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.”

“Why?”

“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.”

OK, time out. FUCKING TIME OUT.

WRONG. WRONG. WRONG!

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.

Another unhappy taxpayer

In another story this week in idiots and groceries, this Oroville, California man is angry at firefighters for getting groceries on duty. He is in particular mad that the firefighters preferred to shop at a much cheaper store farther away from the station. I suppose he prefers, well, you know what – I don’t even know what he wants. I’m pretty sure no one cares what he wants anyway.

I love how “taxpayers” love to use “paying taxes” as an excuse to do and say whatever they want like “I pay your salaries” to emergency crews and especially cops (as well as other government employees). I also love how every single time such a person goes on his/her rant, s/he is making it sound like s/he is footing the bill of one employee’s salary as if s/he’s paying the ENTIRE salary by him/herself.

I mean, let’s say I own 100 shares of Google stock. (If I did, it obviously wasn’t because of this civil service salary. Note to angry Oroville man.) Try as I may, no one is going to take me seriously if I go on some rant and demand Google do what I want them to because I own Google stock.

Eat a dick.

Anyway, it’s almost hilarious to me that near the end one firefighter pretended to apologize some more and then offered to tell him where and how to file a complaint before asking if there was anything else they could do for him, like he did it all on purpose just to poke the bear some more, all while appearing extremely professional.

Guess who abuses 911 even more than civilians?

You shouldn’t be surprised.

Readers from San Jose, California have brought to my attention this piece from NBC Bay Area’s Investigative Unit, which aired recently about a clinic 213 yards away from an emergency room belonging to the same health system on the same campus AT THE SAME ADDRESS that routinely used 911 as transport instead of just pushing a wheelchair or a gurney over there.

Obviously, those of us who actually work 911 already know that this isn’t really that out of the ordinary. Clinics are some of the worst abusers of 911, along with doctors’ offices, drug rehabs, nursing facilities, staffed elderly living facilities, psychiatric group homes, homeless shelters, schools (where they have nurses), jails (where some even have doctors), etc. When confronted and asked to explain themselves, they always use as their excuse “liability” and “protocol.”

Civilians abuse/misuse 911 too, but they’re civilians, and we don’t expect them to know any better. People who know better don’t misuse 911; they abuse 911.

One of the best parts of the story has got to be Dr. Jeffrey Arnold, the Chief Medical Officer at Santa Clara Valley Health and Hospital System, who claimed with a straight face that he had no idea this was going on at the clinic. He also attempted to shift the blame onto EMS by, more than once, saying that someone could have said something sooner to “medical leadership here,” which is completely laughable as we all know this type of stuff has been plaguing all sorts of EMS systems for a long, long time without anyone in management actually doing anything about it no matter who we in the field complain to, including the press. Watch this story lead to exactly zero improvements.

“I think taking somebody by ambulance is the safest way to transport them,” Dr. Arnold insisted. “It is very typical for large health systems, large campuses, to use 9-1-1 to call for emergency assistance. It did not register as something unusual.”

Except most of these calls are not for emergencies and staff could have just walked them over to the ED, assuming the ED needed to be involved in the first place. I mean, I don’t take an armored car to the bank to deposit money even though it “is the safest way” too; I drive myself. Sometimes I even walk.

I wonder what the ED staff would say about all this. That particular ED is very busy even without this flood of non-emergencies and is so infamous for 2-hour destination delays for ambulances that crews would do anything and everything to avoid transporting patients there.

Now, the EMS director for the county did not respond to questions from the Investigative Unit, and I think that is a huge missed opportunity. Santa Clara County’s EMS Agency even has what is known as EMS Reference 808, which is a document they wrote specifically as a guide for such facilities to interfacility transports. It’s certainly one of the more detailed documents on the subject, and the fact that they even have one is slightly uplifting and somewhat surprising considering the general wussiness of EMS managers everywhere.

Download (PDF, 343KB)

Now if only bureaucrats everywhere would grow some balls and stop giving us so many reasons to dismissively roll our collective eyes at the status quo.

Commissioner Carey: Go pound sand

Speaking of other idiots

A super smart Seminole County, Florida commissioner named Brenda Carey is up in arms about firefighters getting some groceries while on duty.

brendacarey

Let me make one more attempt to explain this: Emergency service providers AND THEIR EQUIPMENT stay together AT ALL TIMES so they can respond immediately to a call for service without stopping anywhere such as the station to pick up other crew members or equipment.

So, in other words, Ms. Carey, thank you for your useless opinion.

***Update #1: No disciplinary action considered.

***Update #2: Commissioner Carey is going the typical chickenshit politician “la la la la la la I can’t hear you” route.

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

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