Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
I recently discussed the importance of nursing and the
organization called the LaLeche League. One of my readers
informed me that a frum organization exists that provides the
same service called Neshot Chayil, an abbreviation for
Chizuk Yoldot Lehanaka. We have already discussed that
a support group exists for juvenile diabetes. If any of my
readers know of other religious support groups, please
contact me.
What happens in an emergency? Hopefully there will be a
bystander who knows CPR and we have discussed the importance
of taking this course. If rescue techniques are started early
enough, chances for success are high.
Present guidelines for an adult are to call for help first.
For a child one should commence rescue breathing
immediately.
The reason for this difference is because adults usually need
CPR because of heart problems which requires the special
equipment available in ambulances, whereas in children the
problem usually is a breathing one, which can benefit from
basic CPR skills.
Occasionally, AEDs will be available. AED stands for
Automatic External Defibrillator, which is a device that
automatically reads the heart rhythm and gives a lifesaving
shock if it identifies an abnormal rhythm. These machines are
now carried by many police forces, and may be available in
public places such as airplanes.
An ambulance should be called. Often, Hatzoloh will arrive
first and take over rescue operations such as CPR and AED.
Hatzoloh does an important service. While they are not
doctors and should not be thought of as such, they are often
on the scene much faster than ambulances in all communities
they serve and they are trained to give the important first
aid steps. These people are all volunteers, and we should be
thankful for their efforts.
Ambulances in Israel come in three flavors. A regular
ambulance has an emergency medical technician. Basic first
aid can be done, but no medications may be given. Atan
is a paramedic ambulance. These can give a much higher
level of stabilizing therapy, but can give it only by
established protocols. NaTaN is an ambulance that
includes a doctor. The crew there can give therapy outside of
protocols by doctor's order. However, it should be pointed
out that these physicians are often moonlighting physicians-
in-training or physicians who were unable to find work
elsewhere, so I see little advantage to using Natan. On the
other hand, paramedics in Israel are well-trained and usually
of very high quality.
When the ambulance comes, the patient will first be hooked up
to a monitor, which are three wires attached to electrodes
which are stuck in three separate places on the chest by way
of stickers. They record the rhythm of the heart. Based on
the rhythm seen, proper therapy can be initiated through
electrical shocks or medications. Of course in a
resuscitation, medications usually must be given
intravenously, and therefore an intravenous line or an IV
must be started. IVs are a long needle with a plastic tube
surrounding it. The needle punctures the vein, and the
plastic sheath slides over it into the vein and remains
there. The needle is withdrawn and discarded. IVs are
difficult to start in infants, young children and the obese.
Holding still is very important. Sometimes an IV cannot be
started and we'll discuss this next week.
A message from Glaxo, sponsor of this column.
Hepatitis B is a tragic disease. It, unlike its more common
and less serious cousin hepatitis A, can be chronic and lead
to fatal liver damage. Zeffix is an antiviral that may help
in this disease by attacking the virus that causes it.
Hepatitis B can be prevented by Energix-a vaccine which is
now recommended for all children. Both are made by our
sponsor.
