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Interviewer: It's an end-of-the-world scenario. What medical professional would you want on your team? We'll examine that next on The Scope.

Announcer: This is "From the Frontlines," with emergency room physician, Doctor Troy Madsen, on The Scope.

Interviewer: All right. I'm going be the first to admit that this episode probably doesn't necessarily have any useful health advice in it, but it's more of a fun podcast to do since Halloween is coming up. And I was wondering in the event of an apocalyptic situation, whether it's zombies, robots, or aliens, if we found ourselves in an end-of-the-world sort of scenario, what kind of medical professional would you really want to have on your team? And I would think that perhaps an emergency room physician might be a good one to have.

We're with Dr. Troy Madsen, who happens to be an emergency room physician at University of Utah Health Care. So who should I have? I mean, I've heard some different kind of arguments. One person said an OB/Gyn because they have the basic medical experience and also can deliver babies. I've heard EMTs because they have that kind of in-the-crisis, sort of being able to stop the bleeding sort of a situation. Or an emergency room doctor. What do you think?

Dr. Madsen: Well, here, I've got to be careful because I'm clearly biased. I mean, there's no question about it. And I know you know what you think I'm going to say and I'm not going to going it. I'm not going to say, "ER doctor." Although I think an ER doctor would be great in that scenario because we are trained in all different fields. I'm going to say a family practitioner because they can deal with the emergencies. They've had some training during their residency in dealing with emergencies. And I'm not only going to say a family practitioner. I'm going to say a rural family practitioner.

Interviewer: Get very specific here.

Dr. Madsen: Someone who works in a rural area who does minor surgeries, who does OB, they deliver babies, they do that sort of care, they deal with emergencies, they take emergency call, they do pediatrics. Because sometimes in family practice, people may become more specialized to where they're just doing clinic stuff but this is the one I want. I want a rural family practitioner in that scenario not only because of their training but because they're experienced to handle all these sorts of different things. I think they'd be a great person to have in a zombie apocalypse to take care of whatever ails you.

Interviewer: I guess I didn't consider that because we worked at a large academic medical center where, like you said, people really do specialize.

Dr. Madsen: We do.

Interviewer: And they still have to go to medical school, but they've spent the last 20 years of their life dealing with one very specific thing and probably could get the job done. But a rural practitioner, they don't have backup.

Dr. Madsen: They don't.

Interviewer: They don't have a specialist.

Dr. Madsen: They don't. If they have to get backup, they have to send them on a flight for two or three hours or they have to get them in an ambulance. So they know how to deal with this stuff. And I'm a little biased because I grew up in a small town of fewer than 10,000 people and I heard the stories there from some of these old coal camp doctors in the coal mining towns. And these guys were basically the kind of guy you'd want in the zombie apocalypse.

They would tell stories about miners coming in after head injuries and pieces of their brain sticking out. They couldn't transport these guys. They would just cut off part of their brain and stick the skull back on. And the guys were okay. They survived. They would deliver babies on people's living room tables. So these kinds of old school cowboy types, family practice types in rural areas that we certainly still have out there in a lot of these very rural communities, that's what I want in a zombie apocalypse. They . . .

Interviewer: That's who you want on your team.

Dr. Madsen: That's what I want on my team.

Interviewer: What about a vet, a veterinarian? There are sometimes these shows that have these scenarios where like, "I'm a vet." But they manage to get the job done.

Dr. Madsen: Yeah, I guess if you want to be euthanized or get immunized, you could get a vet. I'm just kidding. No. I think . . . yeah, I mean, it's funny because I once knew a vet, a woman who was in vet school and she said that . . . she made the argument that vets should be able to also care for humans because they care for all other species. Maybe there's some truth to that. I don't know. I mean, they do have a very wide skill set. Quite honestly, vet school is harder to get into than medical school. These are very sharp people.

Interviewer: And the basics are the basics, right? If something is bleeding, you stop the bleeding the same way, right?

Dr. Madsen: Yeah.

Interviewer: If something is giving birth, that kind of all gives birth in the same way, right?

Dr. Madsen: Exactly. I mean, I'm not going to go on record to say I necessarily want a vet over a family practitioner in a zombie apocalypse, but there's something to be said for . . . they have a very wide skill set, they may deal with all kinds of species.

Interviewer: All right. Let's hope that this scenario never comes true.

Dr. Madsen: Let's hope not.

Interviewer: No robots rising.

Dr. Madsen: Yeah, exactly.

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Scot: Halloween's coming up. That means we're going to see an increase of bites no doubt in the ER. Here with Dr. Troy Madsen emergency medicine of the University of Utah Hospital. Do you see more bites like from the werewolves, the vampires and the zombies around Halloween time?

