October 08, 2009

Doctor Heli

A recent episode of The Professionals on NHK World featured an ER doc who works for Japan's helicopter emergency medical service, known as "Doctor Heli" (they use the English words). He flies to the scene and triages and treats on the spot, and then follows the patient all the way through the ER.

The case they followed was a traffic accident victim, and it was more explicit than anything I've seen on American television. The man's blood pressure was rapidly dropping by the time they got him to the ER (about fifty yards from the helicopter pad), so they had to open him up and find the internal bleed.

First surprise: the patient is prepped while the doc scrubs in. Then he gloves up, grabs a scalpel and goes zip. I mean, that fast. Lays the guy open with one swipe. None of this delicate, inching along stuff. I guess you get good at it after a while. But it looked like a butcher slicing open a side of beef.

Second "holy cow" moment: searching through his abdominal cavity for the bleed. Not to be too gross about it, but it looked like a bunch of cooks rooting around in a big bowl of spaghetti, picking up handfuls of intestines and pushing organs out of the way and stuffing in towels to soak up the gore.

Watching the video, the rather aghast interviewer posed the same question I had: "You can do that?" He shrugged. "Sure." Considering how badly boxers and football players pummel each other, and what a gymnast puts her body through on the uneven bars, the human gut can take a lot of abuse.

Third surprise: after the doc fixed the bleed and said "Close him up," a pair of nurses took a big piece of transparent (tinted yellow) adhesive tape--about ten inches wide by a foot long--and literally taped him close. Like a box.

The reason for this became clear a few hours later when his blood pressure didn't rise. He had another bleed. So they just peeled off the tape and rooted around in the spaghetti bowl some more and found the second bleed. The patient was fine after that. It was a truly amazing thing to watch.

Here's a video of a training exercise. Unlike the U.S., with parking lots and wide, four-lane streets everywhere, finding places to land the helicopters is a real challenge.

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# posted by Anonymous mary n.
10/14/2009 12:54 PM   
I understand that infection is the major problem with pawing through the innards. I once listened to a talk by a physician who had operated on a man with cancer. It had spread throughout the abdomen and the Dr. had to search for tumors. The patient died of a staph infection. But his condition was probably exacerbated by the Dr. having to cut into tissues.