Author Topic: When should health care providers bug out?  (Read 21864 times)

Offline GoingToDoIt!

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Re: When should health care providers bug out?
« Reply #30 on: February 12, 2011, 09:16:53 AM »
I am not a medical provider, but it seems to me a key consideration point is going to be family. If the provider is single with no familial obligations, they could be more likely to stay.

If it was me, I would make sure my son was taken care of and not put him in harms way. I would probably treat friends and family at my home or theirs to the best of my ability, but would not likely go in to work. That's just me, and I'm not a provider, but family is a big concern - more so if the provider has children.

Offline surfrescue

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Re: When should health care providers bug out?
« Reply #31 on: February 14, 2011, 04:43:30 PM »
This topic has elicited my first post.

I have a couple scenarios playing in my head.  Living in Los Angeles, my biggest threats are earthquake, infectious agent, and fire storms.  Whatever the situation, I can not imagine staying home.  I train, prep, study, and drill for major emergencies.  I have made preps that will allow my family to remain in place for a month, longer if I am not drawing down the resources.

My everyday job is surf rescue and EMS.  The EMS side is fairly safe.  I can choose when to enter a scene, and have no problem delaying care to ensure that rescuers and patients are safe.  The rescue side is different.  By its nature, I dive into situations where the environment is killing someone.  Big surf, swirling currents, cold water, rocky shorelines, tangled lines and unpredictable marine life are a few of the conditions I negotiate daily.  Firefighters and Law Enforcement face even more dangers.  I get that some are in it for the paycheck, but for many of us, this is a calling.  We provide emergency care because the alternative is unimaginable. 

I have every intention of getting back to my family, but if I know they are secure, I will be combing through the rubble as long as I think I can make a difference.

Offline Heavy G

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Re: When should health care providers bug out?
« Reply #32 on: February 17, 2011, 05:35:44 AM »
+1 surfrescue

Offline buffalosoldier

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Re: When should health care providers bug out?
« Reply #33 on: March 16, 2011, 05:02:17 AM »
I would stay until I felt home security was lacking or until I thought my personal safety was at risk. I am no quitter, and I took a vow to help the sick, but I took another vow to protect my wife.

On another note, specifically those who mentioned self iso. I have a basement entrance to the house, a legacy of the factory history of Western NY state. There is a separate entrance that leads into the basement, which has it's own shower. Back in the day, the fellas coming home from the factory weren't allowed to just tromp mud and work dirt into a home that She-who-must-be-obeyed had spent a day keeping spotless. You went downstairs, you showered up and you changed into clean clothes. I do that now, coming home in my scrubs, showering in the basement, dropping my dirty work clothes in the scrub hamper and changing into clean clothes before I am allowed to go upstairs. I would probably just stay in the basement during a pandemic, to prevent giving something to a loved one but still be on hand if I was needed or it suddenly became time to Bug out.

Online FreeLancer

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Re: When should health care providers bug out?
« Reply #34 on: March 16, 2011, 02:03:38 PM »
This is a tough question, and everyone's situation will obviously play a role in the decision.

First, my wife and I don't have children (unless you count the 3 dogs, which we kind of do), so worry about their safety is not an issue.  Second, we are both physicians, and physicians tend to be altruistic, especially my wife.  Her mission in life is to help people and relieve suffering, so I don't see much possibility of convincing her to bug out as long as she feels she's making a difference. 

She works at a teaching center a few miles from our house, while I work at a clinic 20 miles away.  As long as medical supplies and infrastructure are in place, I'll probably keep making the commute to my clinic.  If the roads are impassable, such as with a bad quake, I'm looking at an all day hike to get back home (thru some sketchy areas) and I don't see myself going back again on foot.  Once home, we will probably do what we can at my wife's hospital until the supplies are gone. 

