The Art of Debrief

Another code. A different country. Wow. How do you teach and train when the staff you’re working with doesn’t see the value in that life? In the states, we wouldn’t have needed to resuscitate that patient because he wouldn’t have been allowed to get that sick. Is it the resources? Is it the system?

There was no towel. They put his jeans under his head to align the airway. Couldn’t make a decision. Why? Because they don’t see a benefit to using the resources. The people, the supplies. What if some one more sick needs that resource and they don’t have it?

A new meaning to foreign.

I almost took a picture. Seven of our team members were moving the bed into the ICU from the ED. Down a ramp, CPR in progress. I ran back to grab a backpack that was dropped when we began compressions. A picture would have been better because it’s almost too hard to describe. Hospital bed outside, working a code on the go, in 100 degree heat. METI tee shirts everywhere. Where was everyone else? I pause for a second. Would that be wrong and insensitive, to take a picture? The family isn’t around. What a great photo, and this is why: Carl is doing compressions; James is holding a bag valve seal with two hands; Brittany is ventilating at the 30 count; Mike and Reneau are rolling the stretcher down the ramp, trying not to pick up speed; Jeremy grabs onto the stretcher to slow it down. Mike has his hat and backpack on. It was actually a calm scene. Trained in America. How can we help?

We placed the patient in the ICU area and got into position. I remembered back to January, when Julian, Jamie, and I witnessed the patient who went into cardiac arrest. This was eerily similar. How do we teach this staff what to do but get them to make the decisions without sacrificing patient care?

I didn’t take the picture. I’m glad that I didn’t. I think it would have been an amazing way of capturing our challenge today but if I had to think about whether it was okay to take the photo, it wasn’t.

The intensevist said only give two epi, they didn’t have enough. She didn’t want to intubate but we wanted to train her. She took a long time to prepare. We switched out compressors many times. We grabbed the ER tech. “Compressions are easy. Teach him to get a good seal.”

She backed out. We gave it to our medic student. In, out, confirmed within 30 seconds. We agreed to ventilate him for 60 seconds more. We knew it was respiratory in nature. He was asystolic.

Vahe said, “What would you like to do? Would you like to stop? Would you?” She shrugged. “OK,” she said. OK? This is so different. What can we take back? More importantly, what can we leave? The art of the debrief.

Posted in 2013 April, Clinical Experience, Culture, Haiti, Patient Stories

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