Please stop using the phrase “I think he’s in shock”

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Yes, I’m talking to you, civilians.

The way you use it is based on watching too much TV and when used in that sense it means “he’s scared.”

The way we use it means something completely different.

So, call 911 for your silly reasons, but stick to the facts and keep your two cents to yourselves. Leave the assessment to us. If you think you know better than we do, then don’t call us and drive yourselves to the hospital. In fact, better yet, skip the hospital and treat yourselves at home since you probably think you know better than the physicians too.

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Department of Medical Sanitation (DMS)

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We bring yet another crazy transient drug-using hooker to the ED.

“Why did you guys bring her here?”

“‘Cause the cops called us and she wanted to come here.”

“Why?”

“Keeping the streets clean. C’mon, you’ve worked here long enough to know that the cops always call us for this stuff. We drive the garbage trucks, and we dump them on you. Actually, come to think of it, you guys are more like the recycling center than the dump…”

“Uh… what are we going to do with her?”

“Just throw her out in the lobby. If you’re lucky, she’ll probably leave in an hour, and she won’t be your problem anymore.”

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Two sets of vital signs

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“Please provide at least 2 complete sets of vital signs on EVERY patient, and additional sets of vital signs if a patient’s condition changes, or after an intervention was performed.”

Sound familiar? I’m sure you’ve seen sentences like this in memos issued by the those tough-guy desk jockeys.

EVERY patient? Yeah, right.

When I’m taking James to the hospital for the 11th year in a row for the same thing every shift, you’re lucky if I even bother. In fact, forgive me if I just wait until we get to the ED. I don’t care if you think I’m a bad medic, or a lazy one. His vital signs are irrelevant.

I really don’t see how this is dramatically different than the decision-making process that leads you to omit spinal immobilization or choose one treatment over the other. Patient presents, tells you what s/he wants, you decide what s/he needs and doesn’t need using your knowledge, experience and judgment. James walks up to the ambulance, wants a ride to hospital for the 2,546th time, he needs nothing at all.

He barely needs ONE set of vital signs; he certainly doesn’t need TWO sets of vital signs.

If I’m wrong, you can fire me.

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Six times a shift

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I know this is going to go nowhere because our bosses are scared of dipshit patients and scumbag lawyers, but as a thought exercise, why is it that fire crews can choose to not respond to repeat alarms and cops can choose to not respond to chronic calls and non-injury wrecks while we go to every single one of our frequent calls? And unlike them, we usually, stupidly, go lights and sirens too. Obviously the cops and the firefighters can decide at the field level what is and what isn’t an legitimate emergency, but we can’t?

We went to the same street corner 6 times in one shift because the resident homeless guy with a movement disorder likes to lie on the ground occasionally when he’s not being handed money, and motorists are apparently too fucking busy NOT paying attention to their driving and instead dialing 911.

I suppose I should just be glad that he leaves at night.

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This is a good example of why we hate people*

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Code 2 for a 13-year-old with back pain. It’s barely 5am.

This is going to be some bullshit.

Sure enough, a 13-year-old girl is sitting on the couch. She is larger than any of the 4 of us on scene.

“She hurt her back before and now she re-injured it. Can you take her to [insert hospital name]? Her pediatrician can see her there.”

“Ma’am, her pediatrician is not going to see her at the emergency room. And certainly not at this hour.”

Of course this is a 3-story flat and she is not on the first floor. Of course she is like 220 pounds. Of course she claims she can’t walk. Thank god for Stryker’s stair chair. Thank god no one blew out a back carrying her.

We get her down and onto the gurney, which she got on without much difficulty.

“It sure makes a difference when you call at night.” Her mother quips, in a vaguely passive-aggressive tone.

I don’t really want to know, but I ask anyway after a pause.

“What do you mean?”

Pointing to another crew member, “That guy is grumpy. When they were here the last time, they were very nice.”

I try to stay out of it, “It’s 5am, ma’am.”

I’m surprised I still have a tongue after all these years of biting it. I really don’t think customer service is an appropriate concept for health care, yet it’s the overarching goal, according to the people in charge who have put in little time at the street level doing what we do.

“I’ll follow you there.” She hops in her brand new car.

Of course she will.

*Among many other examples of people at their finest

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