101 Things the Fire Department wishes you knew



Thursday, March 5

...for the cardiac eval...


I've mentioned before the neat little trick our dispatch center uses to bump calls up and out of the call center fast. Many times before the call is properly coded. The idea is to get us moving and they can slow us down if it turns out to be nothing.

This is a rough translation of the information on my screen at 1:30 AM at Medic 99:

Units: E99, M99
6D1 Severe Cardiac Event

The patient is conscious;
The patient is not changing colors (clammy);
The patient is a first party caller;
The patient is not having trouble breathing;
The patient has a cardiac history;
The problem is: diarrhea

No, really. Diarrhea became a severe cardiac event when the patient stated they had a cardiac history. Gods I wish they would just ask the questions and tell me the answers.

THE EMERGENCY

A woman has called complaining of "Severe cardiac pain."

THE ACTION

For those of you not in the field, there are two amazing things about pre-hospital medicine that can not be explained by science.
First, deaths come in groups of three. Second, there is always a theme for the day. The theme for this day was abdominal pain.
Our patient is lying on the couch in her PJs, looking sick. Not Sick, just sick. I can tell a lot about how sick to your stomach you really are by your surroundings. I'm going to give away a few tricks of the trade here, so I apologize to my fellow caregivers.

  • If I walk into the room and you have a table covered in over the counter medications, an empty glass of water, tissues and a bucket near the bed, you are indeed sick and have run out of options.

  • If I walk in and you have yet to vomit, had one instance of diarrhea and want an ambulance to take you to the ER, you are not sick.

It is against the law for me to refuse this woman the ambulance, even after explaining to her that there is nothing I can do but give her an expensive ride.
"I have insurance" she fires back.
"And this is why insurance is so expensive. People use these services when they're not needed. If you want to go, let's go."
"Can you carry me, I feel so weak." Seriously?
"Of course we can, we just need to get all your billing information and make sure you have a ride home before we go."

The whole way in she never heaved, spit, groaned or rubbed her stomach. At least I was able to finish my chart uninterrupted.

And she was nothing compared to our "ABD pain princess" who we met just an hour later. More on her soon.

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