Authored by Andrew Hague
So long as there are emergencies, we shall need emergency doctors. Is it unrealistic to believe that we can plan our lives so that emergencies never happen? Utopia is dreamland, it is said, but nevertheless, without such visions we have no sense of direction. If the unexpected can be anticipated and avoided then pain, suffering and disruption is minimised.
Introduction
Injury and illness
Injury and illness are the two medical problems. Injury can be sudden and requires emergency treatment. Illness is incremental and treated progressively.Doctors are role models
Much work is done to prevent illness. We see this in better hygiene, personal and social; washing hands and sanitation. Lifestyle affects health and people are advised on diet and exercise. The equivalent advice from doctors about emergencies and injuries is missing. In all societies, doctors are role models. We all grew up thankful for the attention of a doctor at some stage. They brought us into this life and will see us out. Seldom do they pronounce on politics and although they have a good income are never seen as having more than their fair share of wealth. People respect doctors and this status should be used by doctors to influence behaviour. Doctors, whether they like it or not, are role models. What they say, is influential.Causes of injury
There are four classes of causes of injury:1. Carelessness.
2. Recklessness.
3. Aggression.
4. Misfortune
From the first of carelessness to the last of misfortune, the chance of avoiding disaster gets less which means that a doctor has less influence. Nevertheless, statements by doctors will be heeded and when it is understood that the doctor invites redundancy this advice will be respected. We wish for the same from the police and fire brigades. Indeed, the fire service devotes a lot of effort to inspecting buildings for fire safety. Do the police invest time preventing crime or is that left to the deterrent effect of sentencing and punishment? In many cases, it is hoped that people will be careful to avoid injury but still they turn up at the A&E in pain and talking about accidents. Investigators admit that the truth is there are no accidents, only mistakes that were avoidable.
Consequences
A child has no concept of consequences. Over time, by trial and error coupled to imitation, the process of conditioning adds to the memory bank and the child becomes an adult aware of the consequences of their actions. People who have not acquired this knowledge should be recognized by doctors for their ignorance which will become evident in frequent visits to the clinic. Their teachers will have already identified these people at school as slow learners. It is in these encounters that doctors have a role to play. Interestingly, the accident prone are not always those scoring low in education. There are many explanations for mistakes. The person who does nothing may stay safe but achieve nothing and the ambitious may push the boundaries of sense to explore beyond. This is the consequence of having the brain we acquired when we mutated into homo sapiens.Carelessness
There is an assumption that tidiness is safer than a mess. Do more accidents happen in a messy or tidy workplace? I do not know but from my own experience and this includes owning a factory for many years, a mess is not the cause of mistakes and tripping over wires. Where there are obvious dangers, people are alert and avoid them. When there is deceptive safety, one’s attention can wander letting the day dreamer trip or walk into a half open door. Our brains are not born to cope with neatness. The cave and the jungle floor are always a tangle and walking depend on watching where to put your feet for every step. Only since manufacturing required orderliness has a clear path become essential. This allows carelessness.There is the often-quoted story of two mountaineers trying to find their way to the Royal Geographical Society through the back streets of London. These men had climbed the world’s mountains and then one of them tripped over the kerb when crossing the road in London and broke his leg. As a doctor, what can you advise to prevent such mishaps? Obviously, the fellow was safer on Mount Everest than the paved streets of London.
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