This February morning, I arrive in the emergency room at 8:30 am to take my guard, and at 8:40 am I am called in regulation. It sometimes happens; I am posted in the emergency room and I finish regulation. That morning, my reallocation was due to the medical team for the transfer of a 40-year-old man victim of a cardiac arrest. It has been recovered but its very unstable condition requires transport in Rennes. In addition, my regulatory colleague has made the decision to self-print on an imminent childbirth in Laval.
OK. I put my helmet and go! I take the calls. It is a difficult exercise, regulation. The most stressful part of my job and also the least known. When you do 15 to have help, the ARM, the medical regulation assistant, which wins. This person puts you on hold while talking to the doctor then she passes it – or not. If he believes that it is not too serious, the doc can send firefighters, paramedics or just give advice. It can also, if it is an accident or serious discomfort, make the decision to trigger a nursing from the firefighters (ISP), or the mobile medical emergency structure (SMUR). Recently, he also has the possibility of sending a paramedical team on site (without doctor) when the doctor is missing.
The baby will be saved. As for the old man, his cardiac arrest was fatal to him.
It may seem weird, to you, patients, because you are told to do the 15th and sometimes you see firefighters arrive. But if you do 18, the firefighters will systematically pass you to us, on the 15th. However, they can also send a team without delay our green light. This is called reflex departures. However, this remains a fairly simple operation for an initiate. No, what is difficult for us, doctors is to choose.
Choose to give advice or send help. If it is an ambulance, can we allow ourselves a delay? Do you need a doctor or an ISP in addition? Choosing to send an important way is also taking the risk that it is no longer at our disposal for a more serious situation, knowing that, when everything is fine, we have three medical teams in the department, but sometimes also one, and not even located in the center. And when, in addition, the doctor is a replacement …
You have to choose, and very often under pressure. Weigh the pros and cons of just care. It is a question of experience, of intuition. And yet it happens that we are wrong because patients are never like in books. You have to choose, and choose is to give up.
Barely a minute after putting my telephone helmet on the ears, I send the Smur Mayenne on a cardiac arrest of an 86 -year -old man in the Laval outskirts. For the next call, very suspicious chest pain of infarction, also on the outskirts of Laval, I decide to send the ISP de la Baconnière, a town twenty kilometers away. In fifteen minutes she will be on the scene to support the firefighters. It will do it.
Then new call: a 9 month old baby makes a discomfort with cyanosis and pallor. He is very amorphous. His parents, rightly so, are in panic. So too bad for the 86 -year -old man on a stop; I divert the Mayenne medical team towards the 9 month old baby. You have to choose… and I don’t have a third medical team on hand.
The baby will be saved. As for the old man, his cardiac arrest was fatal to him.
Yes, Gide was right: to choose is to give up. Whether or not we have sufficient means to do our job well, regulation remains a position where death is close to death. It may be on the other side of the phone, she is there. And it hurts. For my part, I do not always manage to keep the emotions that assail me at a distance. Sometimes I admit, tears get me in my eyes.
When I was on regulation internship during my CAMU, my emergency medicine capacity, I was impressed by professionalism and the detachment of an ARM, Améline.
That day, Améline had triggered the SMUR in P0, the priority emergency level. That is to say that, without even the agreement of the regulator, she had sent a medical team to the depths of the campaign to take care of a 50-year-old man in cardiorepiratory arrest. This gentleman had been found in his garden by his 16 -year -old daughter who was surprised at the bizarre noise made for the mower. And for good reason: she was idling because her dad had fallen from the machine as a result of heart discomfort.
The girl, who had immediately called the 15th, was now in tears on the phone, necessarily. By signs, Améline had asked the other Arm to send the firefighters and the SMUR to stay online with the girl. She had asked him for her first name – Mélissa – and now found the right words to calm her and teach her in a few moments of first aid.
“Come on, breathe, my big one. We are with you. You did what needed but there, your dad still needs you until the arrival of help. Put it on the back. Place your hands on each other in the middle of his chest with your arms stretched and supports. I will count with you.
– I’m afraid of hurting him.
– No, don’t worry, Mélissa. You can’t hurt him. Go ahead, mass. “
At the jerky breathing of the girl, one could guess that she was massaging. And while massaging, she addressed her dad. She asked him for forgiveness. Sorry to have taken ten minutes to realize that he had made a discomfort.
“Sorry, dad. Forgive me. Don’t leave me, dad. Hang on, I love you. I need you. “
She spoke, she cried, she massaged. All this at the same time. And while I was moved to tears to hear this young girl addressing her father as if she were alone with him, my colleague, she was coloring. Obviously not the least in the world disturbed by the situation, she followed a well -defined color code and filled her calendar for the following week: blue when she could go get her children at school, green when it was up to dad to do so, red on the days when they should go back on their own by bus. And in doing so, she counted and encouraged the girl.
“Come on, Mélissa, that’s what you do, help arrive. Go ahead, continue. One two three…”
For its part, the regulator checked the place in resuscitation service if we ever managed to recover the patient. As for me, with my overflow of emotions, I felt helpless.
When the firefighters arrived on site, Améline hung up and we took the time to debrief both. “It’s horrible as a situation, she said to me. So to protect ourselves, we put a shell. “ Her shell was coloring. Or the shopping list.
His composure impressed me. However, if today I better understand the very distant behavior of certain medical regulation assistants, I remain convinced that by force we fill his bag with emotions. And when it is full, it cracks. With age and experience, I now manage to swallow my tears during regulation. But, once my guard is finished, I let go of everything. Depending on my state of fatigue, either I cry, or I speak. And sometimes too, I violently indignant.
