My answer! (A long and drawn out one...)

I asked a number of my peers about the "Moral Dilemma." I even asked a few non-medical people how they would respond to the question...

No one, said "no," "never," "absolutely not."

A few put conditions on there answer.

The majority said probably or absolutely!

Absolutely = 50%
Probably = 41%
Conditionally = 9%

By the way, I got a 94% response rate, N=30.

So probably not a significant population sample... but it begs further research!

The conditional responses were regarding friends/family involved...

The probably responses all revolved around quality of life afterward issues...

The absolutely responses, were just that! Absolutely!

Many years ago, when I was first posed with this question, I was definately in the minority! I responded with conditions! As I matured in my profession, my viewpoint changed and I became a probably.

I have been involved in Pre-hospital/Emergency medicine for 23 years! (EMT, IEMT, Paramedic, Flight Paramedic, Emergency Nurse, Flight Nurse) My last 2 years, have been in outpatient surgical nursing.

I can't tell you when, that is, exactly the time or year when, my answer changed to probably... But it was after I was a Paramedic! I was trained in Tucson, AZ. At Tucson Medical Center, under the direction of Drs. Kent Carey, MD, and Richard Carmona, MD. That might raise a few eyebrows! Hopefully, at least one person might recognize at least one, if not both names named!

It was shortly there after, that I changed my answer again to absolutely!

One morning I was coming on shift as a Paramedic/Firefighter. I was going through the normal routine of the morning truck check, oxygen, supply and equipment check. I had just finished checking my drug box for outdates/expired drugs, and I had charged up my LP-5 monitor/defibrillator (yes, I know I am dating myself somewhat...) to check my defib settings. After I got a satisfactory discharge... I paused...

You see, I was still a fairly new Paramedic. It suddenly dawned on me that I was given the responsibility and accountability for other people's lives! I couldn't even legally drink alcohol, yet I was pushing narcotics and had electrical interventions available to me! Talk about a reality check!

Complete strangers were calling 911, I was responding, and they completely and utterly trusted me with their lives! And I couldn't even buy them a beer! Talk about a paradox!

I was trained and educated as a Paramedic in Tucson in the mid 80's. Paramedicine, that is pre-hospital medicine was still going through a lot of changes. Our program went "full-bore!" We learned everything that was allowed at the time! One of my Medical Directors mentioned something about we (as Paramedics) are the front line, first line... life and death decisions are made by us! No time to call for medical direction, you need to know what to do, how to do it, when to do it... and this is what stuck with me the most... and most importantly, when not to do it!

My viewpoint, philosophy, and answer changed!

One day, I was dispatched to a Chest Pain. Our response to a remote location South East of Tucson took over 30 minutes. Upon arrival at the scene, my EMT (and Paramedic student) partner and I found a mid-30 year old gentleman, experienceing chest pain. The symptoms were classic for an MI... substernal, crushing chest pain, diaphoresis, nausea... we hooked up our LP-5, he was talking to us appropriately... my partner started to take vitals...

I was turned away from him asking his wife about his history, medications and allergies... when my partner started yelling, "Relax! Put your arm down!"

I turned to face them, saw this gentleman with arms extended out, palms down, purple...

I glanced at the monitor and saw a lethal rhythm, V-Tach! At the time (again, I am dating myself...) I delivered a pre-cordial thump!

My partner looked at me and asked why I just "punched" the patient!

I replied, "Look at the monitor! V-Tach!"

To make a very long story short....

We initiated BLS and ACLS on this individual. Within 10 minutes, we were in the ambulance, on our way back into Tucson to the nearest hospital... which was 30 minutes away! I emptied my drug box into this person. I gave drugs not in the ACLS Algorhithm (in the 1980's...) just becuase! Perhaps he was a diabetic? D50! Perhaps it was an Addison's Crisis? Hydrocortisone! (Methylprednisolone [Solumedrol] was still a few year away...) Lidocaine! Bretylium (now I'm really dating myself!)! He remained in refractory V-fib/V-tach!

Today, it would probably more precisely described as Torsades de Pointes! We have at least two new drugs for that!

However, I poured myself out for this gentleman! I did everything and anything I could to attempt to save his life. Here I was a fairly new paramedic... the most opportune time to have a paramedic present was when you went into cardiac arrest! Arrest to ACLS time = ZERO (0) MINUTES! I gave drugs outside of the ACLS Guidelines... luckily, at the time, they were just that... guidelines....

I did everything and anything I could to save this life!

I wasn't worried about liabilities, I wasn't worried about certifications or licensures... I was worried that I wouldn't do what needed to be done, when it needed to be done! I was worried that my inaction, would lead to a persons demise... his death...

It was at that moment I became an "absolutely!"

It has been many years. In that time, I have been faced with many situation that have caused me to ask myself the same question!

I am proud to say that I have done what needed to be done, at the exact time that it needed to happen! Some say I am lucky that there was no dis-advantageous outcomes...

My answer is simply this...

That patient is alive today, because of what I/we (in the case of my peers/partners) did!

I have no regrets!

...

Absolutely, no regrets!

So my answer to my own question:

My purpose is to save lives. If I need to do something to save a life, I am the only one available to do it, and if I do it, I will lose my license... I don't care!

I saved a life! I sacrificed my own well being, my own security...

Someone lived! That is more than ample payment!