Aurora Colorado Shooting

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Patrick S., M.D. -

Overall I liked this presentation, and I suspect the fact of the matter is that we all, as trained professionals, will rise to whatever challenge is placed before us in an emergency, probably even much more than we think we might. The hardest part I think is having the presence of mind to consciously step back and delegate, rather than trying to do everything down to the details of procedure.
I was NOT favorable about the moral guidance provided me, nor my moral obligation informed to me, regarding 2nd Amendment issues at the end of an otherwise inspiring mass casualty presentation about the Aurora shootings. I think Stuart should spend some more time down in Chile or some other place, where the right to keep and bear arms is not even a dream, much less a reality, and spout off to his heart's content about his political views on various subjects, then give us an update about how that is working out for him. Perhaps he will realize that the right to keep and bear arms - and I mean arms that are equivalent to what my local police force and/or home invader might carry, somehow eerily goes hand in hand with the fact that we can (rightly so) take our right to speak our minds, freely, completely for granted.

Mel H. -

I knew this segment would bring up the 2nd Amendment rights as the discussion continues lets keep it fact based and professional. My summary, gun violence IS a public health problem. The more restrictive the gun laws the less deaths and injury. But this must be weighed against personal freedom and rights. Each country decides it differently. The debate is important. Lets try and do it here with a little more skill than seen elsewhere. Let the debate continue...

Michael F., D.O. -

Bravo to Patrick S. for responding to the Aurora lecture. While the results of that incident are horrible, I had to hope it would focus on the medicine and not tread into the gun control issue. It was bad enough when Andrew Fenton from the ACEP basically stated my dues were going to used to endorse the agenda of politicians like Diane Feistein but to hear it on EM rap was disappointing. To say it is our responsibility as physicians to endorse gun control comes as a slap in the face. Stuart tried to dance around the subject but the message was pretty clear.

As ER physicians we see people abuse themselves, others, the system, as well as their unborn children but we are there to treat and not judge. Why don't you have a segment on women who abuse themselves by taking meth while pregnant. Then you can tell them that they are a threat to their unborn child and are incapable of making decsions so you are going to make a law to make the decision for them. Our job is to treat and not judge. I was saddened to see Mel and Stuart jump on the anti-gun bandwagon.

In every other aspect of emergency medicine the emphasis is on education. In regards to firearms the reaction is to place more restrictions. I completely disagree with Mel. I do not believe that more restrictions will lead to less deaths. Again, I am a law abiding citizen and am bound by the laws passed. Unfortunately, the two guys that tried to break into my house two years ago were not. Had I not had a firearm I shudder to think of what may have happened that night to my wife and two children. Clearly they were not concerned with the law against breaking into someones house. I doubt they are going to be strolling down to the local gun shop to buy their next firearm. I do recall a segment from Australia about how law abiding citizens had been subjected to a marked increase in home invasions after several gun control laws were passed about a decade ago.

I own several firearms and am very comfortable with them. I owe my father (also an ER physician) a debt of gratitude for the education he gave regarding the use, safety, and responsibility of owning one.

I believe Mayor Bloomberg made a comment of how we should be willing to give up certain freedoms for safety. That is a scary statement. I think in no other specialty is there the freedom to improvise and practice medicine like there is in emergency medicine. For a group that complains all too much about litigation, reimbursement cuts, lack of resources, and endless patients, we should be careful not to so quickly push for more restrictions not only on our firearms but our lives.

Tony D., M.D. -

Comilla was brilliant! I was the ED attending on shift at 9AM on 9/11 at NY Downtown Hospital (5 blocks from Twin Towers) and my experience exactly parallels hers: 1) assign junior docs to each patient as they come and have them re-assess, 2) Have senior docs recheck and re-round constantly, 3) Make sure people don't clump up: everyone wants to be where the action is. We saw 350 patients in the first 2 hrs, lost communication and got buried in the dust cloud, then were on generator power for a week. We then became the community resource to bring food and meds to elderly patients trapped in neighboring high-rises. Tony Dajer, Chair, ED, NYDH

Richard S. -

It is clear from innumerable discussions that the Joe-on-the-street 2nd amendment purist has never seen the result of gun violence except on TV. We on the other hand see it all the time. To pretend that we, as ER docs (and first responders, and families of the dead in the Newton massacre and the Aurora shooting etc etc etc etc etc etc etc) don't have an important perspective strains credulity. I think Stuart and Mel revealed their opinion, but not in any overbearing way. Sort of like their opinion on ketamine. I think it is well-worth reminding listeners and the public that even backward countries such as Australia manage to avoid becoming a police state without high-powered weapons sold at the local Walmart and large-magazine assault weapons sold at the weekly gun show. How can this possibly not be relevant to emergency medicine?

Richard S. -

Forgot to add: I happen to be completely in favor of the freedom to own a gun (home protection, hunting, whatever). It's the easily-circumvented loophole-riddled regulations on guns and ammo, and large-magazine and assault-type weapons, that I believe are the issue.

steve r. -

Interesting lecture and must have been pretty tough experience. I was wondering how you documented your care of patients. With EMR cannot even imagine documenting , let alone trying to order meds, interventions, etc. via computer. Do you have protocol where all orders can be done verbally in mass causaulty situation. In these situations how important is documentation, seems like it should just take a back seat to patient care and to hell with it. I work in single coverage ER and am not sure how we could have handled similar situation.

Richard S. -

That is a great point. In fact it would be interesting to hear from our EMRAP experts on EMR use in the ED in general--from the trenches, it seems to slow us down--leading perhaps to even more rushed clinical care and shortcuts in documentation--and to immortalize tiny unimportant "mistakes" that could be represented as significant in court. There are the potentially offsetting advantages, but has this been studied--quality of care, and litigation, as EMR is introduced?

Shu-Haur O. -

I can't believe how many fellow EPs are so seduced into this 2nd amendment rubbish. Maybe it is the alien viewpoint from Australia but I think your country is completely insane to think that bearing arms is a sensible thing to have. Particularly when arms means automatic weapons. Yeah, your precious 2nd amendment just indirectly caused a fellow citizen of mine to get shot. Do you wonder why Australia has barely any gun violence deaths? Or why when I have worked for 7 years in my urban district ED I have seen only 2 cases on gun related injury (and one of those was accidental self inflicted onto his foot)
Here's a hint - much less guns in the community!

Morgan M. -

Shame on you people for politicizing that issue there are plenty of other places to plug your ridiculous liberal gun control agenda . There was no respect payed toward the victims. There was little insight given to us as practitioners to help improve the quality of care we provide in a mass casualty scenario. Did the Obama admin pay for this insert? I love and respect the continuing ME I get from EMRAPS . This was very sub par and I hope junk like this will not be repeated.

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Episode 140 Full episode audio for MD edition 238:22 min - 100 MB - M4AResumen Mayo 2013 en español Español 80:43 min - 28 MB - MP3EM:RAP 2013 May MP3 81 MB - ZIPEM:RAP May 2013 Written Summmary 857 KB - PDFEM:RAP May 2013 Board Review Questions 635 KB - PDFEM:RAP May 2013 Board Review Questions:Answer Sheet 661 KB - PDF