An emergency in public: When should doctors help?

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Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security leading to closures of numerous roads. There were also many health care professionals who were volunteering with the Red Cross to provide emergency services at different Papal events.

In the midst of all the festivities, there were also health care professionals, like myself, who did not have any clinical responsibilities and instead were attending the events given the historic nature of the Pope’s visit to the United States.

At one of these events, I was accompanied by two other friends who were also nurses who worked at the same hospital as me. We were waiting for the Pope to come by city hall in a motorcade, along with thousands of other visitors who were waiting for hours to see him. While we were chatting, suddenly we heard some gasps and screams a few feet away from us. It turned out that an elderly woman suddenly fainted while waiting for the Pope; it was unclear at that time whether she may have been dehydrated or if something else was going on. Thankfully, she was caught by two other visitors to prevent her from falling to the ground, and she was carried away from the crowd to an open area. EMTs designated for the event arrived on the scene immediately and began to assess the patient.

While all this was going on, me and my two other friends looked at each other, and we were trying to figure out if we needed to go help the EMTs since we were health care professionals. To be honest, we struggled with figuring out whether to lend a hand. We knew that we had medical experience that many in the crowd did not have, but we also did not want to potentially impede the efforts of the EMTs, who were assessing and taking care of the patient. In the end, we decided to stay where we were but watched closely, being ready to step in if more help was requested. In the end, the EMTs stabilized the situation, but this setting exposed the anxiety that off-duty health care professionals feel whenever a health care situation arises in public.

One of the things I think about is what I would do if I heard the question, “Is there a doctor around?” I would identify myself as a doctor in that situation, but then I would wonder if I could provide the skills needed to take care of the patient depending on the presenting complaint. Health care professionals are trained differently depending on the field that they are in, and each field brings its own types of patients and subsequently creates comfort zones for us in terms of what we can treat. Sometimes, the emergency situation falls within our area of expertise, but other times it may not.

Regardless of the situation, the hope is that we can bring some form of medical care that could help stabilize the situation while we wait for advanced medical services to arrive. At times, a concern may come up with regards to possible liability, particularly if there is an adverse outcome, and that may make some of us hesitant to offer medical help.

However, it is the hope that good faith efforts on the part of providers to give assistance in medical emergencies would protect us from any potential legal ramifications. Also, if a person is the only one available with medical expertise, there is more of an expectation for that person to aid in a medical emergency in these situations due to ethical obligations.

However, we contrast these situations to others were there were situations of too many health care providers in one setting in a way that was impeding medical care. Typically, this is seen in the inpatient setting, usually when a code is called, which is indicative of a medical emergency. It is normal for numerous health care providers to rush into the room to lend a helping hand, particularly because the situation encountered is usually a life and death situation.

At times, however, the extra set of hands can impede adequate medical care since many voices in the room are trying to give input in terms of what should be done next to care for the patient. At these moments, a code leader is identified to help run emergency efforts, and sometimes, people are sent out of the room to help facilitate care. Having seen many of these situations unfold in the hospital setting, it is no surprise that there may be some hesitation initially to provide aid in a public place when other designated health care providers are in the area.

So in a public setting where a medical emergency arises, based on this recent situation and other experiences that I and other health care providers have encountered in our practice, I think the decision on whether or not to aid depends on the particular circumstances. If designated health care personnel are available and actively giving aid, other providers likely can defer giving aid unless their services are specifically requested so as not to hinder the delivery of medical aid at that time.

However, there are situations where there is a significant delay of medical care from waiting for other health care providers to arrive, or a health care provider is the only one available in a public setting with medical experience. In those situations, there is more of a responsibility for the health care provider to provide help for the time being. I am sure there are various opinions on what to do in this situation, but I believe we can all agree on one thing: Once we become a health care provider, we have special skills that can help  our communities, and we should be ready to put them to use if necessary.

Chiduzie Madubata is a cardiology fellow.

Image credit: Shutterstock.com

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