A Curious Dilemma

24 08 2011

As, a disclaimer the post below is mine and mine alone, it does not reflect who I work for or have worked for.  It does not reflect my co-workers opinions.  It does not even reflect all of my opinions. It is just something that I see on a daily basis and hear complained about on a daily basis.  And I am curious as to what could and would help.

 Mostly we see and hear people complaining about the government or bad service that was provided to them.  This is not meant as a complaint for people who call 911.  By all means I encourage someone to call 911 if they have an emergency.  That is why emergency services was formed, to help those in need.  But the topic is near and dear to my heart because as an emergency worker, I feel as if I am providing poor service to most of the citizens in the area served, if I am taking the non-emergent patients to the hospital because they can’t find another way.  But, as a good ems worker, when the tone drops, duty calls and I will always respond to help you, no matter what I personally think.  It’s just part of the job and I really do enjoy helping people.

So, here is a dilemma…but what is the solution??? I know my fire/ems friends understand the issue. But what are the thoughts of my non-medical, non emergency service friends?  Is there a solution?

 An emergency ambulance is dispatched and responds to someone with a non-emergent situation. For example: Pt. with an infection in there toe.  I’m not denying this would need treatment, but why does it need an ambulance? The person has already been taken to the hospital and treated in an ER earlier in the week and given antibiotics. Now they say the infection is worse. They walk, talk, vital signs are normal. When asked how they got home from the hospital last time they said a cab, but they cannot afford to take a cab to the hospital. Their family doctor is not in today. The problem I see is that now you have someone who is making an emergency unit unavailable  for the rest of the area it provides emergency service for and using it like a taxi or a tank bus. This happens all the time in every city and town. I personally have worked in more than 10 different counties and have friends all over the US who have the same issue. It also happens in inner city areas as well as rural areas.  I do understand why the person is using the ambulance..they do not have a ride and need a way to get to the hospital.   But, is it fair to the other citizens who might really need to utilize this service? Just a question that is bandied about all the time. We have the problem, we complain, but what is the fix???

This doesn’t even begin to touch the real issues.  Say the above person has no insurance, or at the most medicare or medicaid.  Most people don’t realize that medicaid and medicare do not pay if it is not an emergency.  And if medicaid pays, it is only about 30 dollars per ride.  Probably not even enough to cover the ride to the hospital in fuel, equipment used (Blood pressure cuff, pulse oximeter, etc.) and the cleaning solution to clean up afterwards.  Plus the pay for the individuals on the ambulance.  Because, let’s face it, there are not too many volunteers left because almost everyone needs to work today to support themselves and not many have the extra time to volunteer.  Now,  not only is an ambulance unavailable for a true emergency, there probably won’t be enough payment, if any, received to keep up with the wear and tear on the vehicle and when a new one has to be purchased the citizens will again have taxes raised.  

I would love to see a study done through out the US.  I would bet that 50 percent of 911 calls are just what I said above. We could save money for the service by not using the ambulance like a taxi.  I mean, if I have to go to the dentist or doctor I don’t expect an ambulance to take me because I don’t have any other way.  And now we come to another problem…Use of hospital emergency rooms.

 Again, just like the above situation..the person has already been seen once and sent home with medication for the infection.  They are supposed to follow up with their family doctor.  People call 911 because they want their prescriptions filled or they have a fever or a cough or a toothache or have vomited.  Why is this an emergency?  I have vomited and had high fevers and coughs throughout my life and didn’t even go to the emergency room, let alone call an ambulance to take me.  ER docs, do not refill prescriptions.  They treat the immediate problem you are complaining of.

I have been in EMS for20 years now and when I first began, I was told when someone calls 911 you are seeing them on their worst day. Sadly this does not seem to be the case anymore. These non-emergent calls and emergency room visits are becoming the norm.  I think it’s because we as a society are so used to instant gratification.  I have a smart phone and can look up anything in a matter of minutes.  I have a car and can get almost anywhere.  I have cable tv and can find almost anything I want on tv.  However, if I have an ailment and I call my family doctor it takes 3 months to get in. Or 3 weeks.  So, to be instantly gratified I just call the ambulance, then I don’t have to pay for the service at the time of use, and go to the hospital ER where I will again be treated that day and probably not have to pay for the service I received until later.

People complain about medical care and healthplans and ambulance services costing more and more…but this is the reason.  And I can’t think of any other service I receive that I get for free at the time of the service.  Even my doctor and dentist make me pay a little something up front.  