I decided a long time ago that my wife's career was more important to her than mine was to me, so I've positioned myself to support her as best I can by being flexible and giving her all the freedom she needs to accomplish her goals.  In a disaster my role won't change much, I see myself providing security for her travels back and forth to the hospital and holding down the fort at home.  If I'm able to, I'll provide medical care where I can, with what I have available



Offline buffalosoldier

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Re: When should health care providers bug out?
« Reply #35 on: March 20, 2011, 04:02:41 AM »
http://www.nytimes.com/2010/09/02/health/views/02chen.html?pagewanted=1&_r=1

an interesting article on that topic, about a doctor who held down the fort in NO during Katrina, with a high risk unstable pupulation (HIV/TB w/ polysubstance abuse/mental illness) with no power and essentially isolated.

http://www.nytimes.com/2009/08/30/magazine/30doctors.html

another interesting one, concerning that doctor accused of euthanizing patients during Katrina.
« Last Edit: March 20, 2011, 04:19:26 AM by buffalosoldier »

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Re: When should health care providers bug out?
« Reply #36 on: April 22, 2011, 09:55:02 AM »
Being an RN and NREMT-P, my wife a DPT we have discussed this. The safety of our daughter and aging parents by far trumps our jobs. They are just that... a job. Seeing how our employers have treated others, even during blizzards, where the state has closed roads, 7' of snow in SE Pa is a big deal. They threw them under the proverbial bus. I have no qualms about walking away for the betterment of my family. You can always find another job. Not so easy to replace your family.

Offline sdcharger

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Re: When should health care providers bug out?
« Reply #37 on: April 25, 2011, 12:51:47 AM »
Your skills and abilities will always be in demand in your own sphere of influence.  If the bridge is out and the fields are flooded then perhaps you will have to limit your sphere.  The bottom line is that if you have emergency medical or tactical training you will be a vital player in your home and community.  The scope of the emergency will dictate where you can practice your craft.  Perhaps you will not be able to leave your house or neighborhood but I don't doubt for a minute you will be needed wherever you are.

So I certainly agree with the axiom of "family first", but I doubt it will stop there when you are able to expand your influence.

Offline mmcgraw5

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Re: When should health care providers bug out?
« Reply #38 on: May 11, 2011, 07:59:43 AM »
I was delighted to see this thread. Have had recent discussions regarding the triggers for not going in. I have a family and several friends who are preppers. Although my heart tells me I would need to go in, my family and friends have told me" we will nail you to the chair"...All kidding aside, this is not an easy decision. I think most of us went into medicine to "make a difference", (regardless of what the lawyers and current administration try to portray)....I don't know yet how I will respond. My duty to treat is strong and not easily overridden. My duty to my family and friends is also strong. I don't have an easy answer, nor do I feel right about leaving all the other sick or injured to fend for themselves....I'm still trying to sort this out. thanks for the insights so far...

Offline Todd R

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Re: When should health care providers bug out?
« Reply #39 on: May 11, 2011, 02:21:53 PM »
I think most of us went into medicine to "make a difference". My duty to treat is strong and not easily overridden.  I don't have an easy answer, nor do I feel right about leaving all the other sick or injured to fend for themselves....I'm still trying to sort this out. thanks for the insights so far...

This is a very interesting thread and I enjoy reading it every time someone brings it up again. I am not a medical professional of any kind but here's my view of the situation - Walking away from your place of employment (hospital, clinic, etc) is completely different from walking away from your duty as a medical professional. You took no oath to the "place of employment". You can be a care giver wherever you are and have taken an oath to that affect. You will not be the only people bugging out and despite even the best bug out planning, there will be casualties along the way for many... especially those who have not prepared. If you help those along the way who need it whenever the situation does not present imminent danger to yourself or your family, then you have most certainly lived up to your duty.

Offline Oil Lady

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Re: When should health care providers bug out?
« Reply #40 on: May 11, 2011, 03:34:35 PM »

http://www.nytimes.com/2009/08/30/magazine/30doctors.html

another interesting one, concerning that doctor accused of euthanizing patients during Katrina.

This New York Times article you quoted is over 12,000 words long. It seems to be one of the most definitive news pieces ever written about the whole situation.

According to the news article, the grand jury refused to indict the physician (Dr. Anna Pou). So criminal charges are no longer hanging over her head, although civil suits of the wrongful death variety from family members are still pending.

Meanwhile, that doctor is now working to get laws changed which would grant special immunity to healthcare workers who work during official emergency situations --legislation allowing them to make triage decisions without fear of future legal repercussions.

I am glad I am merely a CNA and not a nurse or a doctor. I don't believe I could possibly make such decisions, nor could I in good conscience take part in aiding with them. Although I don't believe I would interfere with them unless I truly believed something criminal on a Hollywood scale was underfoot.

