Sean, myself, and most other emergency medicine physicians were attracted to our field because it offered a breadth of training that seemed widely applicable. I certainly wanted to be able to help any person in any situation instead of being constrained to reading CT scans or focusing on a specific organ system to do surgery. Sean even did a residency in family practice to before these three years of training. How much more broad can you be? (I suppose he can always do surgery next). It is probably this desire of mine that leaves me feeling helpless when I encounter a medical situation away from the hospital but find myself powerless without all those people and resources I normally work with--nurses, radiologists, technicians, subspecialists, CT scanners, ultrasounds, IV fluid, and medications.
The first time this angst struck home was in my last year as a medical student, after I finished my advanced cardiac life support class. That Saturday I ran a mock code on a patient with ventricular fibrillation and rushed to leave the class so I could go biking on Canada road. It was sunny and approaching noon when I started spinning my pedals on the 25 mile stretch. Of course, it seemed like half the world passed me at my max speed. One fifty year old man and his younger friend cruised by me on a slight incline. I was surprised to discover that older man on the ground just 2 minutes later. There was a circle around him and everyone seemed perplexed. Apparently, his younger friend was a chiropractor and had started chest compressions for a 30 seconds and stopped (today I'm still not sure why).
Since he was unresponsive and soon after I checked to discover that he also lacked pulses, I found myself in the same situation I had trained for just an hour earlier. The first step of calling for help was already complete so I moved on to getting someone to start chest compressions while I alternated with breaths.
It is worth taking a moment here to clarify that this is no longer the recommended procedure for BLS. A recent study lends evidence that breaths are not needed and 100 chest compressions for 2 minutes should be continued until EMS can respond.
That recommendation did not exist at the time so I did get a lot of saliva all over the place as I attempted rescue breathing. With the chest compressions he turned from blue to pink. Still, he had no pulses and there was nothing I could do. I knew he needed paddles to assess his rhythm and probably defibrillation, vasopressin, epinephrine, and more people to help with his care.
10 minutes later, and what seemed like an eternity, the paramedics did arrive to detect his ventricular fibrillation. The first shocks he received did not bring back his pulses and the rest of the care I missed I raced to Stanford to see what happened and he headed to another hospital never to be found by me.
As I said, the incident underscored the importance of our whole medical system, every person at the hospital, and all the resources we wield to make my training useful. Of course there is more we could do as a society as Sean touched on 2 posts ago.
For those physicians who strive to be as individually functional as possible there is still wilderness medicine. Another blogger here, Paul Auerbach, has written a textbook on medicine as it applies to remote environments. Maybe I'll start reading more of his blogs and until then I'll stay grateful for any hospital employee and even the pharmaceutical industry.