The rocket scientist and the paramedic intern

Code 3 for an ankle injury. On the freeway. It’s close to midnight. The cops are on scene requesting medical.

An officer comes up to the window as we stop.

“This rocket scientist ran out of gas and broke his leg jumping over a fence trying to get gas.”

A man in his late 20s is hobbling around his car that is stopped on the shoulder, just ahead of the cop car.

“Dude, if your leg is broken, why don’t you sit down?”

He’s clearly not very bright.

He sits sideways on the front passenger seat. His right ankle is obviously broken, with the lateral side buckling under the light pressure of my fingers, and it’s twice the size of his left ankle.

The cops tell us that another officer actually made contact with this guy about an hour before this current event when they found him out of gas but healthy. That officer even offered to either call a tow truck for him or drive him to the gas station and back to his car, but he declined, for reasons that no one can figure out. After the first officer left, the guy struck out on foot to go get gas, but when he jumped over a chain-link fence, he injured his ankle when he landed.

“What hospital do you want to go to?”

“I have to pick up my dad from the airport.”

“Don’t be silly – how are you going to get to the airport with no gas and a broken ankle you use to control the accelerator and brakes? Tell him to take a cab.”

He actually insists a few more times that instead of the ED he needs to get to the airport, as if his father can’t manage a cab ride after navigating airport security, tolerating groin checks and body cavity searches, locating his assigned seat, finding space for his carry-on in the overhead compartment which was probably stuffed full of inconsiderate assholes’ coats and shopping bags, figuring out the seat belt and the tray table and just surviving a plane ride full of grumpy passengers and overbearing flight attendants.

“We’re not leaving you here on the side of the freeway without gas in the dark with a broken ankle. It’s just not going to happen.”

I thought this guy was dumb. But then the ambulance crew shows up with an intern.

Third question in, the intern goes, “Sir, do you want to go the hospital?”

What the fuck?

“THAT’S your third question?”

“Well, he’s A&Ox4, and if he doesn’t want to go…”

First of all, if a basic assessment of one’s level of consciousness has a minimum of 4 questions (and that whole thing is an entirely separate post – don’t get me started), how did he determine that this guy was “alert and oriented times 4” with less than 4 questions?

Besides, asking if someone wants to go to the hospital before conducting his own assessment should be sufficient grounds to have his internship terminated on the spot.

Usually, when I ask if someone “want[s] to go to the hospital,” it’s code for “this call is really stupid and I’m politely hinting that you don’t need to go to the hospital.”

Anyway, I digress…

If we don’t take him to the hospital, then who the fuck are we taking to the hospital?

If we don’t see it as our jobs to strongly persuade force this guy to park his butt on the gurney, then what are we doing here? Why even have EMS? Is this guy a health insurance company intern or a paramedic intern?

Again: no gas, really broken ankle, dark, cold, freeway shoulder, oh, and a big storm in the forecast. And he’s already demonstrated that he apparently can’t walk from here to there without breaking a bone or two.

“So we’re going to leave him here? Are you fucking new? Or just stupid?”

This guy’s going to be an excellent medic. Yup.

10 thoughts on “The rocket scientist and the paramedic intern”

  1. “So we’re going to leave him here? Are you fucking new? Or just stupid?”

    They are not mutually exclusive. The newness will wear off, but stupidity is very durable.

    1. crews who like to inappropriately pressure patients out of transports when they’re new do not magically develop into crews who don’t pressure patients out of transports when they’re less new.

      1. I have to agree. It’s out job to strongly persuade/force people who really need to go to the hospital to do so. I can’t even remember how many times I’ve had to basically tell someone that if they do not go to the hospital the next time 911 is called they could be dead or circling the drain. If these new medics get into the habit of not persuading people who really need to go to the hospital I fell really bad for all the people who are seriously injured or code because people would rather listen to the patient than their gut. EMS is here for a reason. And I also agree that being new will wear off, but unfortunately there is no cure for stupidity. A stupid new medic will just turn into a stupid medic. However, when they end up getting sued over something like this they might actually learn something.

        1. Are you all on the same fucking national register? As EMTs our job is never to force, coerce, or intimidate a patient into going to the hospital. This question (although not its placement) is not entirely inappropriate. Part of a patients bill of rights involves a right to refuse treatment against medical advice. All we can do is make sure that they’re making a completely informed and conscious decision.

          And in response to Medic: the transformation isn’t magic, but your pessimistic attitude is disappointing for anyone in the medical field to see. You’re not going to work on the same rig with the same C/O your entire career, and the next captain you’re with might just catch where you have room for improvement. And, granted you aren’t a complete fool, progress can be made.

          Surprise!

          1. You call it forcing him to go, I call it forcefully advocating for his best interests. I call it forcing him to use his head and think. I call it forcing him to open his eyes and see what mess he’s already gotten himself into. I call it forcing him to realize he needs our help. You can criticize me all you want, but I try hard to fix people’s problems, even if they don’t realize what they need, and my conscience is clean.

            I didn’t lay even a finger on him to get him on the gurney. I used no inappropriate language. I used no threats. Instead I nagged, cajoled, pleaded, and nagged some more. He eventually saw it my way. You don’t work that way, fine, but don’t lecture me because I bothered to try.

            I think I can safely speak from experience when I say that many people make less-than-informed decisions no matter how much informing we do, assuming they even remember what we informed them just a few minutes beforehand. You want to so trustingly call it a “completely informed and conscious decision,” go ahead.

            Since you know so much better than I do, tell me: what is the appropriate and responsible disposition for this patient on the side of the freeway?

  2. I had a coworker, the joke was he could get sent on a corpse pickup and get a refusal. What goes around comes around — any time a woman has a baby, especially somewhere like a Wal-Mart or a fast food bathroom, he gets that call every time.

    I’ve twisted many arms to get them to go. One of them face planted at a store, told me she’d be going for her check-up in three days anyway, she’d like to just handle it then. Enough arm-twisting on her husband, he made her let me throw her on the monitor, full-on STEMI.

  3. To those of you that think this pt is being coerced: please just resign and leave EMS to the pros.

    Any reasonable person in the same predicament would readily agree he NEEDS transport/treatment. Any alternative action is not in the pt’s best interest. Or the public’s, for that matter.

    Yes, the pt has a right to be stupid. However, if we allow him to be stupid (leave him to his own devices on the freeway) then we are allowing a situation that will probably result in death/maiming/severe inconvenience to Mr. Ankle and/or others.

    Our job is to prevent/reduce/reverse entropy if only for a minute. Not contribute to it.

  4. Anyone consider this could have been a head injury as well? If he fell from a fence and broke his ankle, he could have hit his head in the process. His statements don’t sound AxOx4. And, of course we never force people to go. It’s strongly suggested if we think it’s clinically indicated. I was waiting for an actual assessment to follow this angry authors story. Turns out they are just bitching. #burnedoutmedic, take care of your mental health, please.

    1. No head injury. Just poor decision-making.

      The bitching was started by the idiot intern (and no doubt his preceptor) not understanding 2 < 4 and then arriving at a conclusion that led to half-assing his way through the call like many providers who make the rest of us look bad. Excuuuuuuse me for being angry.

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