In the ER then, the big enchilada was a Code Blue. That was a time when an ER doctor could do big things: initiate a resuscitation, perform CPR, intubate the airway (a procedure usually reserved for anesthesiologists), ventilate the lungs, and put in a central line (usually performed by pulmonologists in the ICU), or give fast-acting drugs (adrenaline, noradrenaline, a phenylephrine drip). A full resuscitatian was a big event. It made you feel competent, skilled, knowledgeable, decisive, and effective—a leader.
When I practiced emergency medicine in this Sierra Nevada mountain county ER in the seventies, west-slope ambulance drivers were morticians driving to the scene to pick up the bodies. We decided to train drivers to become EMT-IIs—advanced, invasive, emergency medical technicians, level 2—who inserted intravenous lines, injected cardiac stimulants, intubated the airway, and hand-ventilated the lungs with a bag. All this was performed under the direction of the ER doctor over the radio from the ER base station.
This practice worked so well that one day I realized that I hadn’t performed a resuscitation in the ER for several months.
I took great pause, and for months felt inadequate as an emergency doctor because I no longer led codes in the ER. I no longer performed specialist procedures, ran cardiac stimulant drug drips, or led people from multiple disciplines in a patient’s resuscitation. I seriously wondered what my value was as a doctor who specialized in treating emergencies.
It dawned on me. It was my knowledge, my clinical judgment, and my ability to “see the scene” over the radio, communicate well, direct the EMT-II’s field resuscitation, and make decisions over distance. They performed the skilled technical procedures, while I directed the resuscitation from afar.
That medical competency wasn’t about the procedures I performed, but about directing the field resuscitation through the hands of others, was a transformational insight. If early field interventions saved lives, it was because they occurred on site soon after the event. I was at the scene by radio.
Then I again sensed profound well-being as a doctor of emergencies.