So, now I ask all of you to help figure out how to solve the problem. And I don’t think the answer is to deny people the ride in the ambulance or tell them to suck it up and pay for the trip. I feel very sad for these people.    I worry these people don’t have food because they can’t get to a store.  I worry about them not having electricity or running water because they can’t afford to have their medications refilled.  I pray that I am not in that situation one day, where I have no transportation and I don’t have any friends who could take me somewhere I need to go. I just really don’t know a solution. And I’m curious if someone has any ideas.  Perhaps communites providing some sort of service like a taxi or a bus to people in need of transportation.  

Thanks for your input, and I truly hope none of you ever needs to call an ambulance.  





Faking it, the EMS point of view

30 05 2011

 

 

 

 

This blog today is going to be my contribution to the drug seekers and general low lifes in the world. In my 2o year career, I have been on several runs where the patient was faking. The over the top drama that these people put on does nothing to make me feel sorry for them and in fact makes me want to shake them until their teeth begin to rattle. Believe me, I can be a really caring person, after all why else did I become a paramedic? I wanted to help people. (This actually is true; although the fact that sometimes one gets paid to sleep was also a huge factor in my career choice.) However, if you as a patient think I am fooled by your dramatic interpretation of pain and suffering, think again. Some medics say they are going to write a book one day. Well, when I write mine it’s going to be the Ten Rules of How to be the Perfect Patient.

Rules to live by as a patient.

1. Unless you have been poked in the eye, had something sprayed in your eye, or are truly unconscious and unresponsive, when the person (Me) who is trying to help you asks you to open your eyes than do so. Never has “chest pain” caused someone not to be able to open their eyes.  And frankly, it’s just creepy trying to talk to someone while their eyes are closed.

2. Unless you have been injured in some way, or your legs have been cut off, then my having to lift you out of the car (while someone else is pumping gas at the pump into the same car) due to your “chest pain” does not garner sympathy from me. Especially when 5 minutes after we get to the hospital you miraculously are able to walk to the bathroom without even an arm to lean on.

3. You called me for help. I did not randomly come to your house at 3 O’clock in the morning and bang on your door for fun. So, when I ask what the problem is and why you called an ambulance, please tell me so that I can assist you. I have yet to gain the power of mind reading although it is something that would come in very handy. If you lie there like a lump and don’t open your eyes and speak to me, I do not know what ails you and therefore cannot help. This is a waste of my time and yours.

4. If you tell me you have back pain I will believe you. You do not need to be wearing your fire department t-shirt or have a radio and scanner on your night table in order for me to help you. This is my job, I get dispatched I come to your aid. But, if you are wearing your FD t-shirt and you are on disability from this terrible back pain, I probably am going to wonder in my mind, how someone on disability from back pain is able to climb ladders and pull hose. Despite my concerns and bewilderment over this, I will still transport you to the hospital for said pain.

5. Please, if you call an ambulance for transport because you have a “bug bite” and it itches, try to have the person who will be giving you a ride home from the emergency room show up after the ambulance has left and not before we even get there. We tend to wonder why this person can pick you up from the hospital but not take you there. And it is very hard to feel sympathy for someone who is treated and released from the emergency room before I can even get my report written.

6. When you tell the ambulance people or the Emergency room people that you are “allergic” to certain pain relievers that is a big red flag. It says to us, this person probably wants the really strong pain drugs. In other words, we now think you are a drug seeker.

7. Again, remember that you called me for help. So, when I begin to treat you by giving you oxygen, putting you on the cardiac monitor or starting an I.V. please don’t fight me. If you don’t want to be treated on the way to the hospital, then you should probably call a taxi. This would be much more cost efficient. $25 vs., $750.

8. Please don’t lie to me. I am going to ask you several questions, all of which are designed for me to puzzle out what is ailing you and thereby allowing me to assist you. After we get to the hospital, I am going to tell the nurse and doctor what you told me and what I did to help you during your transport. If you then tell the doctor something completely different, one of us looks like a liar. Guess which one?

9. We cannot and will not take you to your sister’s house. We cannot and will not let you bring food and drinks into the back of the ambulance. You are not on an airplane and I am not a flight attendant. Also, sadly we are not allowed to let you smoke a cigarette during the transport. All of the above things are against OSHA and are just plain dangerous. If you feel the need to eat, drink or smoke en route to the hospital, please by all means think heavily about my suggestion in #7.

10. Last but not least, if you really are sick or injured, please do not hesitate to call 911. Too many times I have arrived on scene to find a very sick individual who just didn’t want to bother us. BOTHER US PLEASE, this is why we chose this profession. We want to help you. Don’t wait until it’s too late and we can’t.

