101 Things the Fire Department wishes you knew



Thursday, April 2

...for the man down...


I lay down all the time and no one sends a code 3 dispatch my way. With talk of dispatch centers adding incoming text messages to their arsenal of information gathering (Oh Gods NO!) these calls still come in and require a dispatch. What was better than the 911 abuse was that this man came with his own pre-hospital tracking system.

THE EMERGENCY

An out of area cell phone reports a man sitting in a parking lot against a wall, crying.

THE ACTION

We've all been there, right? Maybe your best girl left you or you had your iPod stolen and you break down and cry.
Well, this caller thinks you need an ambulance.

We arrive as the engine crew is standing in a half circle around our new friend, who's shirt is unbuttoned. No big surprise there, I often unbutton my shirt to cry, it usually makes people leave me alone.

As I approach to take a report I see electrodes on the patient but no cardiac monitor nearby. Hmmm...I think to myself, we didn't take that long to get here that he got a trace and put the monitor away. This needs further investigation.

"Gentlemen, and citizen, good evening, I'll be your Paramedic," and I lost my train of thought looking at the electrodes.

Written on the right shoulder electrode's white foam circle is yesterday's date and a unit number, Medic 88. On another is today's date and some scribbled initials and a familiar acronym for Saint Closest.

What was written on the third, you ask?

Nothing. And we left it that way. I've heard of this practice before and didn't like it much, but he demanded an evaluation by a physician and, darn it, it's against the law to tell him no.

At Saint Farthest I showed the triage nurse the electrode and she laughed telling me he must have pulled the old ones off because she did the same thing 3 days ago.

Har Har. This is just silly. Maybe if we were given the training and authority to assess and refuse this man an ambulance, he'll stop calling us for a ride across town.

4 comments:

Bitter Blonde said...

Wow. That pretty much sums up EMS as it is now, right there. Nice.

firefighter / paramedic said...

Like I tell all the badge bunnies and bright eyed newbies: We do 2 things. Life saving and heartbreaking. All day everyday.

...KMG-365, -Clear said...

Wow, it just boggles the mind how EMS and the ERs become the defacto place to turn to for EVERYTHING!

Sometimes in a situation like this, a little tactful conversation with the purported patient might incline him to appreciate the "non-seriousness" of his condition and maybe he'll reconsider and sign the waiver.

Not that I'm advocating that we "sway" patients into refusals; but there is a fine line between that, and letting the patient make a "more informed" decision.

More so than the scenario you posted, it is the street EMS folks who just knee-jerkingly transport anybody, anywhere and anytime. Now don't get me wrong, I know they have protocols and procedures to work under (I myself work part time for an ALS provider too), but when it is just so reflexive to "load and go", it actually shows the limitation of the critical thinking skills of some of our EMTs.

I almost think that there should be some policy that allows for a refusal with medical control input. For Example:

Ambo' arrives on scene, makes pt contact. Primary survey done, gets some Hx and does quick/focused 2ndary. Having assessed NO life threats present, a "low risk" patient Hx, and a benign secondary exam - the Medic assesses that this pt/scenario does NOT meet criteria for EMS transport. Said medic then contacts his medical control online, gives the pertinent data and then gets medical control's input.

Hopefully, medical control makes the same assessment that EMS transport is NOT required, and pt is to be advised that this Ambo' will NOT be transporting them to the ED. Pt is advised to seek other means for transport (...I'm not sure yet what this would be, I'm just thinking off the top of my head here...).

Now that I think about it, this sounds like the patient is receiving some type of "Emergency Medical Screening"....(!!!). After all, EMTALA says that once an Emergency Medical Condition has been excluded, at that point, the obligation for further treatment or care is not mandated.

I am also not sure if EMTALA makes statement to "where" that medical screening can take place? I mean, what if you have an Emergency Medicine Resident (a licensed MD) on the truck...can they perform a MSE on scene and then deny AMBULANCE transport?

Hmmmmmm....

Good Blog!
"KMG-365, Clear"
http://bemetweb.blogspot.com/

The Happy Medic said...

KMG,
Absolutely you are suggesting we sway patient's decisions...towards the right thing to do. So many people call thinking we are simply a ride instead of a highly trained evaluation team.
I know who needs an ambulance and who doesn't, that's my business and I'm good at it. Most are.
I know who needs to see a doctor and who doesn't.
What I don't know is what the Doctor will do once the person gets to them.

Imagine I called a tow truck every time I made a wrong turn and asked them to just tow me to where I needed to go. I'd be laughed at. What if I told the tow truck driver that I just wanted a mechanic to "Check things out." Again, laughed at.

We need a big change (buzzword of the year unfortunately) in the way our service is dispensed and handled and I think the online community will prove a strong base for just such an effort. Keep your eyes here for updates on just such a change in the months to come.

Thanks for reading,
HM