The Psychology of Human Action

Abstract

An emergency physician is confronted with two patients, one moderately and the other severely injured following a shooting: on the one hand, a hemodynamically stable female police officer with an arterial bleeding as a result of a perforating injury of the brachial artery; on the other hand, the male aggressor with a shock due to massive intraabdominal and intrathoracic blood loss. Without having examined both of his patients and then treating them according to medical urgency, he spends almost a quarter of an hour with the less injured police officer, delegating the treatment of the multiply injured patient to the paramedic before he takes care of that patient himself. The physician knows about the injury pattern and the resulting vital threat to the patient. Nevertheless, he decides not to address this problem personally. Once he finishes caring for the police officer, he personally begins to spend valuable time with the badly injured patient on site, that is, he decides to “stay-and-play.” This is another error because patients with perforating injuries of the chest are known to benefit from rapid transport with a minimum of treatment done on site to the closest trauma center, that is, “scoop-and-run.”