One of the jobs of a CNA is to clean up the dead body of a person who expires in the hospital, preparing the body to be sent to the morgue or funeral home. I am sure I will dread when the day comes for me to have to prepare my first corpse. But I'll do it all the same because I have to--and because someone has to.

The news story explains that the hospital was without power for many days, and the temperature in the building was over 100 degrees. There was no fresh clean running water, and the sewers were backed up. Over 2,000 people were in that hospital, many of them refugees merely seeking shelter from the aftermath outside. Between the heat, lack of sanitation, 2,000 sweating and many-days-without-a-shower unwashed bodies, and the lack of cooling and/or ventilation, the stench in the hospital was described as unbearable.

I do not begrudge the decision the doctor made. I just know I couldn't do it myself.



 



« Last Edit: May 11, 2011, 03:40:46 PM by Oil Lady »

Offline res1cue

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Re: When should health care providers bug out?
« Reply #41 on: May 29, 2011, 12:03:48 AM »
Interesting discussions so far.. I guess the way I thought of it was, when my ability to make a difference is outweighed by the risk to me and my family.

We don't get a lot of snow in the south, so when last year we got a 4 feet, overnight it was borderline SHTF, as we were unprepared and the city was unable to clear the snow on the roads (they literally gave up and said, "well, it will melt eventually")

The ER staff was basically told they HAD to stay because if they left, they could not guarantee that they could make it back the next morning, and the oncoming shift was not guaranteed to make it up there. I had no problem staying then, being a single guy, and having no real personal risk.

In the event of a pandemic, or some other TEOTWAWKI situation, our ER would pretty much be helpless, and would not be able to make a real impact on the situation, and I would probably just leave.

The math is pretty scary to think about, really, and it is funny how trusting the sheeple are..

In my city of 40,000, we are the only major hospital. With fire medics and firefighters included, we could probably only simultaneously work 5 or 6 high acuity patients (bad MVC's, GSW's, codes), and our level one trauma center could probably only work at MOST 7 or 8 really high acuity patients simultaneously. If some terrible disease, lets say with a 30% mortality rate, infected only 1% of the population, that would be more than we could handle, easily. Not to mention that would be in the city alone, and we are the only hospital of our caliber for a third of the state!

Offline Rom

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Re: When should health care providers bug out?
« Reply #42 on: May 30, 2011, 12:19:00 PM »
What a tough question. The toughest part for me is trying to decide at what point it would be prudent for me to start helping again. The initial decision is easy for me, I stay with my family. If challenged on the oath I took (as a FF/EMT) to protect the public and the obligation I have to provide them with the services they were promised by paying taxes, the response is simple. I made a vow to my wife, before God, to take care of her. And then in the union of our marriage, we created children. Those obligations far outweigh any I have to other folk in need. I feel a bit cold-hearted putting that in writing, but it is how I feel.
Getting on to the rendering aide part, I feel that most bad events (localized or larger, earthquake, pandemic, whatever) progress in a peak and valley fashion. The key, I believe, is to not waste resources trying to control the peak, the main event. Resources are best spent during the valley preceding the event in prevention/preparation, and the valley after the event in mitigating secondary events and fixing the problems that occurred during the peak.
Each event is situational, and it is difficult to discuss how I would react or how I feel we should react to each one. I can say that I am a bit of a believer in organized action (NIMS/ICS style vs free for all). I am not saying that I think we should sit still until some one tells us to act. I am saying that, as an example, two EMTs and a retired nurse working together in a defined area will be much more effective than the same three people striking out independently trying to help everyone they can.  And as long as I'm on this soapbox (how did I get up here...  :o) there is a skill that I think anyone who wants to help after/during an emergency. Being able to teach your skills at a basic level will exponentially increase your ability to "do good" in the aftermath of some sort of event. Teaching folks is not always as easy as telling and showing them.

Offline Doc K

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Re: When should health care providers bug out?
« Reply #43 on: May 31, 2011, 10:10:58 PM »
Walking away from your place of employment (hospital, clinic, etc) is completely different from walking away from your duty as a medical professional. You took no oath to the "place of employment". You can be a care giver wherever you are and have taken an oath to that affect. You will not be the only people bugging out and despite even the best bug out planning, there will be casualties along the way for many... especially those who have not prepared. If you help those along the way who need it whenever the situation does not present imminent danger to yourself or your family, then you have most certainly lived up to your duty.

