Saturday, May 27, 2023

Listen To The Man

 h/t In The Middle Of The Right

Somebody needs medical help.

ER doctor in newspaper article says "Call 911".

B thinks his situation is the exception to the rule, because time/distance.

Sorry, B. But almost certainly, no.

Ditto for the rest of you. I don't care where you live (unless it's Alaska, 200 miles from town, and you and your float/ski Super Cub are 9-1-1).


Suture Self approach: You elected to self-identify as an Ambulance/Driver.

Points To Ponder:

So, if things go to total shit while you're driving someone to the ER, do you stop, pull over, and hope the ambulance - which you'll now have to call anyways - can try to find you somewhere between home and the hospital? What have you got in the car that you didn't have at home for that eventuality? Starting with space, and a well-lit area?

Or do you step on it, trusting to your cat-like reflexes and total lack of red lights and sirens to get them to the ER yourself, and hope that 14 minutes without a heartbeat or oxygen, or sufficient blood flow, can be overcome by medical arts and luck? And that you won't crash on the way, and injure or kill more people in a vehicle neither designed nor intended to transport critical patients at high speeds, with a totally untrained and emotionally compromised driver at the wheel?

What if there's a Big Accident halfway there that you can't get around or through, lacking flashing red lights and a siren?

What if the person you're bringing crumps in the parking lot of the ER, at night, and now you have to go get the ER staff to play Hide-and-Seek, in the dark, with your unconscious (or dead) relative?

What if you went to the wrong ER, because they're not the place equipped to handle the problem? What if they're closed to certain patients, because their CT scanner is down, or they have no cath lab team for a heart attack, or they're so overcrowded there's literally nowhere to treat the patient but the parking lot?

The ambulance would have known that before they got to your house; you don't.

The reason you call an ambulance is that the ambulance brings the ER to you. Paramedics were literally invented 50 years ago to prevent the exact scenario you're describing.


I had some poor (well-meaning) jackass once decide to bring his elderly wife, with a history of cardiac problems, to the ER for chest pain, from only five minutes from the hospital. In town. With the FD's paramedics two minutes away from his house.

She went into full arrest two minutes out, and arrived DOA, and a lovely shade of gray.

And received no treatment for another couple of minutes on top of that for the time it took us to get a gurney and a team, pull her dead ass out of the car and onto the gurney as a sack of jello with sticks, start CPR in the driveway outside the waiting room, and get her inside to a treatment area.

We managed to restore a pulse after several minutes. I don't know her long-term outcome, or if she had any resultant brain damage.

I do know if he'd called 911, she would have received vastly better care, from beginning to arrival. And he wouldn't have been kicking himself for risking killing his wife because of panic.

All of the care she needed would have happened before she got to us in the back of an ambulance, i.e. instantaneously.

Every minute you go without CPR decreases your survival chances by about 7%.

And that's best-case.

(i.e., except for cold-water immersion drownings, after 15 minutes with no heartbeat, we're probably just saving the body for organ donation, and making the family feel better. Hard truth. Do CPR as long as you want. Reality is still a bitch.)

And you can't do CPR and drive a car.


Serious bleeding?

Traumatic Full Arrest, because the victim bled out, which you can't monitor, nor do anything about while driving a car, can be managed and headed off en route by paramedics just by starting an IV and administering fluids (which you can't do either of from behind the wheel), as well as by applying the tourniquet you probably don't have, and positioning the patient better in a vehicle designed for a stretcher with a critical patient on it.

OTOH, the survival rate for TFA runs into single digits.

And that's if you're smart enough to go to a trauma hospital (which - NewsFlash! - isn't every ER).


Anaphylactic shock, with closure of the airway?

What, you have no meds for treating that on hand? You can't intubate en route? Bummer.


And on and on.

There are rare exceptions to the rule, and there's always sheer dumb luck, but as a general rule, the impulse to scoop-and-go on your own with no medical capability en route is a foolish one, with statistics to match, and you're throwing dice with Death with someone near and dear to you as the chip pile, every time you do it.

