When "The Patient Comes First" Can Get You Killed - Rehearse Your Boundaries for this COVID19 Pandemic

Posted by Dike Drummond MD

covid19-pandemic-resuscitation-death-virus-decision-thought-experiment-rehearse-boundaries-OPT150WAs healthcare workers, we learn, "the patient comes first" as our Prime Directive.

Tragically, this reflex impulse to dive in and help without thinking, can get us killed - especially here in the Covid19 Pandemic.

We tend to dive in where the need is the greatest, never questioning our “the patient comes first” programming.

So for instance,

  • as a health care worker
  • if you see somebody down
  • who's not breathing and they don't have a heartbeat
  • you're gonna probably jump on them and resuscitate them.
  • It is a reflex action
  • We don’t even think about it under normal circumstances.

These are not normal circumstances. Stop for just a second.

It is so very important to realize just how dangerous our normal lightworker reflexes are in this Covid-19 pandemic.

ANYONE down and unresponsive
- ANYWHERE - in or out of the hospital
- is a clear and present danger to you and your family
- unless you are completely protected with appropriate PPE

Your reflex decision to jump in and help could cost you your life or the life of a family member.


No exaggeration in that statement. This article came out this week:
A nurse without an N95 mask raced in to treat a ‘code blue’ patient. She died 14 days later

Her name is Celia Marcos:

"Marcos began working at Hollywood Presbyterian in 2004, three years after immigrating to the U.S. with her family. Back home in the Philippines, she had trained to be a nurse, her longtime dream, according to her sons.

At the Los Angeles hospital, she was known for her sweet nature and ability to heal rifts and remain cool-headed, no matter the situation. Filipino colleagues called her “ate” — big sister in Tagalog.

“She’s the type of person who in an emergency you can really count on,” said another colleague, who also asked for anonymity for fear of retaliation. “She’s the calm that we can look to in order to get through.”


Such a tragedy. She was following her training, honoring the lightworker’s urge to serve, help, heal. The virus took her life. May she rest in peace.

Her example shows all of us an important lesson for pandemic times.

You must rehearse scenarios where you are in danger and decide ahead of time how you will address them ...

… so that your programming and your helper’s reflex to dive in with full support does not end up costing you or a family member their life.

We must all begin to talk about all the different patient care scenarios that are an obvious danger to you and your care team colleagues.

Here is a thought experiment being discussed all over the country.

  • You are coming on shift in the Emergency Department.
  • You don’t have your PPE on yet.
  • A patient behind the curtain next to you arrests.
  • What do you do??

Think about this in detail ahead of time!

  • Discuss it with your colleagues
  • Discuss it with your family
  • Rehearse what you will do and say in this specific circumstance

What other dangerous scenarios can you brainstorm with your team or family? Rehearse them too!

What if someone arrests right in front of you out in the community?

What if you hear the alarm of shoulder dystocia on the OB ward?
Do you run in without PPE?

What if a child is coughing in your exam room and is not wearing a mask?
What will you do and say?

Fortunately, some hospitals and some communities have created formal guidelines on resuscitation – both in and out of hospital – to guide your discussions and behavior. Make sure to rehearse what you will do and say as you follow those guidelines as well.

In the heat of the moment – when someone is pulseless and not breathing is NOT THE TIME TO FIGURE OUT WHAT YOU WILL DO AND SAY ON THE FLY.

  • Discuss these scenarios
  • Take part in these thought experiments
  • Rehearse your actions
  • Rehearse what you will say to staff, bystanders, family members
  • BEFORE you are actually thrown into the real life clash between your personal safety and your “patient comes first” programming.



Have you had these discussions with your family, colleagues and care team?
Have you rehearsed what you will do and say in these dangerous circumstances?
Has your hospital, employer or community given you guidelines?

Tags: Pandemic