An elderly gentleman meets me at the door, and politely asks me how I’m doing. He calmly and pleasantly explains that his wife had a full-body seizure that lasted 1-2 minutes in her bed. She is post-ictal, non-verbal and slightly combative in a grabby kind of way. Nothing too unusual about it. We get what we can for our assessment with her unintentionally resisting.
The son, who looks to be in his 40s and reeking of pot, is being an idiot. He asks us to let her be, unhappy with us applying a minimal amount of force to get vital signs and a fingerstick. He doesn’t know much about his mother’s history; her husband provides us with it.
And then, referring to her grabbiness, the son says, “This is unusual for her after a seizure, and that’s why I called.”
“When’s the last time she had a seizure?”
“Oh, like 10 years ago.”
“And how often does she have seizures?”
“Very rarely.”
OK, so basically he has no basis for saying that her combativeness is unusual. Furthermore, combativeness is a fairly common post-ictal finding. So consider this: when someone has a medical emergency, is there a reliable family member present to provide responding crews with reliable information, or is there just a pothead making noises with his mouth?
December 12, 2009 at 5:07 am | Stories | No comment
One of the questions that gets asked a lot on calls and at hospitals is, “How bad is your pain on a scale of 1 to 10, with 10 being the worst?” I don’t really like using it unless we’re talking about legitimate chest pain or discomfort because upwards of 95% of the time, the answer is “10.” OK, so your cut finger is a 10? So what is it when I chop your hand off?
I see the value of this rating in situations that involve comparisons, such as administration of pain medication. Number gets lower, pain medication works. Otherwise I don’t see much use in it.
Now, in response to this question, a lot of people say “11.” And I just look at them and wonder how early in life they failed out of 1st-grade math class. Sometimes, they say “20.” In any event, the ones who give me these numbers are usually the ones who are the biggest pussies.
The other day, this lady screaming with back pain gave us “100.” I have to admit that I’ve never heard 100 as an answer, which made me laugh, even though I believed that she was genuinely in pain.
One of the dumbest questions that I come across on a regular basis is actually something nurses like to ask when we get to the ED.
“When did they call you?” Referring to when patients called 911 for medical assistance.
Well, obviously, the answer is, without fail, pretty much just before we arrived at the ED. Is there another answer? Just what do they think we do after we show up at someone’s house for a medical call? Put the patient in the ambulance and go watch a movie? Or do they think we need a few hours to arrive on scene after the 911 call?
Based on my dealings with them, nurses, even ones that work in EDs, generally have a poor grasp of EMS, much like the general public.
September 15, 2008 at 10:32 pm | Soapbox | No comment
Code 3 for the unconscious at a pool at an aquatic club.
An 9-year-old boy is lying on an exam table in the first aid station, and he says he feels fine. He looks alright. He tells us that he swallowed some water during a lesson, and then he didn’t feel well. When he left the pool with a staff member he threw up some water, along with some breakfast. He’s not sure what happened next, but the staff member says the boy then collapsed onto the lawn right in front of him and had to be carried into the first aid station before he began to become responsive again.
Sounds pretty straightforward – just about any parent would agree to go to the ED with us in this situation. Or so I thought.
I realize, quickly, that his mother is the subservient type who can’t make a decision to save her life. Her son tells her he’s fine, so she says he’s fine.
“Yeah, well, everyone feels fine after they wake up. It’s the passing out we’re concerned about. People don’t just pass out for no reason. Strange things happen to kids at pools. If we were comfortable with you not going to the hospital, we wouldn’t stand around trying to convince you otherwise.”
Indeed, drownings, near-drownings, secondary drownings are very serious incidents. A few months ago, there was a much circulated story about a boy who drowned in bed hours after getting out of the pool on his own. My partner also mentions another similar incident around where he lived where a boy was found dead in bed after being brought home by his parents after swallowing some water at a pool.
“It’s OK. I’ll just take him home.”
I don’t think she understands much. She speaks English but not very fluently.
She ends up calling her husband, who doesn’t want him to go to the ED. I end up on the phone with him, and he questions me about everything that happened to his son, as if I was there to witness it. He also seems very intent on verifying that his son did not have a seizure, as if that was the only thing in the world that would cause a loss of consciousness. I relay to him what the staff told me and now he wants to talk to the staff, as if they’re lying about the event. People always say not to judge anyone, but in the 2 minutes that I was on the phone with him, I decide that this guy is a domineering creep who thinks he knows everything. It’s always interesting how people know your job better than you do. For instance, homeless people always know my job better than I do.
I apologize to the staff as I hand one of them the phone for the interrogation. After he talks to the staff on the phone, he speaks to his wife, who tells us that her husband just told her to bring the boy home.
“He said our son is fine.”
“How does he know? He’s not even here!”
“He’s OK.”
“Will you at least drive him to the hospital yourself? We’d have no problem telling you that he doesn’t need to go to the hospital if that was the case.”
“I’ll just bring him home.”
