Today’s question comes from a First Aid educator who has
… a team of 20 community first aid educators I support.
The big Q, I am in a desert, an emergency doctor, and decide that I should do an emergency tracheotomy or this person will die. Will I get in trouble? I have done it a million times before!
I confess I’m not sure why it’s a ‘big Q’. If the person doing the tracheostomy is a registered medical practitioner, with expertise in emergency medicine and who had done the procedure ‘a million times’ what trouble could they get into? If they perform the procedure in a sub-standard way (taking into account all the circumstances) they may be negligent. Assuming however they have just come upon the emergency rather than arriving as a deployed medical team, then they can rely on the relevant ‘good Samaritan’ provisions (see Good Samaritan legislation – a comparison (February 22, 2017)).
If the procedure is actually contra-indicated, so that the doctor’s conduct represents the delivery of health care that is ‘not reasonably required for the person’s well-being’ (Health Practitioner Regulation National Law Act 2009 (Qld), Schedule 1, definition of ‘unprofessional conduct’), or represents ‘conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience; (definition of ‘unsatisfactory professional conduct’ and ‘professional misconduct’) then the doctor may be subject to issues of professional discipline. But that sort of conduct is not anticipated by the question.
A doctor who has experience and knowledge that can be used to save a patient’s life in an emergency, and where that action is not contrary to the patient’s known wishes, should proceed to act in the best interests of the patient.
Thank you and let me help you out with an answer.. A BIG Q is.. the BIG QUESTION. To add to this, I have met many army medics who’s scope of practice seems a lot wider than most, if they were faced in this circumstance would they still be protected? I am going extreme here… but just throwing a little spark in the question.
Sorry, I did understand it was a ‘big Question’ I just wasn’t sure why it was a big question. Everyone should use the skills they have to save a person’s life, subject to the limitations implicit in the doctrine of necessity, that is not where the treatment is contrary to the known wishes of the patient, but that is unlikely to be relevant in the circumstances suggested by the question. So Army Medics who come across an accident should do what they can to save a person’s life – see ADF medics (or ex medics) at the scene of an emergency (November 26, 2016).
Anthony Dowsley, HeraldSun
May 21, 2009 12:00am
A NEUROSURGEON who talked a country GP through drilling a hole in a dying boy’s head is astounded at the doctor’s courage and skill.
Nicholas Rossi, 12, faced certain death after fracturing his skull in a bike fall until Maryborough GP Rob Carson used a household drill to relieve pressure on his brain.
Leading Melbourne neurosurgeon David Wallace – who talked Dr Carson through the operation over the phone – said the GP was cool and did not panic throughout the emergency.
“He had a calm resignation that it was he or no one,” he said.
“I don’t think he had even seen a burr hole being done and to have the courage to do it and conviction to make such a correct decision is pretty courageous stuff.”
What he thought were seizures described over the phone were actually opisthotonus – where the brain stem is compressed and death is imminent.
He instructed Dr Carson to drill a hole on the same side of Nicolas’s head that his pupil was dilated.
Immediately after a 1cm hole was drilled through Nicolas’s 5mm thick skull, about 20ml of blood oozed out and as his pupil returned to normal, the doctors realised he was saved and could make the journey to the Royal Children’s Hospital.
“If he had gone into the helicopter without the pressure being relieved it is likely he would have died en route or beforehand,” Mr Wallace said.
“Neurosurgeons all around the world are used to this, even some surgeons with their skills would find it difficult. But for a GP to do it is nothing short of astounding.”
Nicholas’s father Michael Rossi yesterday asked that all GPs be trained to perform the emergency surgery.
“He would have been dead without the surgery,” Mr Rossi said.
Nicholas’s condition was the same that killed Natasha Richardson, wife of Hollywood actor Liam Neeson, after a ski fall this year.
Mr Rossi called on Premier John Brumby to provide extra training for regional doctors, including emergency brain surgery.
“It’s something perhaps a younger doctor would not have attempted,” he said.
“It’s a relatively simple procedure, but you’ve got to have the guts to do it.”
Nicholas was not wearing a helmet when he fell off his bike on Friday. His mother Karen, a nurse, felt a bump on his head and took him to the local hospital.
The drill came from the hospital maintenance department, but had been sterilised, Mr Rossi said.
Anaesthetist David Tynan, who was called in to help with the operation, said it was obvious that for Nicholas to survive the doctors needed to release the blood from between the skull and brain.
“The only drill we have in theatre would not be powerful enough for it and so we sent down to the maintenance department for a drill,” he said.
The entire operation took just over a minute.
“It’s pretty scary. You obviously worry, you’re pushing hard enough or pushing too hard but then when some blood came out after we’d gone through the skull, we realised we’d made the right decision,” Dr Tynan said.
Nicholas was released on Tuesday, his 13th birthday.