Anybody that survived riding with you could have waited for paramedics at home, where you don't have your hands full of steering wheel, and can do things that can actually help if they get worse.

You fly planes, B.

In your terms, you're the guy telling the CFI/CATP with 20,000 hours you know better, and hoping you get back to the field before you run out of altitude, airspeed, and ideas.

Some few times, it might work.

Mostly, not.

The quote about bold pilots comes to mind.

If arrival time of medical aid is an issue, you're far better off getting medical training yourself and having a basic kit, than you are trying to be Mario Andretti.

Even if you live in BFEgypt.

The only transport that should ever be contemplated is to move them to a more advantageous location for either a handoff (say, at the dirt road where a maze of unmarked country roads meets paved highway), or getting them out of a forest or canyon to someplace where emergency vehicles or a helicopter can make a rendezvous/find an LZ.

Even then, all the drawbacks I noted still apply.

You should probably have at minimum two people to transport, so somebody is monitoring the patient at all times, with enough kit to intervene, within your training and abilities. If you haven't got that, the odds of making things worse rather than better just multiply.

And the time to play what-if, just like with flying, isn't after all the yellow and red lights on your panel start coming on.

You grok flight plans to the max, amirite?

So make a Medical Action Plan.

Talk with somebody local with serious medical training, and work out now what to do ahead of time for your exact area/situation, instead of trying it on-the-fly after your adrenaline has pegged at 11. 

At 3 AM. 

When it's raining.

Fail to plan: plan to fail.


Hightecrebel said...

Eh, best case scenario around here is 15 minutes, average is closer to thirty, with cases where it was almost an hour for the ambulance to show up. I'd much prefer an ambulance personally, but I fully understand those who don't want to wait.

C said...

Well fucking done Aesop. This needs to be on every channel, every social media page, and billboard. Tattooed on the hand of every dumbass that rolls up to the ER doors with an patient who can't respond or move on their own.

Dan said...

For some conditions calling the medics is better than driving the person in yourself. For many others it wastes time. For an ischemic stroke as an example...which the vast majority of strokes are. Waiting 10-15 minutes for the medics to arrive then another ten or more minutes for them to transport to an ER costs brain cells. And the medics will do ABSOLUTELY NOTHING to treat the clot that is causing brain cells to die. Even the ER won't treat the clot till AFTER they CT scan is done to insure the stroke isn't hemorrhagic. So that time you wasted waiting for the Ambulance to show up is DEAD BRAIN CELLS. There are other example but that's just one. It's a toss up. If you KNOW the ambulance can get there REALLY fast then calling them may be a good idea. But if all the local medics are busy dealing with hypochondriacs you may have to wait a half hour or more for a more distant ambulance to arrive. There is NO 'one size fits all' advice for medical emergencies.

Aesop said...


I understand them too, but they're generally still wrong, for all the reasons outlined.

And if you're an hour from just getting an ambulance, you are 911.
The only people happy about that have to be local undertakers.
(That any county thinks that's anything close to acceptable is the bigger issue. You might as well tell people to bite on a leather strap after a slug of whiskey before surgery too, at that point. It's a Turd World level of medical care.)

If anyone's going to be the ambulance, they should do it right: get an actual one, train some paramedics in the community, form a volunteer EMS, and solve not just your problem, but everyone else's.

Aesop said...


