I was mystified by the article “Breaking Barriers,” which had the following in a caption: “Most Americans aren’t opposed to porcine insulin, but Jewish and Muslim patients might choose to accept the risks of hyperglycemia rather than receive this particular medication.” I cannot speak for the Muslim faith, but as an Orthodox Jewish rabbi, my jaw dropped. The first law of Judaism commands us to break every law in order to save a life. There is no objection or law that prohibits the use of porcine insulin. Just the opposite is true: We are commanded to do whatever is necessary in order to save our lives and maintain our health. No person of the Jewish faith would ever accept the risks of hyperglycemia in order to avoid a medication coming from any animal source. I’m extremely confused where the author got this information, and it’s absolutely contrary to our faith.
Rabbi Baruch Stone, NREMT-I
Author Keith Widmeier, NREMT-P, CCEMT-P, EMS-I responds: According to the informational booklet, Informed Choice in Medicine Taking: Drugs of Porcine Origin and Clinical Alternatives (www.keele.ac.uk/pharmacy/npcplus/medicinespartnershipprogramm/medicinespartnershipprogrammepublications/drugsofporcineoriginandclinicalalternatives/drugs-of-porcine-origin.pdf), porcine medications may be an issue for a number of faiths, but it’s more likely to be an issue for Judaism and Islam.
The booklet goes into discussion about potential exemptions as well. However, I feel that this discussion is straying from the overall message of the article. Regardless of faith—our patients’ or our own—it is imperative that we, as providers, respect the decisions made by our patients. Patients have the right to decide what treatment they choose to accept—or not accept—and providers should not attempt to downplay the importance of the patient’s faith for the desired medical treatment.
Check the Basics
In the April JEMS article, “Active Assessment,” paramedic Brian Pearce was doing what I call a double pulse check.I teach in a private paramedic college, and I notice all the students are trained to practice this, and I disagree with it. I understand the thought behind it, but we must consider that the American Heart Association (AHA), Heart and Stroke Foundation of Canada and Journal of the American Medical Association have referenced that 60% of healthcare providers can’t adequately check for a carotid pulse.
I’ve taken a dozen students and had them access a carotid pulse, and all 12 couldn’t find a pulse in a timely fashion. We live in a culture of fat necks, meaning many patients have lots of adipose tissue in their necks. Unless a provider uses a head tilt/chin lift to bring carotid artery closer to the surface, how can anyone truly feel a carotid and radial at the same time?
If a medic comes across an unconscious patient, they should assume they’re dead, check a carotid only first, then check a radial if there’s a pulse to see if pressure is adequate. I don’t care if I’m perfusing the finger, but I do care if the brain is being perfused. Let’s just follow AHA guidelines instead of changing what works. Assess responsiveness, open airway and check for breathing and pulse while using a head tilt/chin lift. This step still follows the current 2010 guidelines: If there is no breathing and no pulse, then get on the chest and start compressions. Let’s get back to the basics.
Simcoe County, Ontario, Canada
Words of Wisdom
Below are comments from the JEMS Facebook Fan page in response to the following quote by columnist Thom Dick:
—Dennis Youngberg: Treat them as if they were your mother/father.
—Moe Altazan: We’re all guilty of this at one time or another. It takes practice and compassion; we have to make it a natural habit.
—Marcia Chapman: Too many are paying more attention to their clipboard or computer than to their patients. Building a rapport with your patient is just as important as any of your other skills—it takes practice to develop and ongoing use to master.
—Smiley Rie: So very true. It might not be an emergency to us, but to most of them it is. And my other favorite saying is this: “It’s not about our egos; it’s about the patient.”
—John Michael Fisher: I was taught this during school so now it’s second nature for me, but I only sit in the jump seat if I’m playing with the monitor, doing something airway, or if the patient falls asleep. I always sit on the bench and play to precept everyone.
—Sharon Cox: True words. I can’t stand it when paramedics or EMTs don’t talk to their patients or are too clinical with them. A kind word, a smile, a held hand and a little reassurance goes a long way.
—Curtiss Orde: Amen to Thom’s quote. JEMS