In my opinion, this may be one of the best comments on this discussion. 

Thanks!
Doc K

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Re: When should health care providers bug out?
« Reply #44 on: June 01, 2011, 12:55:25 AM »
I certainly don't begrudge anyone's decision when it comes to picking between their professional responsibilities and their family's well-being, it's a tough and very personal decision, but we need to keep something in mind.  A health care provider working outside of the healthcare system will soon find themselves not much better off than someone with a first aid card. 

For serious trauma and disease, what can a provider ultimately do outside of a hospital setting without all the ancillary services and supplies?  If you don't have imaging, laboratory, pharmacy, OR, ICU, etc., the chances of providing definitive care begin to approach zero.

Like it or not, we are cogs in a complex machine; we're most useful as part of the system.  Once we are no longer a part, either by removing ourselves from it, or the system collapses, many of our skills are worthless.

Offline PAGUY

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Re: When should health care providers bug out?
« Reply #45 on: June 01, 2011, 05:10:54 AM »
This is a question that has been asked in many different ways by many different people for many years.  I have heard it asked in the early 1990's in places that are not talked about, after flooding in the midwest, and during riots in LA after a judicial verdict was handed down.  In all of these it comes down to the individual.  In the end if you are not able to survive the scenario in tact how are you going to help others.  You might try to be all macho but, in the end a DEAD medic is a DEAD medic and they can not help anyone.  A live person with some basic first aid knowledge is a LIVE first aid responder.  Stay alive and well first and then you will be able to treat others.  You might be able to make one heroic attempt to save anothers life but, if you ensure a basic level of safety for yourself first you will be able to save many others.  Just my two cents and a couple decades on the job. 

Offline Doc K

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Re: When should health care providers bug out?
« Reply #46 on: June 01, 2011, 10:13:03 AM »
A health care provider working outside of the healthcare system will soon find themselves not much better off than someone with a first aid card. 

For serious trauma and disease, what can a provider ultimately do outside of a hospital setting without all the ancillary services and supplies?  If you don't have imaging, laboratory, pharmacy, OR, ICU, etc., the chances of providing definitive care begin to approach zero.

Like it or not, we are cogs in a complex machine; we're most useful as part of the system.  Once we are no longer a part, either by removing ourselves from it, or the system collapses, many of our skills are worthless.

I only partly agree with you on this one.  Yes, for serious trauma and disease the modern system with all its services and layers of complexity and reliance on the system would not function and yes, many of are skills would be worthless.  However, there is still much a physician or other healthcare provider can do that is way beyond first aid.  Knowledge is a huge part of it, and someone with a first aid card doesn't have much knowledge.  As a Family Medicine physician, and one who studies and practices Wilderness Medicine, there is still a lot that can be done.

Depending on your area of specialty this issue will be a bigger or smaller factor.

Doc K

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Re: When should health care providers bug out?
« Reply #47 on: June 01, 2011, 01:34:56 PM »
I only partly agree with you on this one......    As a Family Medicine physician, and one who studies and practices Wilderness Medicine, there is still a lot that can be done......

Just for the hell of it....I'd be interested to see a list of critical conditions in which a primary care doc, without support or significant supplies, would have a reasonable expectation of influencing the outcome.  Skip sanitation, hygiene, nutrition, and self-limiting conditions.  Remember, you've bugged out, you can't stabilize the patient in the hopes of transferring them to the healthcare system for definitive care.

Offline Doc K

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Re: When should health care providers bug out?
« Reply #48 on: June 02, 2011, 06:01:53 AM »
Just for the hell of it....I'd be interested to see a list of critical conditions in which a primary care doc, without support or significant supplies, would have a reasonable expectation of influencing the outcome.  Skip sanitation, hygiene, nutrition, and self-limiting conditions.  Remember, you've bugged out, you can't stabilize the patient in the hopes of transferring them to the healthcare system for definitive care.