That 10-15 minutes you think you "saved" gets wasted anyways.
1) Is the ER you're driving to even a Stroke Receiving Center?
2) Is their CT working now? Is it open, and staffed 24/7, or do they need to get the on-call people moving first? D'ya suppose a bona fide heads-up before you pull in on two wheels might be a better way to skin that cat?
3) How long until they can get Neuro spun up to assess that CT?
4) Do they have any ICU beds available?
5) No one at the ER is expecting a hot stroke, so you have to register, get triaged, etc. before anyone even knows it might be a stroke.
6) Driving them in your car will also do ABSOLUTELY NOTHING to treat the clot that is causing brain cells to die, plus miss out on all the lead time just mentioned.
7) Then you've got to get a wheelchair or gurney, round up a crew, and manhandle the victim out of the car and into the ED. As opposed to having gotten a dead-on balls accurate assessment en route by radio or telephone, initial vitals and presentation, an IV or two established, and the patient already being on a mobile gurney, and headed to the right hospital for the problem, with everyone alerted and waiting for them to arrive.
They may even meet up with a LifeFlight for a straight handoff to Big City Neuro Unit, which you won't get rolling along in your Chevy Malibu.
And if you drove to an inappropriate/saturated/non-Stroke capable ER, they'll sit there and wait for the exact same ambulance you skipped, to transfer them to the right ER. Some distance away.

Wait for the ambulance, or shoot yourself in the foot.
Suture Self is always second choice.

You want right-now First World medicine, where you live is a factor.
You want to live 100 miles from anything? Okay. Enjoy the view and all.
But suck it up for trauma, heart attacks, strokes, etc. You get what you pay for.

You're still better with trained professionals doing not just the driving, but any ten other things you can't do yourself from the driver's seat, sweating bullets. Even if you have to wait for them to get there.
Starting with such paltry things as maintaining an airway.

But if anyone's granny or gramps, or spouse, can hold their breath for a half hour, load 'em up and git 'er done.

no use for a name said...

Impaled myself on a glass door as a lil' shaver and a nurse auntie put pressure on it with a hot towel wrap while Pappy floored it to the hospital about ten miles away.
Removing the stitches actually hurt worse.
I need to get down to FLA and thank her again.

Anonymous said...

Great advice Aesop, points I'd not considered. Thank you

Tucanae Services said...


Sir, this is the complexity of the stroke protocol that Aesop alludes to --

No way I could carry out the first 15min of that protocol let alone the balance of it. We keep a well stocked med kit, but it is no way capable of this level of care.

Tucanae Services said...

SO and I are >60 so we know we might need a lift. If EMS asks "are they allergic to...", I don't know is a bad answer. We have typed up cards on each of us. Name, age, typical vitals, current drug usage, allergies, last medical procedure, primary physician and number, medical coverage. On the back, results from last physical. The cards sit in a holder next to the front door with the red med symbol. I update it as needed.

We lost a family member at our house once. The pandemonium that ensues NOBODY is thinking clearly. Hence the med cards.

bubba said...

Was at a farm house with my dad, age 69. Visiting with a cousin, two and half miles from hospital. Started driving home for lunch, Dad says, "I don't feel well." Turn to look at Dad and he's just keeled over against the dash, while belted in front seat of pick up. I throw him back into the seat and floor the truck. It's noon, main street in small town, 1,500 people, main street is fairly busy. Turn on my flashers and floor truck up main street. Cars in front of me see me coming at high rate of speed and pull over. There's a highway intersection between us and the hospital, our light is red. I tel the Lord that it would be nice if the light would turn green before I go through the intersection, but I'm going through no matter what. Light turns green as we reach the intersection and shoot across the highway taking a little air in the process. Pull up to the main entrance of the hospital and pull dad out of the truck and start doing CPR on the ground. Hospital is under construction remodel and not sure where the emergency entrance is anyways. I'm fairly andrenalized and as I'm blowing air into his lungs and then compressing his chest I wonder how many bones I'm breaking. Just then the ambulance crew walks out to get lunch and asks me if I need help? Yes!!! They whisk Dad away and start his heart. He needed a three way bypass and a pig valve but he got another 12 years. Saw him die three more times in the next twelve years, last one was the last one.

Stealth Spaniel said...

