Before I start this post proper, may I say a real big thank you to Tom Reynolds, from http://randomreality.blogware.com/, for his commenting on my blog - my hits have gone through the roof since. Just shows how influential the great man is...
My work at the roadside, as anyone who has read the last entry or so would know, requires me to do quite a bit of quick thinking and rapid decision-making. Do I intubate, how much fluid does this patient need, and so on. Whenever I am put in such a situation, there is often a lot of soul-searching afterwards. Did I do the right thing? Today, however, I was in totally different situation where I needed to think quickly, and where, if my choice was wrong, lives would be affected. I will put it to you, my readers, to decide.
Today I was attending a Coroner's Inquest. The specifics are not all that important - maybe I will talk about those at another time. Suffice it to say, when I arrived on scene I was presented with a very unwell man, with severe injuries. He was deeply unconscious, and I treated him rapidly, and got him to the hospital alive. Unfortunately, he died a few hours later.
I was asked to look at the time it took for me to be called by the Ambulance Service and the time it took me to get to the scene. The Coroner then asked me the $1000,000 question: "If you had arrived on scene earlier; if the Ambulance Service or Police had activated you sooner, would he have survived?" I felt I was on safe ground at that stage, and said that, as I was unaware of the post mortem results, I could not answer that question. I was handed the PM report.
As I scanned the report, looking closely at the injuries to various systems; the brain, the heart, the lungs, the spine; I came to an awful conclusion. These were survivable injuries. He had not suffered a massive brain injury. His lungs and heart showed little more than bruising. Sure, he hadn't escaped with minor injuries. But they were survivable.
What to do? I was being asked a question that, in my heart, I knew the answer to. For those who may not know, the Inquest is an open Court, and the family were sitting there, right in front of me. I have sworn, on a Bible, to tell the truth, the whole truth, and nothing but the truth. But, do the family need to know that their son, their brother, could have been alive today, had the speed of response been better?
So, there I am, with seconds to spare, and a decision to make.
My answer: "Yes, if I had been able to get there much earlier, he might have survived." What was initially scheduled as a 15 minute appearence to give a precis of my actions at the scene turned in to a gruelling hour of questionning. How much earlier would I have needed to get there to save his life. 5 minutes? 10 minutes? Would he have survived if you had arrived when he was still conscious and talking? Why didn't the police call you? Should they have that knowledge to be able to determine that he needed more help than a paramedic crew? Could I have driven faster? And so on, and so on. Balance of probabilities, explanation of Revised Trauma Scores (more about them in another post, maybe) and Glasgow Coma Scores (definitely more about them!). I was relieved when the Coroner thanked me for the evidence I had given, and I was allowed to leave the witness stand.
The Court was adjourned after my evidence, but, before he left, the Coroner looked at the family and apologised for the way in which that evidence had been presented to them, how distressing it must have been for them, as he was himself surprised with the answers I had given.
And so I left the Courtroom, hurrying to my car, head down, trying not to catch anyone's eye. As I was getting into my car I felt a tap on my shoulder. I turned, with sinking heart, and found myself face to face with one of the family. He looked at me, with tears in his eyes. "Thank you," he said.