When the lights go out

[Veneficus]

Yesterday several of my collegues and I were engaged in a discussion about technological advances in medicine.

One of the topics that came up was the reliance of technology in medicine.

Now I think it is fair to say that none of us are anti-technology, but at what point does our reliance on technology fail us?

One of the things European medical students, which I am honored to say I am one of, take pride in is the depth of education as well as the basic skills that are expected of everyone who will eventally be called "doctor."

Technology makes things better, at least easier and often more accurate. But it costs a lot. Part of medical care whether we agree or like it or not is cost. Technology makes medicine expensive.

There is also the issue of effectiveness. It seems to me that in my US experience as soon as that technology is taken away, it basically paralyzes the system.

This has direct implications for the disaster scenario as well as determining if people can be diagnosed and treated at a reasonable cost.

Now our debate was centered around what physicians should know and be able to do as a minimum as well as what the minimum acceptable technology level is.

But I thought I would put it to the gallery here in the EMS perspective. What should EMS providers know and be skilled at that is technology independant?

What is the minimum of the current technological devices that should be used in EMS?

What happens if this minimum cannot be met?

 

[Bullets]

Pretty much the entire EMT-B scope is independent of technology. so once the lights go out everyone should be able to provide a quality BLS assessment, do CPR, provide O2, and transport pts to appropriate facilities or staging points depending on the apocalyptic scenario of your choosing.

Most squads i know have backup generators for their buildings, so they will have supplementary power for some time. Our squad is going solar, so we can run generators off the batteries instead of the old diesel hog from 1954 we keep out back

 

[Wyoming Medic]

I think advanced cardiac care would be the biggest sufferer. Obviously. we rely upon cardiac monitoring equipment to make sure we are treating a problem correctly. Without the ability to cardiac monitor, it will be very hard to give appropriate medications.

The next biggest problem I see (which would not necessarily bother EMS) is in imaging. Now patients will have to be evaluated for spinal cord injuries just as they were in the "old days". Abdominal pains would be evaluated by exploratory surgery.

Sadly, while we as an industry may possess the ability to perform without our fancy gadgets, Emergency medicine in general cannot. Emergency room docs are so afraid of lawsuit and facility administrators are grabbing ever larger pieces of the treatment pie (even if they have ZERO clinical experience), that patients will die because of the fear of reverting back to older techniques.

A standard of care has been established and that standard involves technology. And as we all know. a majority of folks who see medics or the ED docs do not actually need emergency intervention. So out of fear of "numbers", I thinks patients would not get treated.

Do I think pre-hospital EMS can survive without technology? Sure, but we would have to revert back to the way were were. Do I think EMS as an entire system can handle failure? No way.

WM

 

[firetender]

The New/Old Frontier

Human Connection.
Working with whatever is available.

That's what we work with now
That's what we'll work with when the lights go out.

 

[MrBrown]

It seems to Brown that American ambos love thier technology and flash bells and whistles ... the problem with that is people become lazy and dependant on technology.

Back in the day we only had three lead monitors (Lifepak 10 and such) which could not do a 12 lead and so would only see anterior infarct, probably. However, the rest of your non-technology driven assessment would lead you down the path of thinking that the particular patient in question was having an infarct: sweaty, grey, chest pain, short of breah +/- pulmonary edema etc

Another good example is SPO2. The SPO2 might be 99% RA however, if you are prudent and not a lay loser cookbook ambo your physical findings will tell that the patient might be hypoxic; cyanosis, air hunger, increased work of breathing, +/- decreased level of consciousness.

 

[Veneficus]

the question is not so much if life would go on without technology, but what is the minimum technology that providers can still function with.

 

[MrBrown]

the question is not so much if life would go on without technology, but what is the minimum technology that providers can still function with.

Absoulute minimum Brown could function with? A glucometer and a Lifepak 10.

 

[CAOX3]

the question is not so much if life would go on without technology, but what is the minimum technology that providers can still function with.

A stethoscope.

I could wing a diabetic, usually by surroundings and such and I diagnose all my MI's without a monitor.

 

[Wyoming Medic]

Absoulute minimum Brown could function with? A glucometer and a Lifepak 10.

I'll 2nd that!!!

But it also triggered a memory or two.

I remember my first ambulance job. The trusty LP 10 in all its glory. 3 whole batteries to choose from, that cool creepy green screen.

Then we got the little plate that sat under the paddles so we could use the patches. HOLY NEW TECHNOLOGY BATMAN!!!! No more having to practice and get the 14lbs of pressure needed for successful electrical conduction (or whatever the pressure was).

But we didn't have the defib patches for peds, so we had the clip on pedi defib adaptors that went on the adult paddles.

Oh yes, no finer piece of technology

WM

 

[Sasha]

Planning out how you're still going to be a doctor after 2012, Vene?

 

[Veneficus]

Planning out how you're still going to be a doctor after 2012, Vene?

No,

Just marveling at the ability or lack there of, of some providers.

You know: "How am I going to survive without my lifepac 10,000x that takes all measurements for me, tells me if I got the tube, identifies the rythmn, calls the hospital, administers the appropriate medications, prints out the report, and submits the billing information. How did we ever get along without it?, It is now the standard of care which cannot be effectively rendered without it."

 

[cruiseforever]

No,

Just marveling at the ability or lack there of, of some providers.

You know: "How am I going to survive without my lifepac 10,000x that takes all measurements for me, tells me if I got the tube, identifies the rythmn, calls the hospital, administers the appropriate medications, prints out the report, and submits the billing information. How did we ever get along without it?, It is now the standard of care which cannot be effectively rendered without it."

Watching the faces of people being told no more cell phones or computers would be priceless.

It would be equal to telling a new medic that he cannot use the monitor to take the B/P.