Well, just off the top of my head, there is a tension pneumothorax which can be treated with just a needle, there is a collapsed lung that can be treated with a chest tube (or improvised with a siphon tube from my brewing equipment), there is a femur fracture reduction (where a person can bleed to death inside their own leg) which requires no special equipment, there is an airway obstruction which can be treated with a tracheostomy (equipment can be improvised), and there are deep lacerations from any number of injuries that can be repaired with just a few items.

But don't discount the sanitation and hygiene and nutrition.  Prevention goes a long way.  However, without prevention, I don't think a person with a basic first aid card knows how to place an IV or when to use one or how to make a rectal rehydration kit.  These are things that do take a lot more than basic training, and again it is just knowledge.  This knowledge is not only for professional healthcare providers.  It is for anyone.  It is just us who get to practice it a lot more.

Doc K

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Re: When should health care providers bug out?
« Reply #49 on: June 02, 2011, 08:57:36 PM »
Well, just off the top of my head, there is a tension pneumothorax which can be treated with just a needle, there is a collapsed lung that can be treated with a chest tube (or improvised with a siphon tube from my brewing equipment), there is a femur fracture reduction (where a person can bleed to death inside their own leg) which requires no special equipment, there is an airway obstruction which can be treated with a tracheostomy (equipment can be improvised), and there are deep lacerations from any number of injuries that can be repaired with just a few items.

But don't discount the sanitation and hygiene and nutrition.  Prevention goes a long way.  However, without prevention, I don't think a person with a basic first aid card knows how to place an IV or when to use one or how to make a rectal rehydration kit.  These are things that do take a lot more than basic training, and again it is just knowledge.  This knowledge is not only for professional healthcare providers.  It is for anyone.  It is just us who get to practice it a lot more.

I don't disagree that these procedures can be critical lifesavers when done under field conditions, but I would argue that many primary care docs don't have the experience to perform them (like my FP wife), and I think likely bug out trauma situations where these procedures alone would be considered definitive treatment are rare. 

Doc K is a supercharged FP doc, due to the benefit of additional military C4 and wilderness training, and is probably the equal of any ER doc.  However, even after successful placement of a thoracostomy tube, cricothyroidostomy/tracheostomy, or a femur reduction, isn't there a high probability the patient will require evacuation to a setting permitting definitive surgical/hospital care?  Isn't it usually the case that these procedures are necessary due to some significant traumatic injury that will require fluid resuscitation, lab and imaging support, and a qualified surgeon/OR?   When these procedures are performed in a battlefield or wilderness setting, isn't every effort made to get the patient out on the next helicopter?  Is it likely that an individual doc in a bug out situation will have the quantity and quality of supplies and support to get the patient back in the fight, let alone multiple patients?

It's been over a decade since I had much exposure to critical care medicine, back when I subjected myself to 18 months of anesthesia residency, so my airway and vascular access skills are no longer the sharpest.  But I won't forget many a frantic night in the OR trying to get enough lines, fluids, and blood products into some poor trauma victim in order to keep them alive, at least until we could deliver them to the SICU (because it's bad form to have a death on the OR table).  In those situations, I was always aware of being highly dependent on staff, supplies, infrastructure and technology in order to accomplish my task.  It's hard for me to imagine success by a solo provider in a primitive setting. 

How much IV fluid, meds, and supplies can you carry when bugging out?  Is it reasonable to think that a solo healthcare provider could successfully manage a single patient on the supplies you could carry, let alone two or more, with significant trauma?

As far as prevention goes, I'm with Doc K 100%, it's the best bang for the buck, in any situation.

Offline Doc K

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Re: When should health care providers bug out?
« Reply #50 on: June 02, 2011, 10:26:21 PM »
FreeLanceR,

You make some really great points, and I truly don't disagree.  I am under no assumption that I am going to be the one superman that will save everyone.  In reality, without a full system in place, people will die of things that they usually do not die from now.  "Common" things will kill. 

However, I keep thinking back to the Middle Ages.  Yes, people died way more without "modern" medicine.  Yet there were a lot of individuals whose lives were saved by the knowledge of the town "medic", often the local monk (or local monastery).  Without their higher-than-the-common-man knowledge, many more people would have died.

