Free Murder and Mayhem by D. P. Lyle Page A

questions are similar regardless of what the emergent situation is. The key is to get as much information as possible in the shortest time and with the fewest questions. In true emergencies time is often the enemy, and the physician doesn't have the
    luxury of taking a long history from the patient. I always taught my students that in such situations you can get most of the information you absolutely need with the following three questions:
    1.  What's wrong or what happened? We call this the "chief complaint." Seventy percent of the time the diagnosis can be narrowed to a very few choices with the answer to this question. A complaint of chest pain leads you in one direction or line of thinking, nausea in another, and headache in yet another.
    2. Have you ever been hospitalized or treated for anything in the past, and if so, for what? We call this the "past medical history." The answer tells the M.D. about the medical problems that the person has experienced in the past and gives him the necessary background to evaluate the current problem. Many of the patient's past illnesses will have an effect on his current illness or injury, and, indeed, many of these past illnesses may still be active medical problems. Heart disease and diabetes would fall into this category since they don't go away but, rather, tend to progress.
    3.  Do you take any medications or have any allergies? This tells the M.D. what the active medical problems are, such as high blood pressure, diabetes, heart disease, hepatitis, and so forth, and how they are being treated or managed. This information also guides the M.D.'s treatment so he can avoid drug interactions and the use of known allergic drugs.
    These are the general questions a physician asks of any patient in an emergency situation. If the victim is not conscious, much of this information can be obtained from relatives, friends, another M.D. who knows the patient, or medical records. MedicAlert bracelets are also helpful.
    After this basic data is obtained, more pointed questions are
    asked to fill in the areas of concern. For a patient with a head injury, the following questions are essential:
    Do you have a headache? Is it localized or general?
    Do you have blurred or abnormal vision?
    Are you experiencing dizziness or poor balance?
    Have you been nauseous or vomiting?
    Do you have any soreness or stiffness in the neck?
    Do you feel any weakness? Is it generalized or only in one side, arm, or leg?
    Are your eyes sensitive to light?
    Do any of these symptoms worsen with a change in position or movement?
    Then, of course, a complete physical and neurologic exam is performed. Based on the answers and the findings on the exam, lab work, X rays, and other tests would be obtained as indicated.
    How Do Hospitals Ration the Blood Supply in Major Natural Disasters?
    Q: I have an odd question for you. Let's say the big one hit Los Angeles tomorrow, devastating the city. I imagine the blood supply would be depleted rather quickly. How aggressive would doctors be about getting blood donors? Would doctors at temporary M.A.S.H.-like medical facilities solicit healthy people off the street to give blood? Would they be able to screen this blood quickly for AIDS?
    A: Every hospital has an emergency or disaster plan that deals with catastrophes such as an earthquake. That said, whenever a
    major event such as you describe occurs, these plans may be overtaxed and become quickly inadequate.
    M.A.S.H.-like field hospitals would crop up out of necessity, and the blood supply would be rapidly consumed. The Red Cross and other organizations would transport blood, and volunteer donors would be called in. The Red Cross keeps a list of clean donors that they regularly call on when needed; blood would be obtained from them. Yes, people off the street might be used. So far, so good. Labs would be set up to supplement those of the local hospitals to type and match the blood and screen it for AIDS and hepatitis.
    Screening