Nut in charge of nuts

Code 3 for suicidal subject. It’s 3am.

We arrive at the residential psychiatric program. Same place as the other night, but different staff. Obviously the B-team.

“She left already.”

“Huh?”

“We put her on a psych hold and called for a private ambulance.”

“So why are we here?”

“She was tired of waiting and called 911.”

“Let me guess – it probably took no more than an hour.”

“Less.”

“So it’s like people calling 911 from the ER waiting room.”

<Silence>

“And you did nothing to stop her from calling 911.”

“They have their own cell phones and we can’t really take them away.”

“You do realize how stupid this sounds right now, no?”

“We’re not supposed to handle their private property.”

“You really think that’s a super-critical policy that you should totally follow without question?”

<Blank stare>

“And once the ambulance came and left, you didn’t think it’d be a good idea to call 911 back and cancel us?”

“Sorry.”

I’ve noticed that the nut houses tend to be staffed by other nuts.

As I’ve said before, with all due sympathy to psychiatric problems, as far as EMERGENCY medical services are concerned, fuck psych calls and psych facilities. All of them. All these “I wanna kill myself” calls can be handled by a pat-down and a van with child locks. Sending a 911 ambulance for these calls is like burning down your house because you saw a hairy spider. Anything less than an actual self-harm call with an actual injury or overdose or whatever, we should not be responding to them. Period.

His knee hurts too

Code 2 for not feeling good. At a street corner. Late at night.

We don’t see anyone on the corner, or any of the other 3 corners.

“Alright, I guess just come around the block, take another look, and call it good.”

We nearly get a full block away when some guy on a front porch waves at us.

“Shit, it’s the goof house.”

Of course. It’s a nut at the nut house. Who can’t even get the location right. He was the one who called. He’s in his mid-20s.

“What’s up?”

“I don’t feel good.”

“Uh huh.”

“I’m shaky.”

“OK. I don’t see you shaking.”

“I have a headache.”

“So do I, thanks to you.”

“I feel like I’m going to die.”

“I’m going to tell you right now that you are not going to die.”

“But I’m scared that I’m dying.”

“You ain’t dying.”

“I’m sad.”

“You want to hurt yourself?”

“No.”

“Mm hmm.”

“How long have you been sad?”

“A month.”

“Oh dear lord.”

A staff member comes out.

“I didn’t even know he called you.”

“He wants to go to the hospital.”

“He has that right.”

“Yeah, but is it appropriate?”

“No.”

It’s stunning that this staff person actually said no. She’s over-qualified for this position.

“He said he doesn’t feel good. For a month.”

“First I’ve heard of it. The doctor and the psychiatrist come every other day.”

“So we can leave him here with you?”

“Yes.”

“Alright dude, go back to bed.”

“You’re supposed to be the ambulance!”

“And you’re supposed to be staying here with these nice folks and following their directions and not sneaking out of the house and calling 911 for no reason.”

“But my knee hurts!”

“OK, man, now you’re getting into the nonsense territory. In fact, I’m pretty sure you’re just making stuff up at this point. No one at the ER is going to actually do anything for you. Let me go further and go out on a limb here and tell you that I’m certain they don’t want to see you. And not to mention how unhappy they will be with both you and me, not that I care much how they feel about me. But you, my friend, you don’t want them to be unhappy with you. My suggestion is you get a good night’s sleep and listen to these people here.”

No one called us back from that address for the rest of the night.

Part of the job

Code 3 for intoxicated subject.

The cops have a very dirty young man sitting on the curb, handcuffed. He is drunk, and he is being a total asshat. He keeps asking why he is being detained. For a moment, he looked homeless.

“This guy was sitting in front of a stranger’s apartment, completely naked, covered in shit. We somehow got him to put his clothes back on.”

Two of the 3 cops are not wearing gloves.

You guys actually touched him? My god.”

He is probably not homeless. He looks like just another college student who didn’t know when to stop. It’s just that the poo caked all over his feet and hands are kind of dried up in the way we only see in homeless people and neglected old people.

It is so gross that we actually bag his hands and feet.

“I’m sorry,” I offer my partner.

“It’s part of the job,” he maturely replies.

Then it hit me. IT IS SO NOT PART OF THE JOB! And it absolutely does not have to be. How is it that people’s unbelievably bad behavior is just par for the course? When did it become just another day when some asshole spits blood in our direction? Why have I not ever ended up pressing charges against combative drugged-up scumbags we are forced to fight when they get squirrely?

Just complain and don’t do anything

I read a couple of items about anti-frequent flyer programs and community paramedics the other day. Now, just like any other new idea, of course there is no shortage of resistance.

There was some discussion that centered on concern that the Fresno, California program would lead to some repeat caller who is legitimately sick with serious chronic conditions (like repeat episodes of hypoglycemia or COPD exacerbation) being denied care or transport. I don’t buy that at all. I may sound all grumpy and dismissive on this blog, but I can tell you even the most cynical medic doesn’t think 911 abuse when s/he finds an actual sick person. Even if it’s the same person. Besides, Fresno blacklisted only 8 people in 3 years. Sounds pretty careful and judicious to me.

Now let’s look at the California Nurses Association. They – surprise, surprise – oppose community paramedics, claiming safety concerns because paramedics are too stupid to do it and people are going to be dying left and right as a result. Listen, California Nurses Association, I have met many of your folks, and while most are competent RNs, many are forever complaining about why paramedics are bringing patients to the ED and generally failing to display any sort of sense. The irony is fucking delicious that you oppose the concept of trying to reduce 911 calls and ED visits. Like any profession, you have your share of idiots too, especially in such non-ED settings as Not My Patient Skilled Nursing Facilities and everyday clinics (and this McDonald’s). That’s not even including all your visiting and hospice and advice and school and jail and dialysis nurses who call us for the absolute dumbest fucking bullshit.

And what have YOU done all these years to reduce repeat 911 callers and repeat ED visits other than give people such shitty discharge instructions as “call 911 if you don’t instantly feel better” and “come back when you need your band-aid changed”?

Saddest thing I’ve seen in a while

Code 3 for stroke.

An elderly man is supine on a bed. His family is there, and they’re the historians since the man is baseline non-verbal but clearly has as good an understanding of his surroundings as anyone. They say they called because he was “weak” and unable to sit up.

It’s quickly obvious that he isn’t moving his right arm or right leg.

“Does he usually move his right arm and leg?”

“Yes.”

“Fully?”

“Yes.”

“So when did he stop moving that side?”

“Yesterday morning.”

I don’t even bother asking why they didn’t call 20 hours earlier. It’s not like their answer, in the unlikely event that it isn’t “I don’t know,” regarding this at-one-point-potentially-reversible devastating disability is going to make anyone happy anyway.

One by one, I ask him to move each extremity. When we get to his right leg, everything appears motionless as he tries and fails, and when he realizes this, he then lifts his right leg off the bed with his left foot.

It is almost surreal.  Definitely poignant.

You should wear a helmet but you don’t have a brain anyway

Code 3 for fall.

So there’s a ladder on the ground. Looks like some guy fell off of the ladder.

Apparently, this person thought it a good idea to rest his ladder against a rolling metal gate, the type commonly found in driveways, while he was doing some work high off the ground. rollinggateObviously, when a car triggers the sensor, the gate opens.

Except this guy’s ladder was resting against the gate. So, as the gate opened, the ladder fell, and he fell with it.

Normally, this would be the end of the story. This guy, however, insists that people were “messing with” him by opening the gate.

“Dude, just let it go.”

You call, we haul. Now get in the friggin' ambulance.

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