Frankly I don’t really directly care what happens to this boy. It’s not my son. I’m not going to miss him if he dies. I’d like to think that his parents feel that they should do everything for him to ensure he’s happy and healthy, but people make stupid decisions all the time. That being said, indirectly, I care very much about what happens to this boy, and here’s why:
1. There’s more paperwork when we don’t transport than when we do.
2. I’m going to have to document the hell out of the parents’ refusal of transport. Why I have to write a bunch of stuff to protect myself when I’m not the one being stupid is a constant source of frustration, given the sheer amount of stupidity everywhere.
3. If anything bad happens to him, a lot of people – from the State to my supervisors AND everyone in between, family or not – are going to want to know why we didn’t take him to the hospital. And the explanation that his parents are stupid and decided – against professional advice/nagging – to not bring him to the ED just doesn’t seem enough. I suppose it’s difficult to tell the parents of a dead child that it is all their fault, even if it is in fact all their fault.
My partner goes outside to grab some paperwork. I turn around to call the base hospital.
“XXX Base. Dr. YYY. Contact time 12:45.”
“Hi, this is unit ZZZ with an AMA call.”
AMA stands for Against Medical Advice.
“Sounds like that’s all I’m doing this morning.”
“Sorry, doc. This is an 9-year-old boy who swallowed some water at a pool, said he didn’t feel well, and then vomited some water. After that he collapsed in front of the pool staffer that was with him and had to be carried into the first aid room. The staffer described a loss of consciousness. He’s alert and oriented now. His vitals are…”
He interrupts me.
“I will not in any way, shape, or form consent to this AMA. Take him to the ED, and get the cops if you need to. I’ll even talk to the cops if they have any questions. This kid needs to go to the hospital.”
“Yeah, the parents are adamant about not going. I’m kinda glad you said that.”
“Re-contact if you have any problems.”
“Thanks. Incident number is XXXXXXX and the pt’s last name is YYYYYYY.”
Great, now we have to break the news to them. The mother I can handle, but I just don’t want to talk to the father again, asshole that he is. Somehow my partner ends up with the phone with the father on the other line, trying to explain to him how the base physician is concerned enough about his son that he is ordering that we bring him to the ED no matter what, and how it would be easier for everyone if we just left the police out of it. He acquiesces, but of course not without a bunch of ranting and raving.
“The whole health care system is broken!”
“I’ve been all over the world and this country’s got the worst doctors!”
“Everyone is overreacting! This is so unnecessary!”
“What are your names?”
Anyway, we end up at the ED without much fuss, and the father shows up, ostensibly from work. He looks like an arrogant, overbearing jackass. And then he opens his mouth and confirms it as he starts talking down to the nurse.
“Is there a doctor that’s going to come see him? I think this whole thing is completely unnecessary, but in any event, I want to know about every test that’s going to be performed on him and why it’s being performed!”
There are a lot of paramedics who are so burned out that they really don’t give a shit. About anything. I’m not sure exactly how burned out I am, but I’d like to think that I’m responsible. I’d like to think that I have a healthy fear of being in trouble and losing my license. I’d like to think that when I’m on a call, people can rely on me to make sound decisions, medical or not.
In this case, my partner, with more than 20 years of solid experience, and I could have just turned around and walked away with a signed AMA form, without the headaches and the condescension. We could have been back at the station napping or watching TV or reading a book. The boy would probably have been fine afterwards anyway, but it wouldn’t have been completely impossible for him to have a negative outcome. This wasn’t a cut finger or a stubbed toe. We could’ve made his parents happy at the pool even if it meant grief for them later on. But I don’t work like that. My partner doesn’t work like that. And apparently the base physician doesn’t work like that either. Even though it’s not my child, and I don’t really care about him per se, I’m interested in being responsible, especially when his parents are being irresponsible and intransigent, and I see this as my job.
I’d like to think that people who call 911 know that they can rely on this simple fact, but after being abused constantly, many of us just don’t care anymore, and as a result make poor decisions, leading to negative outcomes. These parents are fortunate to have a crew that, despite the burnout, is trying to be responsible for them and trying to nudge them towards good medical decisions for their son, but they don’t realize that. This is nothing new; we’re surrounded by ingrates. This is just a big “fuck you” in different words. In many ways, these people are no different than the drunk homeless dipshit on his third ambulance ride of the day.
Code 2 for the person who can’t stop urinating. At 4am, of course. Besides, if you can’t stop peeing, why would you want to be on a gurney where you certainly can’t pee anywhere but on yourself? Can’t wait to get to this one…
Dude in his 30s opens the door and walks to his kitchen counter, where he was eating.
“What’s wrong?”
“I can’t stop peeing. I keep having urges.”
“How often do you pee?”
“Every hour.”
“That sounds pretty normal to me… Any prostate problems?”
“No.”
“Are you thirstier than usual? Eating more than usual?”
Of course I think to myself how dumb that question could potentially be since he was eating as we walked in.
“No.”
“How long have you been peeing a lot?”
“Two weeks.”
“Two weeks? So why call now? What’s different?”
“I’m peeing every minute.”
“We’ve been here a few minutes and you haven’t had to pee… You have 3 cars out front, why did you call an ambulance?”
I don’t talk people out of ambulance transports, but this was just too stupid.
“I didn’t want to wake my family up.”
But apparently it’s OK to wake the 4 of us on an Engine Company, and the 2 people on the ambulance. Six people have to get up for you because you can’t stop peeing.
“Well you could’ve asked them for a ride earlier in the day, you know…”
He starts walking all over the house, looking for his family, who probably, just like us, wishes they were somewhere else. His uncle pops his head out of one door.
“Hey guys, I’m sorry. I told him to just wash it off with soap and water but he insisted that I call you guys. His friend here is going to get taken to psych services.”
“Great.”
Dude walks up to us and tells us that his best friend bit him.
“Where did he bite you?”
“I’m not sure. I think in the legs.”
“What do you mean you’re not sure?”
“Well, I was trying to restrain him. He’s got psych problems.”
Sigh.
“Drop your pants then.”
“Are you guys up?”
It’s 3am. This jackass thinks we don’t sleep. AND he calls us out for this bullshit.
“Just drop your pants and show us where you think he bit you.”
Superficial bite marks.
“Just wash it with soap and water, like the officer said.”
“I just wanted you to check it out. Can you wrap it or something?”
“It doesn’t need to be wrapped. It needs to be washed though. Do you want to go the hospital?”
We arrive at a pizza place, and there a few guys surrounding one guy with a big towel wrapped around his hand. They even have his arm elevated, and the guy freaking out.
“What’s wrong?”
“He has a paper cut on his finger.”
Great. I don’t want to call anyone a liar, but someone mentioned an amputation. We unwrap the towel. We’re confused.
“Where?”
“There!”
“Err… I don’t even see blood. There’s a paper cut all right… Who the hell called 911 for this?”
Usually, when someone is about to give birth, there is a lot of planning that goes into it. Dry runs to the hospital with family members, tours of the L&D wing, check in with the OB/Gyn doc, etc.
Now, in the poor parts of town, why go through all that trouble when you can just pack your bags and call 911 when you – correctly or incorrectly – think that you’re about to go into labor? Unlike your baby-daddy, the medics will get you to the hospital. The medics will get you to the right floor within the hospital. Besides, the medics don’t require cash on the spot like cabs and buses do. And when you get there, the staff will call your doctor for you. You don’t need to do anything at all. All you need to do is, after the baby is born, call 911 when it spits up milk. But that’s another story.
We issue driving licenses and still, look how many problems, inappropriate behavior and illegal activities are associated with them. It’s only logical that getting pregnant is regulated on some level. There are always a bunch of people who are against abortion for whatever reason, so why not restrict pregnancy? Fines and community service make a lot of sense, and they can partially offset all the money that is spent on all these unnecessary pregnancies and child care issues and all of their associated financial implications.
February 2, 2008 at 10:54 am | Soapbox | No comment
Criminals like to lie; it’s not a surprise. But did you know that when they get arrested, criminals like to claim some sort of medical problem and leave officers with no choice but to bring them for medical evaluations at hospitals, wasting everybody’s time?
Now the officers have to babysit them for hours instead of being in circulation responding to calls for police service while these criminals get cleared at the hospital by physicians who instead could be treating other non-criminals at these very overcrowded hospitals before bringing them to jails, which for liability reasons, turn away people with the smallest of problems, even though they have some medical staff on duty.
One officer told me that he had to bring some guy he just arrested to the hospital because he had a hangnail.
“Hangnail?”
“Department policies.”
“Hangnail? Really?”
“If he’s complaining about it. Gotta cover my ass. And the department’s collective ass.”
Sometimes the medical problem a criminal makes up requires the officers to request EMS. You know we LOVE these calls. More people’s time being wasted. Of course, if I’m at one of these calls, that just means I’m not at some other person’s house for the week-long ‘flu or at the payphone for the homeless dude who has chest pain that’s cured by a hospital sandwich. Pick your poison, they say.
March 22, 2007 at 1:13 am | Soapbox, Stories | No comment
Sharp, reproducible, coughing-a-lot chest pain that’s been around for weeks. In other words, most likely bullshit.
I have him take off all his jackets and shirts so I can do a 12-lead, which is the responsible thing to do, at the minimum. Even though he stinks, I still do it because there are things that I have to do even if I don’t want to, and this is one of them. Most medics wouldn’t. My partner bags up all his clothes nicely, and he starts complaining that it’s cold. I turn the heater on. His complaining starts turning into cussing.
Unremarkable 12-lead, we give him a blanket and we’re off to the hospital. We’re waiting in triage and he’s still complaining about being cold. We get him a couple more blankets. He accuses us of deliberately stripping him and making him cold, and says other crews don’t make him take his tops off.
“That’s because they don’t want to smell you.”
So that is EMS in a nutshell: be responsible and get no thanks, or save yourself the mental stress and get in trouble later for not providing necessary treatment that patients don’t want.
March 19, 2007 at 9:51 pm | Soapbox, Stories | No comment
