Why doctor

It must have been a pediatrics weekend. Sat started with a 7 year old with status asthmaticus, an acute asthma attack that has progressed to the point that it cannot be treated by the standard nebulizer treatments of albuterol. Brave kid just focused on his breathing did not whimper or anything the paramedic rode in gave some solumedrol via IV. We ran to the hospital because he was not responding to the medications (would have ran anyways) and thus he needed intubation to keep his airway from swelling closed. If not intubated he would need a cricotomy/trachotomy. While normally, our ambulances have the capacity to intubate in just such occasions. The pt was still conscious w/ a gag reflex and therefore needed RSI (that's rapid sequence intubation) where a chemical agent paralyzes the pt by inhibits the action of acetylcholine at the neuromuscular junctions (just thought I tie in a little cell bio while we are at it) the side effect of this is that you have just but the pt's life in your hands. The pt can no longer breathe for themselves and thus this must be followed by intubation. While this may sound like a terrible solution, putting the pt in respiratory arrest on your terms is much better than the pt falling into respiratory arrest on his/her own. We made it to the hospital, the pt was able to be intubated, and aside from the trauma to his throat and the tears of a mother, everything turned out ok.

What bothers me is the what if. If we had not made it to the hospital in time, we had the skill level on board to perform RSI (paramedic skill and even I as a EMT-I can intubate) However RSI is not in our protocols, and thus do not have the succs. I am not blaming our medical director for this lacking RSI protocol, obviously, the director's knowledge outweighs mine and the liability and subsequently the choice lies with her. This is part of why I want to be a doctor not being able to do everything I can especially when I know what needs to be done distresses and troubles me to no end. My experiences here at CVFD have made me want to be involved in the teaching/training of other healthcare professionals not just other doctors. Perhaps later as a medical director I can help to effect changes in the prehospital setting w/ research and we can advance the quality of healthcare.