Code 3 for fall/ETOH/back pain. It’s 4am and this Saturday night is just not getting any shorter.

I can hear the wailing as I climb up the stairs to the run-down apartment complex. This is going to be a bunch of bullshit.

Dirty apartment. Several children. No one sleeping.

“Hello, ma’am.”

“I fell and my back hurts.”

“I smell a lot of alcohol. Did you have a good night?”

Just trying to break the ice. Even at 4am. Your friendly neighborhood paramedic.

“I had a great night. Not that great after I got home.”

So she fell against a bookcase against the wall from a standing position. Fall is a really strong word for this from what they’re describing; more like backed into the bookcase. I inspect the undamaged bookcase. I look at her back. There is a little red mark on her back. She says her back hurts all over. Including the spine. Great. Huge emergency as usual.

“What hospital you want to go to?”

“I don’t want to go.”

“What? So why are we here then?”

At this moment it’s still a sincere and reasonable question.

“I called you guys,” her son speaks up.

“What for?”

Still sincere.

“I was scared. So I called 911 like I’m supposed to.”

Not sure where he got this fine piece of advice.

“Not necessarily. So what can we do for you then?”

Now it’s rhetorical.

“I thought you were going to help her.”

Help her with what exactly?

“We are. You call us, we take her to the hospital. That’s how it works.”

Like I’m going cut refusal paperwork on a drunk moron who fell down and has spine pain.

“OK,” the woman agrees to the transport surprisingly quickly. Thank god.

“I’m glad you’ve agreed, ma’am. Thank you.”

Much easier this way.

She is strapped to the longboard. This immobilization shit cannot go away soon enough. Fucking administrators and desk jockeys have no spine. (Oh hey, that’s a pun.)

“You’re an asshole,” the son bravely states, probably with some liquid courage.

“What’s that?”

Of course I heard him the first time.

“I’m sorry, but you’re an asshole.”

I love how people are just brave enough to insult us but not brave enough to leave out the qualifier.

Now 6 of us are no longer looking at the patient and are slowly closing in on him in this small apartment. The rest of his relatives and/or friends watch silently. Wise move, unlike numbnuts here.

“You don’t get to call us names. Especially at 4 in the morning. What makes me an asshole?”

He’s beginning to realize his mistake as our shadows grow on him.

“I, I don’t mean all of you. Just him. When he, uh, asked why we called.”

Still closing in on him.

“She didn’t want to go to the hospital. You wanted her to go. I talked her into going. She’s going now. Isn’t that what you wanted?”

“You didn’t have to be a dick,” he weakly insists.

“Alright dude, you got the result you wanted. Think about that.”

I stop advancing and remember that I just want this call over as soon as possible so we can all go back to sleep. We all stand down.

Since I’m such an asshole, we carry her down the stairs on the longboard. More unnecessary strain on our backs. The female EMT mumbles under her breath on the way down, “I guess we’re not taking any riders.”

We load the patient in the ambulance.

“Can I go with her?”

Wow, this guy is really an idiot.


“Called it,” says the female EMT with a big grin.

Proof that the pain scale is stupid

I’m at an autism spectrum disorder talk and someone pointed out that the Wong-Baker Faces pain scale does not work when assessing autistic children.

Without thinking, in a room full of multidisciplinary personnel, I blurted out, “I don’t think it works with anyone!”

The room instantly erupted in certain laughter.

That is my totally nonscientific, anecdotal evidence that the pain scale is stupid.

Not something I’d do, but…

Kenneth Hallenbeck, a Brevard County Fire Rescue firefighter/paramedic, was fired for flipping a patient off the gurney and criminally charged.

So, I am absolutely not defending Hallenbeck. I am merely pointing out that someone appears to be perfectly able to walk. The story alleges that someone was asked to get off the gurney at triage and refused. Hmm.

You three were absolutely wrong

Code 3 for abdominal pain. At the skilled nursing facility. Which is approximately 1000 feet from the ambulance entrance of the nearest ED.

Fucking kill me.

The fire crew and the 911 ambulance crew arrive at the same time, just slightly behind a private BLS ambulance crew, already unloading an empty gurney.

I think I know where this is going.

“Which room?”

“Uh, I don’t know. We didn’t call you.”

The staff politely insists that 911 was not called. But they ask around anyway.

After a few moments, “Sir, this way. Room 45.”

“OK. Thanks.”

It’s a few turns and a few hallways down. Guess who’s in front of us?

The private BLS ambulance crew.

“What room are you guys going to?”

“Room 45.”

Two nurses are in the room, and a staff supervisor arrives, noticing that there are just a few too many people responding to a patient who essentially just needs a ride.

“So who called 911?”

“I did.”

A woman in her 30s speaks up. She appears confused and near tears.

“They told me they called for an ambulance and it was going to be 20 minutes, so I called 911.”


“My grandma can’t wait 20 minutes! She’s in pain!”

Her grandmother is sitting in a wheelchair in the room, not in any apparent distress. She’s had abdominal pain for more than a day.

Perhaps sensing everyone’s dismay for the completely unnecessary, (wo)man-made, duplicate response, the younger woman who called 911 starts crying, “I’m sorry! I don’t want to get anyone in trouble!”

Why she thinks any of us would get in trouble is beyond me. Really, she should be asking if we fine people for this shit.

(Of course we don’t. EMS agencies have no spine.)

Perhaps because of the tears, the fire captain and the staff supervisor begin to console her, “It’s OK. You did the right thing. If it was my grandmother, I wouldn’t want her to wait either.”



The entire point of the private BLS ambulance is to run these very transfers from SNFs to hospitals. The SNF did what every oversight agency would LOVE for facilities to do but usually don’t – CALL AN APPROPRIATE PRIVATE BLS AMBULANCE TO TRANSFER THE PATIENT AND NOT A 911 AMBULANCE. The patient is obviously not in extremis. The ED is 1000 feet away. She could have wheeled her grandmother over there. The private BLS ambulance gave an ETA of 20 minutes, which is a perfectly reasonable response time for a private BLS ambulance, AND THEY ARRIVED BEFORE THE 911 CREWS ANYWAY!

This is exactly the time to say to her, “Yes, you absolutely should be sorry. You were impatient and did not want to wait. You called a 911 ambulance when a private ambulance was requested. You were being selfish and you are hogging scarce resources, scarce resources that other people in this city may need. You absolutely did not do the right thing. If it was my grandmother, I’d take the time to comfort her while waiting for the private ambulance instead of spending it tying up an emergency line talking to a stranger on the phone.”

But nooo, that wouldn’t be good customer service.

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

%d bloggers like this: