October 20, 2011

The First to Respond

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Imagine that you are a doctor, standing at the bed of a comatose patient. Her boyfriend is asking you a flurry of panicked questions about her prognosis, and you are trying to console him. Suddenly, her boyfriend falls down and has a seizure on the floor in front of you. What do you do? What rushes through your head?

I found myself in this predicament in my second week of medical school at Weill Cornell Medical College. We were at the Margaret and Ian Smith Clinical Skills Center for our First Responder course where this situation was re-enacted numerous times in front of first-year medical students. The comatose patient was, in fact, a patient simulator machine. The “boyfriend” in this case was what we call a “standardized patient” (standardized patients are actors who are trained to simulate a set of medical symptoms and have become widely used in medical education).

The First Responder course was integrated into the WCMC first-year curriculum in order to teach us how to respond to medical emergencies following the tragedy of Sept. 11, when many of the medical students felt that they lacked the skills or knowledge to help. We know little about illness and disease, despite the white coats we’re given at the start of our medical school education. And yet, people who see us on the streets in our white coats see us as doctors.

We spent that morning of the second week of medical school sitting through hours of lectures. We listened to a wide variety of cases and learned how to respond appropriately. But witnessing these emergencies firsthand was a completely different experience. How you respond in that split-second is very revealing. Everyone wants to think they will be the person who remains calm, who takes control and who knows just what to do.

Outside the walls of the Clinical Skills Center, helping a stranger in need is rarely simple. There are many variables to consider: Who is the stranger? Do they have any other major medical problems? Do they have an infectious disease? Is it safe for me to help? In the Clinical Skills Center, many trained professionals were available if something went wrong. On the streets, there might only be you or me, a lowly first-year medical student. People expect you to take the lead, to know what to do and maybe even to save the day. Within the heat of the moment, it’s difficult to remember Powerpoint slides or even mnemonic devices that tell you what to examine first. Emotions run wild, from fear and anxiety to excitement and anticipation. You try to rush your thought processes and yet your brain cannot work fast enough. You desperately want to help without causing further harm.

Knowledge about these situations can breed skills and confidence. Whether you are out for a run, at the local supermarket or at a family reunion, here are a few things that anyone can do to help in an emergency situation:

1. Assess the situation and ask if the injured person is okay. Make sure the scene is safe beforehand.

2. Call for help. Placing an emergency call can save a person’s life, especially if you are unsure of what else to do. Dialing 9-1-1 will bring trained professionals to the scene.

3. In the case of bleeding, apply direct pressure to the wound or laceration for at least ten minutes. If possible, elevate the body part while maintaining constant pressure — this will help stop the bleeding.

4. If someone is having chest pain, allow him or her to sit down and relax. It is crucial that this person is transported to the emergency department by EMS. Ambulances have access to an automated external defibrillator if the situation worsens.

5. If someone is having a seizure, help him or her to the ground. Remove any dangerous objects nearby. You can place a pillow under the head to protect against head trauma. If possible, also turn them on their side in case of vomiting.

6. Lastly, do no harm. Do not do things you are not comfortable doing, but do your best to maintain your composure and manage the situation.

If you are interested in First Responder Training, which covers these topics and others in more depth, you can visit www.Firstrespondertraining.gov to learn more about certification.

Just a few days after my First Responder course, I was walking with a friend to meet up with some of our medical school classmates. A few steps ahead of us, a woman tripped and fell in the middle of the street. I ran up to her and asked if she was okay. Another man nearby had helped her stand up. She merely had a scrape on her knee, thanked me and told me she would be fine. Fortunately, there was a Duane Reade pharmacy at the corner (as there is on every block in Manhattan) where she was able to purchase some Band-Aids and first-aid ointment.

I had been thinking a great deal about what it means to be a first responder over the previous few days. Despite my new certification, I wondered how I would respond “when it counts.” I had surprised myself by being so quick to assist the woman. Furthermore, no medical knowledge was required, but merely a willingness to help. Sure, it was only a knee scrape, but it was a start in the right direction.

Silia DeFilippis is a first-year medical student at Weill Cornell Medical College. She may be reached at emd2008@med.cornell.edu. What’s Up, Doc? appears alternate Fridays this semester.

Original Author: Silia DeFilippis