101 Things the Fire Department wishes you knew



Monday, January 19

...for the altered mental status...8:13


Finally getting to the good stuff on our busy day from long ago.

Nothing pleases your pal Happy Medic more than a family member who has been to Medical School at the scene of a call that has no emergency component. I wonder if they're forgetting all that expensive schooling or if they just get confused when it's Mommy who wants help.

THE EMERGENCY
A man has called saying his mother is complaining of general weakness.

THE ACTION
We have a code on our forms I know by heart. No Not PDAL - Alcohol Intoxication. It's the other catch all - GMWD General Medical Weak/Dizzy.
I'd say a third of my clients fall into this giant hole of a classification including my new friend 'Erma.'

A quick aside for those following along at home. When I use the name 'Erma' its more about describing her and her situation than just keeping her name private, if I could even recall it. No, Erma is an old teaching tool my Paramedic mentor Beemer used to describe my now favorite kind of patient: The elderly female with numerous general complaints that don't seem to add up to much, but none of the signs explain the symptoms and vice versa. You need to put on your Sherlock Holmes hat and get to work asking all sorts of questions just to figure out what makes sense and what is Alzheimer's poking through.

So back to the Erma I met today. Erma's son, the Doctor, is concerned his Mother has been neglecting herself and her health and requests we take her to the not so local ER for an eval. I love it when an Doctor tries to tell us what is going to happen at the scene. They are welcome to make recommendations and offer guidance but the minute they stop asking for things and start ordering things is when HM let's the lawyers in.

"May I see your Physician's ID, Doctor?" I ask when he tells use we should be starting an IV on the patient who is now wandering the house looking for her coat.
"Why do you need that?" he asks taking half a step back.
"I'm required by law to confirm you are indeed a Physician, then I must radio to my Physician at the hospital that you are taking over care at the scene. Only then can I work as a Paramedic under your license."
He looks from me to my partner, who looks up with a blank look and simply nods.
"Do your job, she needs care."
"From what we've been able to record when she's not evading us, Doctor, is that our services may not be needed in the capacity you expected. I'm more than happy to take her in to be seen, but please understand we have strict protocols in place for a reason and I'm simply following them."
"Then what protocol are you following now?" Ah, the point where we have to classify her into a pre-determined square has arrived. If I answer "Altered Mental Status", protocol calls for meds. If I answer "Stroke" I need to start a line and leave quickly.
Without missing a beat I tell him, "Assist a Citizen." The back door left open by those who have come before me which allows us to wiggle when needed.

"That's unprofessional, I want to talk to your supervisor." He points to me as if a referee will jump out and declare him the winner of our little confrontation.
"Fire Control, this is Medic Van 99, I need a Paramedic Captain at this location."
He can't believe I did it. I called his bluff. I know I have all the cards on this one and he was hoping I'd take the easy way out and just throw Mom in the van and go.

The Captain arrives and pulls me outside to get my situation first. Just inside the door the son tries to push the Captain around.
"I'll have you know your people here need to learn to follow instructions."
The Captain stands tall. "May I see your ID card please, Doctor?" and I smile.
"I don't see what the deal is here. Take her to the ER. I'm a doctor." He's starting to pace, a clear sign of frustration.
"Until you can ID yourself as a physician and speak with our online Medical Control Physician and assume licensure of my Paramedics, they operate under standing orders and from what I can see we don't have what your mother needs."
"And what's that?" The son asks.
"A family to help her through a rough patch. Medic 99, you're in service." He says over his shoulder and we await confirmation of the order. I want to jump out from behind the Captain screaming, "Take that Doctor Boy!" doing some king of victory dance, but i don't.
"Control this is Captain 99," he speaks into the mic," Medic 99 is in service on a No Medical Merit, I'll be on scene for a few moments assisting a citizen."

We cleared and monitored the radio waiting for the recall of an ambulance so we could jump the call, saving another crew a lot of frustration. We ran into the supervisor the next shift and he informed us the son wasn't actually a Medical Doctor, but just a PhD in mental health.
A good thing for his mother if he ever takes the time to help her out.

2 comments:

medicblog999 said...

Nothing much to say about this one other than..... I WISH I WAS THERE. My partner and I are cracking up with this post. What I would have given to see his face!
On a serious note, Kudos to your supervisor for backing you up so well. What turned out as a very positive experience for you could have so easily gone the other way if your supervisor had gone down the safe line and told you to do what the "Dr" had wanted, due to fear of a complaint!
Thanks for that post. Lol!

Firecap5 said...

I love it when people get told in a way that they can't complain about that they are indeed, wrong.

Nice job! Knowledge of your protocols has served you well!!