Folks-wise advice here. I don't care how many times you are TOLDANDTOLDANDTOLD about proper ER training and all that it takes. When Patient Zero is your mama/daddy/grandparent/close family member or friend; fully half of your brain cells go into panic mode and refuse to communicate. Driving like Andretti will simply get you/your loved one/another damned fool on the road-dead. Call the good people who do this for a living: they know stuff, have stuff, and their brain cells are communicating. It doesn't mean you are inactive. Calling 911 will get you someone to talk with, get basic advice and questions from, and help you keep it together until the ACTUAL PROFESSIONALS arrive on scene. They have probably done life saving goodness 12 times that day and they know the difference between a heart attack, a drug overdose, and a stroke. Do you? I say get all of the basic medical training that you can fit into your hat, but chances are you will never be a brain surgeon, a cardiac MD, or lift a person onto a gurney that weighs 300 pounds. S is hitting the fan faster than any of us thought possible, so take advantage of being in a first world country-while we still are.

Anonymous said...

I live in an old folks park (over 55). I'm 80. We experience about a dozen or so deaths here every year and perhaps a 100 or more ambulance calls. If I experienced chest pains or some other serious symptom I'm driving or my wife will drive me to the ER. I will get there within 5 minutes while the ambulance sometimes takes twice as long or doesn't show up. If I'm unconscious or worse then my wife would call 911 and watch me die before they get here. Ironically the hospital is a block and a half away.

Anonymous said...

I'm in a gated tree farm that houses 260 homes.
The ambulance is only 15 minutes away but they took an hour to find me because they don't understand the house number system that THEY demanded so adopt.
It's happened to other people as well.
The fix was to transport patients to the gate to be picked up but the ambulance services are saying NOT to do that. Probably a billing issue.
Also one winter the ambulance was stuck on the main road a mile away because the road commission didn't plow the road

Aesop said...

@Anon 10:53,
All the time you "save" by not waiting ten minutes, you lose by not having anyone know you're coming, what you're bringing, what they need, or what they need to do and who they need to call.
Bonus points for heaping guilt on your next of kin when your plans come to crap.
Thanks for illustrating hard-headed stupid more vividly than I could have.

@Anon 12:47,
So what have you done to address the ambulance co.'s incompetence issues?
And how would you get out to the main road if it's not plowed?
You're going by snowmobile, or mushing sled huskies, or what?

You guys are doing a great job of Yeahbuts, but you're ignoring the central issues: you're not qualified for driving nor treating, you're emotionally compromised the entire time, and you can't drive and treat at the same time, so all you're doing is ensuring the people most dear to you receive no care at allfor an additional time period, while you put them, yourself, and everyone else on the road at risk. Well-played.

You might as well save time, and just ankle-chain your loved ones to the bumper, and drive on. Or just slap 'em on the kitchen table, and start "operating" at home. It makes almost as much sense.

I tell people I'm a lifeguard in the shallow end of the gene pool, and this issue is but one of dozens that illustrate succinctly why that's so, 24/7/365/forever.
Word to your mother: throwing people in the car and hauling ass like a mad fool to the ER went out of fashion in the 1960s. That's before most of you were born. Catch up.

John Wilder said...

Always have a plan. Or, better yet, plans.

Sven said...

A man once told me "Know your limits". Add on to that "Imagination is a poor substitute for reality".

Just because you think you can, doesn't mean you should.

There are times (more than many people want to admit) that you should leave it to the professionals, for the sake of your loved ones.

Tucanae Services said...


You mention 1960. 1962 was when a functional EMS was erected in our town. Initially it was contracted out, private party. Only later did it become integrated in the fire dept.

RCPete said...

Our county relies on a couple of fire department ambulance services and several small ones, some tax supported, others from donations. Our local ambulance went toes up 10 years ago for reasons, but most of those reasons have retired or fled the area, so I'm hopeful it will restart.

The ambulance takes 30-45 minutes to arrive here in BFE. Depends on which one and whether they have staff at the station. The better response was at 03:30, while the driver got a bit lost for the other. (Rookie, and the local FD had a first responder call to help guide.) Neither of my rides were dire, but Code 3 to the hospital is about 40 minutes in good weather. Add 15 for winter if the roads are iffy.

People who live further from services will sometimes arrange to meet the ambulance at a predetermined location en route. If God smiles, the first responders handle the first leg of the transport. Seems to happen most often with cardiac events with people who are 20-40 minutes further from the ambulance. Trauma cases usually need/get airlift, but those are 60 or 120 miles away. If weather is a problem, forget it. Lost pilots also happen. Sigh.

