The Lazarus Delusion

I’d like to ask my fellow EMS professionals a question:

What is it with working the useless trauma codes, folks?

And by “useless trauma codes,” I’m talking about 99% of the ones we transport.

I’ll admit to a certain fascination with resuscitation, particularly early in my career. I think every medic has, to a certain extent. Resuscitations are hard work, but they also represent the opportunity for us to utilize all our skills, and what medic wouldn’t be jazzed by that?

Raise your hands if you’ve ever thought or voiced the following sentiment:

“Damn, I’m bored. I could use a really good cardiac arrest call right now.”

Yeah, that’s what I thought. Just about every EMT has – hey, wait a minute. You there, in the back. You don’t have your hand raised. Yes you, the one with the moist eyes and perpetually wringing hands. You mean to tell me you’ve never wished death on your fellow man to relieve your boredom, even in the abstract?

Please pick yourself off the floor, Empathy Boy. I didn’t mean wishing death on specific people. I’m talking hypothetically, that if Billy Bob was destined to arrest anyway, that you fervently hope it happens in your district, on your shift.

Oh, so you have voiced that sentiment? Yeah, thought so. You may sit down now, Empathy Boy. Perhaps you aren’t too namby pamby to be in EMS after all.

So since we’re pretty much unanimous in that sentiment, let’s talk about what we expect to accomplish.

Do we really expect to save a life? Nationwide, the survival rate from out-of-hospital cardiac arrest hovers around 5%. If you happen to live in one of those large urban centers with progressive EMS systems, perhaps your chances are substantially higher, but still, most places have survival rates not much higher than they were in the days of Johnny and Roy, and that presupposes a medical arrest. Traumatic arrest survival rates are less than one percent, and that number includes a very high percentage of people who “survive” in a neurologically devastated state.

Were it me, I’d just as soon not be a turnip, thankyouverymuch.

Are we practicing on the dead, in the hopes that we keep our skills and minds sharp to help the next salvageable patient? Perhaps some merit to that, I suppose.

But the simple truth is, the vast majority of traumatic cardiac arrests are dead when we get there. Dead, as in Assuming Room Temperature. Gone on the Celestial Transfer. Admitted to the Eternal Care Unit. Soon to be eating their salads from the roots up. D-E-A-D.

I won’t bore you with the science, but NAEMSP has a position paper on the subject that outlines some common sense guidelines pretty well.

I’ll boil it down for you:

Victims of blunt, multiple-systems trauma who are absent of vital signs on arrival of EMS are dead, no matter what rhythm you get on the monitor.

Victims of isolated blunt trauma to one body system who are absent of vital signs on arrival of EMS and present with asystole are dead.

Victims of penetrating trauma who are absent of vital signs on arrival of EMS and present with asystole are dead. You can add pretty much anybody with a rhythm of less than 40 beats a minute to that list.

Any traumatic arrest victim that requires fifteen minutes or more in transport time is dead.

Those people are no longer viable. They have been reduced to a tragic statistic. Every time you load ’em in the rig, turn on the woo woo box and go tear-assing through the streets in a futile effort to save that life, your chances of becoming a tragic statistic increase exponentially.

We are gathered here today to mourn the passing of John EMT and Jerry Medic, selfless caregivers who gave their lives in the service of their fellow man. John and Jerry died trying to save a wreck victim with a fractured skull, cardiac tamponade, bilateral pneumothoraces, and a stellate liver fracture, but who also happened to have an agonal rhythm on the monitor. Funeral services for the mother and two children they hit will be here in the chapel at 2:00 pm Tuesday.

Unless you want a similar eulogy, practice a little common sense, please.