The short list I provided may be associated with much larger trauma that would kill without ancillary services, but not all the time.  Blunt trauma to the chest from a fall or a horse kick or whatever can cause a tension pneumo.  This may be treated (and a life saved) with needle decompression and/or chest tube placement.  That patient may eventually die from resultant pulmonary edema or infection from the chest tube or pericardial effusion from the initial trauma... but then again, they may not.

Without that small intervention, they would most definitely die.  With it they may live.  For me, it is all about increasing the chances, even if they are small.  I think healthcare providers would become much better at triage.  They would be able to look at an injury and say, "Sorry, these injuries have too low a chance of survival to "waste" my limited supplies." 

How much IV fluid, meds, and supplies can you carry when bugging out?  Is it reasonable to think that a solo healthcare provider could successfully manage a single patient on the supplies you could carry, let alone two or more, with significant trauma?

Now, I agree also agree with this.  In a real bug out where I am leaving my home, I would only be carrying minimal supplies, and that would be saved for my family alone.  In a "bug out" situation, which is often a "bug in" I would have much more supplies on hand and I would be more helping to others.

Doc K

Offline 2mommas

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Re: When should health care providers bug out?
« Reply #51 on: June 04, 2011, 12:53:15 AM »
One of the first things taught in nursing school is,, take care of yourself.   If you don't , you cannot take care of anyone else.  Just  as on an airplane, they tell you to put YOUR mask on first, so that you can take care of your children.
I was recently in a tornado/flood,  simply because the office I work in , refused to let us go home  when it was safe.   They are always pushing NUMBERS.   It seems the  State level decision makers always put us in danger, when THEY went home early , or did not show up at all.
Your first responsibility , is the committment you made first.  TO YOUR FAMILY.
You cannot choose your emergency , but you can plan who you bug out with.     I have friends in the office that I will be sharing  my bug out location with,  by choice.     GOOD COMPANY

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Re: When should health care providers bug out?
« Reply #52 on: June 04, 2011, 01:05:42 AM »
It is sobering to think about what will happen when the S really HTF.  We are used to relatively predictable standards of living, which includes access to complex healthcare, and will be shocked when it's no longer an option in a new dark age. 

I was purposefully a little hyperbolic in comparing bugged-out healthcare providers to boy scouts with a first aid card.  There certainly is good we can do with our knowledge and limited supplies, but I don't think we should forget that our outcomes will often be substandard when compared to what we are capable of as part of a system. 

Like I said before, bugging out is a tough decision for everyone, and definitely not one-size-fits-most.



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Re: When should health care providers bug out?
« Reply #53 on: June 08, 2011, 11:18:01 AM »
I can't get this topic out of my head.  The complexity and specialization in medicine seems to mirror modern society as a whole, such that when enough of us are absent from the systems we normally function in it leads to a cascade of failures affecting more and more people. 

Intrinsically I don't like this, I prefer to delude myself with the idea that I can come in and out of systems as I wish with little negative consequence to myself or others.  I like to think that my self interest is paramount.  But in reality when a critical mass of individuals make a similar decision to leave, the system will at some point collapse, perhaps irrevocably.  If a critical number of soldiers are removed (or remove themselves) from the theater, collapse of the military operation is inevitable, followed eventually by the collapse of the society backing that military.

I have this image in my head where I've bugged out, catch a bullet in the gut, go to the nearest hospital and find that the staff has bugged out with all the supplies, and I'm left to die a horrible death from peritonitis wondering if this would have happened if I'd stayed in the system.  Or, alternatively, I get to the hospital and everyone's there doing their job and wanting to know where the hell I've been and why I've left them high and dry.

Offline Doc K

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Re: When should health care providers bug out?
« Reply #54 on: June 09, 2011, 12:10:57 AM »
This is why I went into Family Medicine!  I wanted to be able to do a little bit of everything.  Jack of all trades; master of few. 

And my goal is to never get a bullet in the gut in the first place!  :)

I agree with your sentiment on this whole thing, though.  It is easier to think of ourselves as outside the system, because we actually see the system that many don't realize is there; however, we are still a part of it whether we like it or not.

Doc K

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Re: When should health care providers bug out?
« Reply #55 on: June 09, 2011, 07:56:56 PM »

And my goal is to never get a bullet in the gut in the first place!  :)


Me too!