Yeah, use the ambulance if at all possible!


Mike in GA said...

Great advice from Aesop as my recent personal experience illustrates.

Background: Age 71, good physical condition. About 6 years ago developed a sensitivity to insect stings; e.g., two ant stings on the inner wrist caused the underside of my entire forearm to swell with fluid. No other reaction.

Two weeks ago, while watering newly laid sod, got stung by an unknown insect on L knee cap. Went into the house to apply sting ointment, and while applying the ointment my heart rate jacked up to ~150 to 180, started sweating, and a got a bit lightheaded; breathing was OK--obviously an allergic reaction, and the first time I had one this severe from an insect sting (or anything else).

Called my wife to transport me to the closest ER (11 miles away via country roads then a highway--15 minutes with normal traffic). Got 2.3 miles from the house at an intersection with a secondary road and I had passed out (still breathing). My wife called 911 with our location, which is 7 miles from the dispatched fire/rescue unit. When I regained consciousness, car was parked at the intersection, passenger door open, and wife standing next to me talking with 911. The ambulance arrived a few minutes later, got me stabilized and transported me to the hospital.

We did not call 911 from the house because the reaction DID NOT SEEM THAT SEVERE in beginning.

As Aesop pointed out, arriving at the hospital without notice would have delayed my treatment. The ambulance crew got me stabilized (important!) and communicated with the ER (important!). So, when I did arrive at the ER, they were ready for me. More meds from the ER Doc and I was released 2 hours later.

Subsequent examination of the sting area 2 days later revealed 3 sting marks in close proximity, which I suspect were administered by a yellow jacket (common in our area)--so I got a triple dose of venom.

Lesson: If one is having an unusual reaction to anything (whatever that might be) or known symptoms to heart attack or other serious condition, don't try to tough it out and be the ambulance driver. Call the pros!

SteveP said...

I can illustrate Aesop's point with an incident that happened to me.
This is going to be a long post so please bear with me.
Yesterday, May 28, 2023 three friends and I were shooting at our club range, which is the local police training facility, and is several miles outside of town. We were on one of the ranges on the back side of the facility.
Two guys were shooting AK47s. I was standing 3 feet behind, and 2 feet to the left of one of the shooters. On his 4th shot the bullet ricocheted and broke into at least 3 pieces. 2 pieces hit the shooter in the thumb and chest. He was bruised but the skin was not broken.
The largest piece hit me in the upper left pectoral area just below the clavicle. It penetrated almost all the way through but did not exit, nicking the artery. When I felt the strike I looked down to see a stream of blood about the size of a pencil blast from my chest. I stuck my finger in the hole and yelled, "I'm shot! Get an ambulance here now."
One guy grabbed me and a towel, sat me on his tailgate, and kept me upright while helping me keep pressure on the wound. The other two started trying to call 911 but cell service is spotty on that part of the facility so one jumped in his truck and hauled ass for the front gate to make the call and guide the ambulance to my location. The third one cleared all the weapons.
It took the ambulance about 20 minutes after the call went through to reach me. I never lost consciousness or went into shock and I was later told that when I was loaded into the ambulance I had turned gray.
On the ride to the hospital the ambulance was forced to come to a complete stop 3 times due to traffic not moving out of the way.
According to the doctors and nurses this is a textbook example of everyone doing everything exactly right and it is the only reason I'm alive. If they had put me in a truck and driven me to the hospital I wouln't have made it.
All four of us are trained in first aid and emergency trauma care.
The bullet didn't sever any nerves so I still have full use of my arm and hand. The artery was repaired with a stent so I'll have to take Plavix the rest of my life and I will have limited mobility of the arm so the stent doesn't move, ie, I won't be swimming laps in the pool anymore and I have to be careful about raising my arm above my shoulder.

Anonymous said...

I am an experienced ICU/trauma RN and l would still call the EMTs