# 4626
As a paramedic I frequently took precautions for my patients that quite often, I knew were probably unnecessary.
Victims of car accidents nearly always got a cervical collar, and most were strapped onto a backboard, despite their often vehement complaints. Why? Because of the slight possibility that they might have a spinal injury that could be worsened by movement during transport.
Patients with chest pain were ferried from where ever we found them by gurney to the ambulance . . . even if they insisted they were okay to walk. Why? Because the exertion of walking might bring on a fatal arrhythmia.
Most of the time, these (and a hundred other) precautionary actions were unnecessary. Most people in car wrecks don’t have neck or back fractures, and many heart attack victims wait hours before calling an ambulance and could probably easily make the walk out to the ambulance.
But you do these things to protect the 1 in 100 where these steps would make a real difference.
When you are responsible for the health and safety of a patient you are expected to do everything reasonably possible to protect them.
Call it the `mindset’ of a paramedic (or anyone else charged with the safety and protection of others)
Even if, in retrospect, some of those efforts might seem `overkill’.
Nearly every year, some area of the United States’ coastline is threatened by a hurricane and some form of evacuation is ordered by local emergency management officials.
Those who live in low-lying or flood prone areas often have 24 hours or less to get to safety, a process that for many is invariably difficult, expensive, and inconvenient.
And the vast majority of these folks will return after the storm has passed to find their home intact. Discovering that they could have safely stayed home and ridden out the storm.
But of course, sometimes we end up with scenes like these, proving the absolute wisdom of evacuating before the storm.
Remnants of Crystal Beach, TX After Ike in 2008
Hurricane Andrew (1992)
Because of early warnings and an emphasis on evacuation of damage prone areas, hurricanes in the United States have become mostly a killer of property . . . not people.
Katrina, which claimed more than 1800 lives in 2005, was an exception. And that was primarily because New Orleans sits below sea level and so many people failed (for a variety of reasons) to get out of the area in time.
Emergency planners must make the decision about whether to order an evacuation 36 to 48 hours in advance of a the storm. They know that the storm may lose intensity before making landfall or that it may veer away at the last minute.
They also know that the costs and burden of evacuation on the affected communities will be high. And sometimes evacuations can end up costing lives, as happened during the exodus for Hurricane Rita in 2005.
It’s a tough position to be in. Particularly when you can’t possibly know how things will turn out.
And it isn’t so different from the position that the World Health Organization found itself in a little more than a year ago, when they were faced with an emerging novel influenza virus that was quickly spreading around the globe.
Although not as deadly as some influenza pandemic strains of the past, the concern was (and remains) that the virus could pick up virulence, or antiviral resistance, and pose a bigger threat down the line.
And so the WHO, the CDC, and most of the public health agencies around the world went on the offensive. They geared up to deal – not so much with the pandemic at hand – but with the pandemic it might become.
Today newspaper editorials, bloggers, and pundits are attacking the WHO, and other public health organizations, for overreacting to the pandemic threat. They, of course, have the advantage of a year of hindsight.
Even those pundits who maintained from the beginning that this virus wasn’t worthy of global concern, did so from the safety of the sidelines.
It’s not as if they were going to be held responsible for an inadequate response should the pandemic turn ugly in the fall.
Those who insist that a pandemic has to be a scourge like 1918 forget that for most of the world, the 1968 pandemic was almost a non-event. And the 1957 pandemic – while a bit more severe – was hardly cataclysmic in nature.
History has shown that pandemics, like hurricanes, often don’t live up to the hype. But knowing that doesn’t give emergency planners the luxury of ignoring their potential for disaster.
Could the WHO have done a better job communicating the risks of novel H1N1 to the world?
You bet.
Although I have serious doubts that the press would have delivered the message to the public much differently, even if they had. This was a big story, and it was milked by some aspects of the media for all it was worth.
More than a year ago, I predicted that no matter how the pandemic turned out, this was a no-win situation for public health officials. I regret to see that I was correct.
Before We Ride Down And Shoot The Survivors
The No-Win Situation
Hubris And The Flu
This year, we may see sections of our coastline threatened by a hurricane, and evacuations ordered. With luck, the storms will turn out to be less than feared, and a lot of people will return to find their homes unscathed.
And no doubt, some of those people who evacuated will curse the emergency managers who `panicked’ and ordered them to leave their homes.
Paramedics will continue to backboard and place C-Collars on anyone who might have a spinal injury, despite the protests of the patient. And patients with chest pain will be placed on gurneys, even if they think they can walk to the ambulance.
Those whose job it is to protect the public are expected to take these measures when lives are at stake. It is their duty to assume the worst, and act with an abundance of caution.
And the same holds true for the WHO’s declaration of a pandemic, and gearing up to deal with it. Even if the threat doesn’t end up being as great as initially feared.
They have the duty to prepare for the worst.
They shouldn’t be excoriated when things turn out less dire than they planned for.
* * * * *
Note: On the subject of conflicts of interest by advisors to the WHO, I’m holding any judgment in abeyance until the facts are in.
I’m not surprised in the least that leading experts in vaccines and antivirals would have ties to the pharmaceutical industry, and simply having such ties doesn’t make them guilty of malfeasance.
Unfortunately, many see political or economic opportunity in lodging these accusations, even without proof of wrongdoing, and the press is only too happy to print them.
I will need to see a lot more than blanket accusations before I’ll buy into any of these stories.
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