Hey Doc, I've been meaning to ask you something.  Doesn't being a USAF officer make bugging out a non-issue, they don't look too kindly on that, do they?

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Re: When should health care providers bug out?
« Reply #56 on: June 10, 2011, 02:12:59 AM »
Hey Doc, I've been meaning to ask you something.  Doesn't being a USAF officer make bugging out a non-issue, they don't look too kindly on that, do they?

 ;D
Ha!

Yeah, they rather frown on such behavior. 

Things would have to be REALLY bad for me to consider that in my current situation.  I still have a few more years before I am out of the USAF, but this will be a future issue for me.

Actually, since I am living overseas, the issue is even more complicated.  What would/could cause me to bug-out, and my family, while overseas?  Where do we/they go?  Do I send my family without me, and let them try to navigate international travel in a bad situation? 

Gets very complicated.  Not a mental exercise I like to think about.

Doc K

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Re: When should health care providers bug out?
« Reply #57 on: June 11, 2011, 07:58:18 AM »
Hey Doc K

I think the answer to this is a simple one.

As a health care professional I would ask myself, Am I still getting paid for being in this dangerous situation (I.E. working in the hospital)?
Are there systems of support still in place to prevent me from getting infected (access to PPE, Clean Water, Fresh Face Masks)?

If so then I would say, as I can still provide a duty of care to those in need and I can Provide and protect my family.

If however the answer is NO to any of the above, them my first duty of care is to myself and to my wife and children, (If im not getting paid for example how to I provide for my family) No PPE then the risk of contracting a Virus / Bacterial Infection and or passing it to my immediate family is too great.

Hope this helps

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Re: When should health care providers bug out?
« Reply #58 on: June 15, 2011, 12:07:34 PM »
I was just reading the Hippocratic Oath to see if there is any mention of what to do in there. It does say:

'If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.'

Would abandoning your position as life-saver and escaping with your family be seen as playing God? Are you making the choice to 'take a life' or not 'save a life'? I do believe one should exercise their role with caution and shouldn't risk their own death. Even firefighters go by certain rules in determining whether a building or area is safe to enter.

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Re: When should health care providers bug out?
« Reply #59 on: June 16, 2011, 09:29:48 AM »
I think the ideal presented by the traditional Catholic hospital system (a system which is just about extinct now) helped solve a lot of the problems presented by a wholesale calamity striking a region. If you have a non-Catholic hospital trying to rise to the challenge of a Katrina scenario, well over 50% of your hospital employees will have spouses and children and who will want to leave and tend to their families.

But fifty years ago, most Catholic hospitals had nursing staffs composed almost entirely of nuns (nuns who were fully licensed and highly competent nurses). The nuns lived in a convent right there on the hospital campus. They LIVED there, weren't married (didn't even have boyfriends) and certainly didn't have children. If they had parents or siblings anywhere, they didn't aways live nearby. So there was no conflict for them in staying. Tending to the sick was their duty, and their loyalties weren't in any way torn. If faced with a Katrina scenario, those nuns would stay. Period. And they wouldn't stay begrudgingly, they wouldn't perform their duties fretting in a half-focused haze while silently worrying about their homes (they could see their "home" from the hospital -- a nun's dormitory), nor would they be constantly running for the phone to call and check on their non-existent kids. They would remain at their posts for as long as the hospital building itself remined standing. And if for some outrageous reason the building were to fall down, they would help pick through the rubble to find the survivors and carry them to a new place of safety and just keep on caring for them.

You don't have to be Catholic (which I'm not, BTW) to see the value of such a system. I see the demise of the Catholic hospital system as yet one more factor contributing to the ongoing erosion of the former resiliency of our society. There are too many people who think that --if America were ever faced with another monumental long-term crisis-- we as a nation still have it in us to duplicate the same commitment AND RESULTS that we mustered during World War II. But too many aspects of our whole society have changed since that era. I have no doubt we could as a nation pull together and put forth the emotional commitment, but as for actual results .... The nation-wide assets avilable to us to actually accomplish anything during a crisis scenario just aren't as plenteous or as potent anymore. All the "Rah! Rah! Sis-boom-bah!" commitment in the universe won't make up for a lack of assets. And the virtual elimination of nun-nurses from our healthcare system is one of those irretrievably missing assets.