What exactly do we do?

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Firstly, this post has little to do with the current tribulations in my life. Secondly, I have written about this before, using different words, but maybe if I keep saying it, people will start to catch on…

The fact is regardless of my job title or place of employment, I am an emergency provider. I bring the emergency mind and skill set with me wherever I go. Once employers actually see it, they really like it.

However, there are some emergency providers, both in the ED and outside of it, who do not understand exactly what it means to be an emergency provider in the year 2015. It is a bit more complex than many people imagine.

Historically, starting in about the 1960s in the US and yet earlier outside of it, there was this idea called “emergency medicine.” The idea was basically that temporizing treatments could be used in order to treat “medical emergencies” and save lives and limbs. The knowledge of things like pathophysiology, pathology, etc, were by today’s standards archaic.

The reality today is that it is a continuum of care, starting with the first people to render aid, such as bystander CPR, all the way through post emergency, surgical, and intensive medicine, areas to disciplines like occupational therapy that “saves” lives and preserves function. The idea that there are “emergency” treatments as a unique and specialized body of knowledge is just antique. Does anyone really believe cardiologists and cardiac surgeons are not taught how to handle cardiac emergencies? The same for a host of other conditions and specialties.

So what exactly does an “emergency provider” do? Well, as I have eluded to already, it is more of a mindset than a skill set. Necessary and valuable for sure. But valuable for what?

I would first like to give proper credit and call attention to an article that I have found puts it into words better than I can. But the error of the article is that it focuses on holiday times. In reality, it is everyday! Please read it here:

http://www.huffingtonpost.com/edwin-leap-md/the-er-holiday-sanctuary-_b_6217066.html

I think Dr. Leap describes it perfectly. The ED, and by extension out of the ivory tower and into the fire departments, EMS agencies, and police departments, who actually help people at the point of impact in their own neighborhoods at 0’dark 30, are the modern embodiment of help and sanctuary once provided by the Catholic church in Western countries.

Casting aside religious dogma, the fact is most nursing and palliative care was once provided by church authorities. You can hate that all you want, but it changes nothing.

As described above by Dr. Leap, the Church doesn’t really take an active role in that anymore. It does to a lesser degree in some places, but for the most part, if you show up at a church after hours, at best you will find a locked door, and worst you will set off an alarm and get arrested by the authorities without benefit of first seeking asylum.

That brings me to a US Coast Guard recruiting commercial.

Taken together with the other blog spot, this is what a modern emergency provider is.

The port in the Storm is the ED. It stands out among its surroundings, a bright beacon of light in the darkness. Walk around any city with an emergency department in it after 11PM. It’s light shines all through the night. In every Western Country, whether it says “Emergency Department”, “Accident and Emergency”, ” Oddział Ratunkowy“, or any other translation, in big red and white letters. Even in the most uncivilized of places, you can find a Red Cross, Red Crescent, the Star of David, and other “protected” symbols of medicine, emergency, and sanctuary.

Emergency service is the line in the sand. Whether an accident victim, a fire victim, an abused/trafficked person, crime victim, or even unwanted newborn, it is a place of safety.

Again as described above by somebody else, even people who have just lost their way in life, homeless, hungry, addicted, lonely, scared, or even criminal, it is a place of sanctuary, where help, not judgment, is sought and found.

We are the rescuers in the dark. Whether it is a concerned and medically uneducated mother at her wits end because she doesn’t know what to do for her crying child with a fever, a person burned over 90% of their body, the neglected elderly person who has outlived their friends and family, when they call or show up at our door, we help them. Some just need directions.

We are the time honored exceptions of society, our primary concern is humanity. We strive for benevolence in our endeavors. We are not people who respond to cries for help with “that is not my job.” I know many providers now see themselves as public officials. These same providers don’t understand that mantra makes them “government agents” not helpers of humanity. When enough of them are hurt or killed, they’ll come around again. Good people are working on it.

Our “job” is to help those in need. Sometimes it is with medicine. Most of the time it is not. It is always an “emergency”. People who do not know what else to do or where to turn seek our aid, for our mindset, our problem solving ability, our knowledge of the system, to know and be able to do things they cannot.

Anyone who thinks otherwise is a worthless relic of a bygone era. In that era we believed we could cheat death and live forever. In that era we thought what was done by emergency providers was separate from everything and everyone else. There was less to know and less to need, people did not lose their way very often because life was simpler. Today anthropologists no longer consider Homo Sapiens as modern humans. We are now Homo Sapien Sapien, we are reliant on technology. Human knowledge is so vast people have become hyper-specialized in what knowledge they possess and require the rest of society to act as part of the team, playing the positions they cannot.

This is our world. While the world may have changed, our role has not. We are the port in the storm. We are the line in the sand. We are the rescuers in the dark. There is no problem too big for us. There is no problem to small for us.

According to the Oxford dictionary.

Succor:
A noun and a verb.
Assistance and support in times of hardship and distress.

The next time you or somebody else dismisses what they feel are “not real emergencies” beneath them, remember this word. It is exactly what we do.

In the original Battle Hymn of the Republic (Not the bastardized, happy, religious versions sung by church choirs) there is a stanza:

He is coming like the glory of the morning on the wave,

He is Wisdom to the mighty, He is Succour to the brave,

So the world shall be His footstool, and the soul of Time His slave,

Our God is marching on.

All narcissism aside, when people seek out our help. It is in frustration and desperation. Nobody stops by the ED, ICU, or Surgery for a chat. Nobody calls 112, 911, etc. Because they are having a good day and want to see how we are doing. Nobody summons the police, fire, or EMS when everything is fine and they have life under control.

In some places people cannot afford to pay upfront for the GP. Even if they don’t have to pay, in modern times, this provider almost never helps people with their problems. They are not open at night. They are an antique specialization of medicine no longer relevant in today’s world. More like concierge medicine than actual help. That makes emergency the providers of both first and last resort, everywhere in the world. Day and Night. Weekends and Holidays. That means us.

I have said it before and I will say it again…If I have time to help people with minor problems, to get them a glass of water, to tell them how not to get dehydrated, to teach first aid to non-medical people, to offer simply knowledge and support, so do you. If you do not, you are the problem, not the people who call for your help. If you are constrained by your system, you are responsible to change it. If you think the world and society is going to change to meet the definition of the work you would always like to do, I have bad news for you. It won’t. I have some other news for you too…Not all aspects of work are enjoyable. It doesn’t mean you can slack off on the parts you don’t like.

So while providing a glorified taxi ride, handing out pillows and turkey sandwiches, relieving pain for conditions that cannot be cured, and palliating those whose lives cannot be saved doesn’t seem exciting or glamorous, it is a part of that whole port in the storm, line in the sand, rescuer in the dark, thing. It is a part of providing Succor and sanctuary.

I am not asking you to like it. But if you cannot do it, and do it well, you have failed to be a competent emergency provider. Get with the program or take a walk; but stop embarrassing us and dishonoring the position the public has bestowed upon us who do live up to our part. We don’t need or want you. You are not an emergency provider. You are just a little kid pretending to act like a hero.

Anything about this you don’t understand?

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