. A part of the frame of the underside of the truck had broken through her window and had pinned her chest against the seat. He could barely see into the front seat, as the ceiling of the car was compressed down against the upper part of the seats and had bent the frame of the seats. Through the console area, he could see a large woman in the passenger seat, mostly in the foot well. At the top of the seat on the driver's side, he could see part of the upper torso of the driver, completely crushed, almost amputated, by the frame of the seat.

He felt a tap on his back and withdrew. The fire chief, the rescue squad leader and the paramedic were standing there. Another rescue worker stepped in and began working in the rear seat.

"Doc, we've got a real problem," began the fire chief. "It's pretty obvious that the driver is dead. We can't get to the woman in the front seat through the passenger side of the car. With the gas leak, we can't cut through the seat. Access over the seat on the driver's side is blocked by the driver. Even if we get the driver's door open with the jaws of life, we won't be able to move his body out. I think we can get the kid out by cutting the material of her seat. This should give us enough slack to slide her out.

"I'm afraid to cut anything metal. Any spark could set this whole thing off. Any ideas?"

"Can you get the driver's door open?" asked Dr. Parks.

"Yes," the reply came from the rescue team leader. "But the driver's still going to be in the way. With him pinned between the seat and the roof of the car, we still won't be able to get to the front seat passenger."

"We'll have to cut. As horrible as it sounds, we will have to cut through the driver's body to release it. It is almost cut through anyway," observed Dr. Parks. "Right now, we can't be concerned about the dead; if we don't get that woman out, she will die."

The rescue crew came in with a large inflatable bag and placed it on the hood of the car, between the hood and the lower frame of the tanker. Dr. Parks heard the sound of an air compressor and the bag expanded and began to take some of the weight of the truck off the roof of the car. Another rescue worker inserted the pneumatic teeth of the "jaws of life" into a small opening between the driver's door and the pillar post.

With an ear-wrenching groan, the door bent open. The driver's left arm, completely amputated, fell onto the road surface. Wretching, the rescue worker stumbled to the grassy roadside, falling to his knees.

The paramedic reached in through the back window and between the seats and unfolded a sheet across the passenger. A firefighter approached with a large saw, the one they used to cut through timbers in a building. It looked sort of like an electric circular saw, but the blade was much bigger and it was gas powered.

Dr. Parks stepped back and turned away as the firefighter cut through the mid chest of the driver's body. Blood spattered the sheet placed over the passenger as the body came loose.

Immediately, the paramedics, Dr. Parks and the rescue crew jumped in to check the passenger. She was alive, with a weak and thready pulse. The paramedic placed a cervical collar and carefully moved the woman as she positioned a device that allowed for immoblization of the upper back, as there was no way they could extract this woman on a full spine board. She would be immobilized on a full board after removal from the car.

All three living victims from the car were flown to a local trauma center and did well, despite significant injuries. This family was extremely lucky to have a well-trained and equipped local emergency services organization. Unfortunately, they lost their father and husband, but without the interventions and rescue techniques provided, they would have all perished.

I don't think we pay our emergency services personnel nearly enough. These folks are true heroes. Thank you.