Keep Them Awake? - IAED Journal

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Keep Them Awake?November 28, 2017

Jeff Clawson, M.D.

Best Practices

Editor’s Note: This column was originally printed in the Letters to the Editor section of the Salt Lake Tribune on June 7, 2016.

Ever since we started watching movies, at least of the “talkie” kind, we have heard cowboy, after soldier, after cop, after ambulance driver, after bystander make the common statement about a victim, “Don’t let them go to sleep!” or they’ll die. Everything from slapping, to smelling salts, to cold water, to just plain cajoling them has been tried with some success on the silver screen. However, the fact that nobody “really” dies in the movies or television, doesn’t mean that it works. All the while this recurrent moment has simply created a monstrous urban and rural myth: Keeping a dying patient awake will prolong or prevent their death. In a letter to the IAED’s local newspaper the Salt Lake Tribune, Dr. Clawson “saves the truth” while putting this notion to a proper, and needed, death—all within the 200-word “Letter to the Editor” limit.

Blast

Let’s set a ubiquitous, medical legend to rest (“City worker to the rescue,” June 3). Time and time again, a lay helper or reporter mentions that an injured patient was “kept alive/saved” by keeping them awake—based on the myth that if the patient goes to sleep, they’ll die.

As an emergency EMS and 911 physician, I can unequivocally state that this just isn’t so. Whatever is going to kill the patient, happening inside their body, is not changed by urging them not to go to sleep.

With external or internal bleeding, shaking or urging the patient to “stay awake” can actually make the problem worse by increasing blood pressure, thereby pumping out more blood, which their body is working to preserve.

To help with “passing out,” the best help is keeping their airway open—no pillows behind their head, simply keeping their head tilted back—not forward. “Helping” grandpa with a pillow just hastens suffocating when he needs oxygen the most.

This happens all the time and is a common, silent killer happening well before the EMTs or paramedics arrive. Every 911 dispatcher knows this and will so advise when needed. It’s not “going to sleep” but what’s causing your unconsciousness that kills you.

Jeff Clawson, M.D.