Dr. Troy Madsen: You know, I don't know. I'm working Halloween this year so I'm really curious what I'm going to be seeing that day.

Scot: All joking aside though I thought this would be kind of a fun way to talk about bites.

Dr. Troy Madsen: Yeah.

Scot: You know, so a werewolf could be a dog.

Dr. Troy Madsen: That's probably the best comparison.

Scot: Vampire could be a vampire bat I suppose.

Dr. Troy Madsen: Yeah, yeah. Some sort of bat.

Scot: I don't know what a zombie would be though.

Dr. Troy Madsen: See I'm going to have to compare a zombie to a Komodo dragon just because I imagine the zombie bite is the absolute worst kind of bite you could get.

Scot: Yeah.

Dr. Troy Madsen: So if I were to pick one sort of bite out there that's just a horrible bite to have, just nasty that's just going to do you in and make you one of the walking dead it's a Komodo dragon.

Scot: All right, let's talk about bites for a second. Let's say you get bit by a dog for example.

Dr. Troy Madsen: Yeah.

Scot: What's the major concern that somebody should have immediately after that?

Dr. Troy Madsen: So the immediate concern right afterward is, you know, just the bleeding. Making sure you stop the bleeding, hold pressure on there, make sure there are no issues with that. Once that's under control then the next big question is does it need to be repaired? Is this a laceration that needs to be sewn up and if it's a gaping thing, if you've got a lot of tissue coming out of it, if it's on your face, if there are cosmetic issues, that's something that needs to be sewn up.
One of the big things for me in the emergency department is do we need to worry about rabies? Now if this is a dog, let's say a werewolf in this situation-

Scot: It is a werewolf.

Dr. Troy Madsen: It is a werewolf, that's what we're talking about here. Absolutely with a werewolf you would be concerned about rabies. And since, you know, you may not get bitten by a werewolf the next concern would be a dog where you just don't know anything about the dog. Those are the situations where we get concerned and we give the rabies vaccine. We make sure you have a series of shots. It's I think down to four shots now. I think it used to be a few more and you hear all kinds of horror stories about rabies vaccines. I've heard people say, "Well, you have to get it injected into your stomach," which sounds awful. That's absolutely not the case.

Scot: Not the case?

Dr. Troy Madsen: No, it's not.

Scot: It used to be the case?

Dr. Troy Madsen: I don't know, not since I started practicing.

Scot: All right. That's good news.

Dr. Troy Madsen: But maybe years ago because that sounds miserable. But yeah the rabies vaccine is not that bad but we give it as a precaution because if you get rabies you can't cure it. It's a horrible thing and it'll kill you.

Scot: All right bite number two that you might get around Halloween, blah, vampire.

Dr. Troy Madsen: That's right.

Scot: What happens if a vampire bites you?

Dr. Troy Madsen: So a vampire, you know, vampires are bats so I think the best analogy there is a bat bite.

Scot: Okay. Do you see a lot of bat bites?

Dr. Troy Madsen: We don't. I very rarely will see one and you know kind of the weird situation is we'll actually see cases where a person wakes up in their bedroom and there's a bat in the room. And this is really interesting because the US Centers for Disease Control has said, "If you wake up and there's a bat in your room you need to assume you've been bitten."

Scot: They made a statement on this.

Dr. Troy Madsen: They have made a statement.

Scot: Okay.

Dr. Troy Madsen: And it's in their guidelines that you need to have the rabies vaccine. Again, it's getting back to that whole rabies thing and that's our big concern with bat bites.

Scot: The last bite you might get around Halloween time, zombie.

Dr. Troy Madsen: Yeah.

Scot: Be turned into the undead. And you compare that to a Komodo dragon.

Dr. Troy Madsen: Yeah, yeah. Komodo dragons. Obviously we don't see a lot of Komodo dragon bites.

Scot: Sure.

Dr. Troy Madsen: But if I had to draw the best comparison I could to a zombie bite I would say a Komodo dragon.

Scot: And why's that? Yeah.

Dr. Troy Madsen: Because it's just the worst bite you can get. It's amazing how much bacteria Komodo dragons have in their mouths. These locations where they actually have wild Komodo dragons there are reports- I mean that's how they kill animals with just the amount of bacteria in their mouth. I mean there's the force of their bite but they're mouths aren't really that big, but they bite these animals and these animals have severe sepsis, like severe bacterial infections and will often die within hours.
So if we were to ever get someone say from the zoo, if you had like a zoo handler that came in after a bite, man, I would give him every antibiotic I could. I'd have him IV antibiotics, admitted to the hospital, because these things are awful.
So Halloween's coming up. Be safe. Watch out for those werewolves, vampires and zombies. And if you do happen to get bitten, I'll be waiting for you in the ER.

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