Despite our best efforts, endless training, and reading, some of our patients will die. This has been a taboo subject that is difficult to broach in the best of times. We aim to start a conversation here with the hope that
it continues with your Medical Director, PA, Surgeon and fellow Medics before you are ever faced with this difficult situation out on your own. Often prolonged field care involves treating the most critically sick or injured patients longer than you expect to. Inevitably some of these “sickest-of-the-sick” will not make it to see definitive care and you will be left to ease the suffering during end of life care alone. While you may have to deliver end of life care by yourself, you may not have to make all the decisions alone.
In this episode Dennis and Doc Powell discuss how to treat expectant patients. This could be as part of a multi-patient MASCAL or a happen to a single patient who is critically ill or injured. If it happens during a MASCAL, once you are done treating your urgent patients, what do you do when you go back to your expectant patients? It’s common to skip over discussing and training on losing patients… Taboo even. The fact is that it will eventually happen to some of us; No matter how good of a medic we are, patients will die. Doc Powell has spent innumerable hours in Intensive Care Units with the best and brightest medical teams a patient could hope for. Even in this setting the top notch care, medicines and interventions are not enough and patients code and die. This is part of medicine whether we talk about it openly or not and while many of these situations will be complicated and stressful we hope to give you a few tools to help manage the situation in a more professional manner.
How do you decide if your critically ill patients are expectant, when alone in a tactical or resource strained environment?
After that decision is made, what can we still do?
How is telemedicine different for curative vs. palliative cases, if at all?
For further reading on the subject:
National Concensus Project Clinical Practice Guidelines for Quality Palliative Care:
Great Podcast! Palliative care = CARE. You’re not “giving up.” We address this in the new Pain and Sedation CPG so check that out for some concrete medical recommendations.
Doug, thanks for the nod during the recording. Just for clarification, the patient referred to was a local national girl (not a team guy) that was obviously not eligible for evac through our coalition medical system in Afghanistan (closed head injury – GCS < 8). I "called the code" on that patient and reassured the medic. Afterwards, he thanked me. Our medics are do-ers and they will continue to attempt to "fix" things – even more so when it's one of our own. Physicians can and should make these decisions when able. I think it's one of the best ways we can support our guys in the field.