# 4123
Barely seven months after the discovery of the novel H1N1 virus in Southern California, and in Mexico, the fall wave here in the US and in Canada appears to be on the downward slide.
We know far more about this virus today than we knew back in April, and while it could still throw us a curve ball, the consensus is that we’ve been very lucky this time.
The virus has been relatively mild, and thus far we’ve seen a high morbidity – low mortality pandemic.
Invariably there will be some who will declare the global reaction to this viral threat to have been over-the-top, horribly expensive, and not worth it in the end.
And to give critics their due, while some are utilizing 20-20 hindsight, others espoused that opinion very early on.
Of course, those who are not charged with protecting the public’s health, have little to lose by being wrong. They can take pot shots from the safety of the sidelines, and if they are proven wrong, no one will remember.
Public Health officials dare not adopt a cavalier attitude, even if they aren’t 100% convinced of the magnitude of a health threat.
As a paramedic, I responded to thousands of emergency calls over the years. Car wrecks, heart attacks, strokes, traumas of all sorts – and the ubiquitous `unknown problem’.
My partner and I would crank up the siren and speed our rig through city streets to get to the scene. Once there we’d carry in our first aid kit, drug box, EKG and telemetry equipment.
When people call the cavalry, they expect the cavalry.
And even if the patient didn’t look severely ill or injured, we’d do a complete assessment. Vitals and history, physical exam, and if needed an EKG and an IV.
What some might consider `overkill’. A waste of time, effort, and money.
And most of the time, it is true. The `emergency’ turns out to be something less than advertised. Sometimes it will be a false alarm, other times it might be genuine illness or injury, but not really an emergency.
I’d guess that less than 10% of my emergency calls were run back to the hospital (with patient onboard) as an `emergency’. Our goal was to stabilize the patient and our skills and equipment, nullify the emergency at the scene.
The truth is, a good medic tries to avoid a 10-18 (lights & sirens) run with a patient in the back. It is stressful for the patient, makes it difficult for the technician to monitor the patient, and it presents a potential danger to the public.
Of course, sometimes, patients who appear stable can `crump’, or crash on you. So even if you are transporting in a non-emergency mode, you never take your eyes off of them. You never assume that their `minor’ problem won’t get worse.
To do so would be dereliction of duty. Most of the time, though, emergency calls ended up being `routine’.
The `rule’ I learned as a medic was that 90% of the patients I would see didn’t really need an ambulance. About 5% would have a bad outcome, no matter what I did to help.
And only in perhaps 5% of the cases would my interventions be truly needed, and would I make a real difference.
One could argue that 95% of the emergency calls that paramedics handle are `wasted’ responses. Or at least didn’t require a full out emergency response. The statistics certainly back that up.
It isn’t at all like TV, where every call is dramatic, exciting, and lifesaving.
My point?
That paramedics and fire rescue respond to most calls assuming they are genuine emergencies, even when they know most of the time they will prove to be non-emergency situations.
To do anything less would be totally irresponsible.
And so it is with public health agencies like the CDC and the WHO (World Health Organization). They can’t afford to assume that a emerging threat - like a novel influenza virus – won’t turn out to be a true emergency.
Nor can they assume that a `mild’ virus will always remain so.
They have to assume the worst, and respond accordingly. Otherwise the world can be caught unprepared, and many lives could be lost as a result.
To carry the paramedic analogy a bit further regarding our current pandemic, rescue units (WHO, CDC) have arrived on scene and and determined the patient is sick, but doesn’t appear to be in critical condition.
We are in `routine’ patient care mode now. IV’s are in (vaccines), EKGs attached (ongoing surveillance), and we are transporting to the hospital in non-emergency mode (treating the sick).
No need for lights and sirens. Things are manageable. At least for now.
But we are still a long way from the hospital. And while the `patient’ looks stable, now is not the time to turn our back on the patient.
We need to remain vigilant.
No matter how good the patient looks right now, that can change in a heartbeat.
Ask any medic.
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