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A thought provoking article published in the N Engl J Med (2013;368:8–9) discusses what is known as the bystander effect—‘the human tendency to be less likely to offer help in emergency situations when other people are present’. Originally applied to the pre-hospital context, the authors express concern that this effect may have moved into our hospitals where patients are cared for by a large number of health care providers, with a sometimes overwhelming array of investigations to interpret, especially in the critical care domain. They argue the need to guard against becoming passively involved in patient care as more and more experts enrol in the case. Teamwork and coordinated co-operation should be something the EM team is familiar with.
Essential medicine blood
Another interesting topic tackled by the N Engl J Med (2013;368:199–201) is how blood should be categorised. Despite reliance (or even dependence) on blood transfusion in emergency care, blood remains unlisted in the WHO ‘Essential Medicines’ list. The importance of this is perhaps in the developing world …