The next drug to add to the EMS formulary should be water. That’s right. H20. How many times have you been on a call and the patient has asked for water only to be told by every EMS responder in the room, “No! You can’t drink anything!”
Really?
The reason we don’t let people drink water is so they don’t throw up and aspirate while the anesthesiologist is trying to intubate them at the start of surgery. This all comes from two cases in the 1950’s where pregnant woman aspirated during delivery. If you are going to have scheduled surgery, the surgeon will often tell you, no liquids after midnight. The problem with this was they were telling this to old ladies who go to bed at seven at night. Their surgery wouldn't be until three in the afternoon. They were going into surgery dehydrated and hypoglycemic. Nowadays, many progressive surgeons just say no liquids for two hours before surgery.
Research Suggest Drinking Before Surgery Helps Recovery
New Rules: Eating, Drinking, Anesthesia
Research shows people who are allowed to drink water, apple juice or Gatorade do better than those who are required to abstain. They are not dehydrated. Their stomachs may even be emptier due to the fluid moving things through their system and they spend less time in the hospital.
Translate all of this to EMS.
Why do we keep insisting our patients can't drink water, and only the kindest among us get them ice chips to suck on?
How many of our patients who are asking for water are candidates for emergency surgery? Maybe the guy with the bullet hole in his abdomen screaming out for water like the soldiers in the movies shouldn’t be given a drink, and certainly it shouldn't be given to anyone vomiting with altered mental status as the result of a head injury or someone having a stroke who can’t swallow. No water for them. Fair enough. But most patients can quite comfortably drink some water without any ill-effects. And even for those who may have surgery like those with hip fractures, how many of them are going to be under anesthesia within two hours of when they ask you for a sip of water? Not many. Two-thirds of hip fracture surgeries take place more than 24 hours after the patient’s arrival in the ED.
Timing of Hip Fracture Surgery
The "nothing to drink before surgery" mantra should not apply to all EMS patients on the oft chance that a rare individual patient will have some type of unexpected surgery within hours of their arrival.
Old woman feeling weak. Her apartment is hot and has poor airflow. She wants a drink of water. "NO!" nine of the ten responders (Police, fire and EMS go to every call in some towns) in the room shout. "No," you say, calmly. "It’s okay." (If she calls her doctor instead of calling 911, he is going to tell her to drink fluids.) "I’ve got a cold bottle of water in the ambulance. You can sip on it on the way to the hospital."
"You can’t drink," I hear medics say all the time. "But I am going to give you water right into your veins instead."
Maybe water or Gatorade might be a better, safer, and less invasive intervention for certain patients than an 18 gauge needle in their AC.
For hypoglycemics we are taught that if they are are able to swallow, we can give them some orange juice to drink if there sugar is low. Better than putting in an IV and running the risk of extravasation or hyperglycemia if we push Dextrose.
Our state hyperthermia protocol actually does allow us, if the patient is alert and oriented, to "give small sips of cool liquids."
Many people don't know that.
I always carry extra water with me in the ambulance. On hot days I even carry a cooler of ice and water. It comes in handy.
We pick up a schizophrenic man who has been shouting at his demons. “Would you like a cold bottle of water?” I ask. Talk about an immediate way to civilize someone. The British had tea. We have water. We toast each other and chat on the way to the ED.
Have some water with me. Works like a charm, although one patient did pour it all on top of his head.
Woman sitting on a bench in the sun waiting for the city bus has trouble getting up. She's alert and oriented, but diaphoretic and very tired. Here drink this.
It's not quite like the TV commercials where Bobcat Goldthwait eats a Snickers bar and turns into Mariah Carey, but it works. She perks up.
Everybody loves cold water.
Homeless person fell and cut their knee. We clean and bandage it up. He doesn’t want to go to the hospital. Okay, he is alert and oriented. Thank you for your signature on the refusal. “Would you like a cold bottle of water? And how about an apple? You have a bad tooth? Take an orange instead.”
Yes, sometimes we carry fruit. I don’t let them eat on the way to the hospital. I’m not that radial yet. Maybe after I get the water added, I will ask for fruit.
It’s not like we don’t let some patients eat and drink. Hypoglycemic? Have some orange juice. How about a peanut and butter jelly sandwich?
We have a big homeless population in Hartford. They are all hungry. Maybe some day I can give them crackers to eat while we wait in the triage line. I confess sometimes my partner and I take turns going into the EMS room to get some fruit and crackers for ourselves while the other waits with the patient for a nurse to call our turn to come to the desk. Our patients are hungry too.
Every morning we stop at Cumberland Farms. They give us free coffee, tea or soda. It normally costs 99 cents. I don’t feel comfortable getting stuff for free so I always buy something to go with my free drink. Lately, I buy a bag of ice for $1.99. I put the ice in my cooler which is filled with water from the case I bought at the Stop and Shop the night before for $2.29. On baking hot days, with the sun beating off the blacktop, my partner and I are water philanthropists. Ed Newman has his prize patrol. Bill Gates writes checks all the time to deserving charities. We drive down the street on 90 degree summer days with an eye peeled for people who are sweating, tongues hanging out, trying to find shade in the tiny shadow of street posts. “Hey!” We shout. We lean out the window and hand them glistening cold bottles of Aquafina. “Have a good day! May the force be with you Peace be with you!”
Talk about a feel good treat.
And good public relations for your service, too.
Sit down with your medical advisory committee and work out a list of who it is okay to let have a drink of water.
It’s a kind gesture.
