Shanghai’s anti-epidemic has entered a critical period, and we are concerned about all the happenings in Shanghai that are either touching, heart-wrenching, or sad.
Beginning yesterday, the post “An elderly man with asthma in Shanghai died without timely treatment” has spread widely. An asthma patient in Shanghai died because 120 people refused to be rescued. Today, the Shanghai Health and Health Commission released the investigation on this matter, and believed that the emergency doctor involved was improperly handled and had been suspended.
Photo source: Weibo@China News Weekly
Did the emergency doctor on the scene really handle it improperly? Under the circumstances at that time, because of other emergency incidents, but another critical case was encountered, did the emergency doctor have a more appropriate approach?
Today is hotly debated, please come to the former emergency doctor and current emergency science popularizer Zhang Yuanchun to talk about his views.
Ambulances may or may not have “AEDs” available
What exactly happened, you may have seen the introduction of the patient’s family member on Weibo, you can add the description from the perspective of the emergency doctor in the report of the National Health Commission:
“After learning that the patient was in an emergency, the medical staff who conducted the on-site nucleic acid test rushed to the patient’s home for dozens of minutes of emergency rescue, and then died due to ineffective rescue. The ambulance was The emergency patient of another household in the same community is in the process of first aid, and the emergency patient has boarded the car, and the ambulance is ready to go to the hospital.
At this point, the ambulance was stopped by the helper, who asked the ambulance paramedics to lend the vehicle-mounted defibrillator. Since the patient was in his own home, the emergency doctor in the ambulance could not judge on the spot, and he did not agree to lend it out of consideration for sending the emergency patient to the hospital first. “
The first thing to say is that “loaning a vehicle defibrillator” probably won’t help.
After a series of popular science education, we all know that automatic defibrillator (AED) is the key equipment to deal with sudden cardiac death. If the deceased does suffer sudden cardiac death, the appearance of AED is very important .
However, Shanghai’s ambulances do not have AEDs.
Maybe many friends will not understand why ambulances are not equipped with life-saving AEDs? !
Because there are paramedics in the ambulance, they use a manual defibrillator, not an automatic defibrillator like the AED.
AEDs are easy to use, so configured in public for temporary accidents, trained members of the public can use them, and only for sudden cardiac death. The medical emergency situation faced by ambulances is complex, and it is inconvenient to use a simple AED, but to use a more expensive and more functional manual defibrillator.
In China, except for a few areas such as Shenzhen, which are equipped with additional AEDs, the standard configuration in other areas is only manual defibrillators.
Image source: Courtesy of the author
Manual defibrillators are more powerful than AEDs, and their use is much more complicated, requiring specialized training, not to mention that ordinary people can’t use them, and many non-emergency doctors can’t use them.
Therefore, there is no situation where AEDs are lent separately and used by medical personnel for on-site nucleic acid testing to save lives. It can only be “lent” by emergency doctors and manual defibrillators.
Let’s look at the medical staffing on the ambulance.
Ambulances in Shanghai are generally equipped with 3 people: a driver, a doctor, and a stretcher (which can also undertake some first aid work, but the stretcher is not a medical staff). Beijing ambulances are generally equipped with 3 to 5 people, a driver, a doctor, a nurse, and 1 to 2 stretchers.
So if you lend out a manual defibrillator, it means that all the medical staff in the ambulance are on loan, and you cannot take care of the patients in the original ambulance, so you can only take care of the other side. If the original rescue object has an accident, the emergency doctor will also have corresponding legal responsibilities.
You can only choose one of the two. Emergency physicians are bound to be in a dilemma.
Does that mean there must be no solution? How can the current choice be considered “improperly handled” by the National Health Commission?
A similar situation I experienced
I may not be able to give a standard answer, but let me tell you a similar situation I experienced many years ago.
Around 2007, I was working at the emergency center in Chaoyang District, Beijing, on a weekend. My ambulance was sent to the home of an asthma sufferer on a first aid mission.
At an intersection before reaching the patient’s home, he was suddenly stopped by a man with blood on his face, standing in the middle of the road: “We were hit by a big truck, I My wife is delirious now, go and save her!”
I followed the direction of his finger and I saw a traffic accident scene. A large truck and a small car were involved in a traffic accident. A person was thrown out of the car and lay on the ground. There was another person standing next to him, who should be the driver of a large truck, talking on the phone at a loss.
“Did you call 120? Did 120 send you a car? We’re on other emergency missions and can’t pick up your patient,” my driver said. “Go and save my wife! Go!” The blood-covered man repeated this sentence over and over again, never leaving the front of our ambulance.
I immediately called the dispatch command center and explained the situation. The dispatcher said: “A call for help from this accident has been received, and an ambulance has been dispatched.” Let’s continue with our original task. It has always been a basic requirement to complete the first aid task according to the command of the dispatcher. We have been doing this all the time, but not this time, because this man with blood on his face will never let us go!
Fortunately, before the dispatcher’s phone was hung up, I said to the dispatcher, “He won’t let us go, we really can’t carry out the original first aid task, otherwise we will let the dispatcher go. The ambulance of this traffic accident first aid mission to perform our first aid mission?”
The dispatcher agreed!
We took this traffic accident victim to the hospital. Later, it was learned that the injured person was a herniated brain. Fortunately, the operation was carried out in time, and his life was no longer in danger. I called the dispatcher again and asked about the asthma patient. The dispatcher replied: “The patient has also been safely sent to the hospital.”
At this time, my hanging heart will be on the ground. Because I am also afraid that this asthma patient will have an accident. After all, he formed a medical relationship with me first! Really terrified.
Dilemma, but full room for workaround
Fortunately, in my later life in first aid, I never encountered a similar situation again.
Tell me about my experience, I hope it will be helpful for everyone to understand Shanghai! It’s really a dilemma, but there are really workarounds.
We certainly hope that the on-site doctors and dispatchers have professional capabilities. Under the requirements of regulations, we can accurately judge who should be rescued first and how to save them first. However, the details of the scene are still unclear, whether it has been judged before. With this option it’s not clear either. It is easy for bystanders to analyze, but the experience of the parties may be another matter.
I hope the incident can promote the improvement of related processes, and I hope that the medical resources in the epidemic area can be allocated more reasonably. This may be comforting to both parties.
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Planning: Eric | Producer: Feidi
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