I hope this helps some of you understand why paramedics and EMS professionals have such a sick sense of humor. We deal day in and day out with the most irritating of situations. I truly do like to help people. And I am not a trauma junkie (one who enjoys the blood, guts and gore of accidents and injuries) like many. I really enjoy trying to solve the puzzle of why a person is sick and more than that I like the feeling of accomplishing something when I really have been able to help. Despite my above “rantings” we do not turn people away. America today is overly concerned with healthcare and what is going to happen in the future. Hopefully someday things will be fixed and I won’t have to write my book on how to be a good patient.

Man I love my job!!!





Nakedness in EMS

12 05 2011

I live in Kentucky.  I don’t live near a nudist colony (as far as I know), however I am again surprised at the amount of calls we receive requiring us to respond to someone who is naked.  Not just your normal run of the mill nakedness, like someone fell in the bath tub or someone died in their bed.  No, I’m talking about crazy, running around in your birthday suit so others can see you and have to call 911 nakedness.  Recently I was dispatched to a man who is,  “Running around his apartment naked and he won’t put his clothes on.”  I figure this isn’t really my business it’s hot and if the dude wants to run around naked in his apartment so be it.  The police should just tell him to shut the windows.  But, after we got there it turned out that he was having a pretty serious cardiac event and he was apparently hypoxic (not enough oxygen to the brain) and this was the cause of his abnormal behavior.  We got some pants on him and some oxygen on him and got him to the hospital without further events.  However because of that call I was reminded of another “naked call” I went on years ago…Let me take you back to when I ran as a chase medic.  For those who don’t know, this means I responded in a cruiser to the scene at the request of the ambulance crew.  

The ambulance had been dispatched to assist police.  Nothing was mentioned about the nature of the problem and paramedics were not requested.  I told the guys to have fun and call me if they needed me.  After about 30 minutes they requested me to the scene for a possible overdose.  Now, most people in EMS hear overdose and think, respiratory compromise and sleepiness.  I think this is due to at least 50% of the overdose calls we get involve narcotics.  So, with this being on my mind, I drove up to the scene.  Four police cars and the ambulance had the street blocked, so I parked half a block away, got out and lugged all of my equipment up to the ambulance.  No one had been yelling for me or seemed to concerned.  

I climbed up into the ambulance and asked what was going on.  Before anyone could answer the patient who I now realized was lying on the cot with his hands cuffed to the sidebars started screaming for someone to help him.  And I mean screaming.  High pitched, deafen your ear drums screaming.  The crew was trying to hold the patient down because besides screaming he was flailing his legs and thrashing about.  I leaned down and spoke softly trying to calm the patient down.  But, it didn’t really work,  so, over top of the screams I again asked what was going on.

I was informed that the patient had walked into someone’s house and screamed that he needed help.  Then he took off and started running around the neighbor hood and the police had finally caught him after he ran down a hillside.  The police brought (read dragged) him back up and had called the ambulance because the guy just wouldn’t calm down.  The police officer was telling me all of this while I was doing my assessment.  As I pulled the sheet down I realized the guy had no clothes on.  I quickly covered him back up.  I looked at the cop and said, “Is he naked?”  The officer informed me that no in fact the guy had his socks on.  I looked at the rest of the crew, all men, and said, “None of you could have warned me?”  The police officer was still laughing at my shock, and  I now realized with horror that the patient had not just been running around the neighborhood.  NO, he had been running around the neighborhood in nothing but his socks.  

We continued with our treatment and took the patient to the hospital.  All the while he kept screaming and hollering.  We found out later from the police that the guy had apparently dropped 3 hits of acid and indeed this was an overdose.  Moral of the story, don’t drop 3 hits of acid at once, and even bigger moral…don’t take pictures of yourself doing so on your cell phone, it’s a surefire way for the police to have enough evidence to arrest you after you stop freaking out.





A First For Me

1 05 2011

As I mentioned in the previous blog..this was written several years ago but I think it’s appropriate to post it here.

A first for me

Yesterday I delivered a baby boy at 5:13 AM. It was the first time in my 16 year EMS career that I had delivered a child. The baby and mom were both healthy and it was a very easy delivery which I thank God for. Having heard sooo many horrer stories about bad births I’m glad my first one was easy.

It gave me pause to think…I was the first person in the world to hold that child. He is a fresh, clean slate and has all the hopes and dreams of the world to look forward to. Who knows he may one day be the president of the United States, a Pro Basketball or Football player (he had really long fingers..lol.) or he may just grow up to be a normal, loving person and great member of society. Either way I was privileged to get to help him into this rocky, wonderful world of ours to begin his journey through life.

All of us make mistakes in life and all of us have regrets. It was a very unique experience to be able to meet someone with none of those. I wish Hunter all the best in his life and thank God for this wonderful experience.





It’s a boy

1 05 2011

In my career as a paramedic I have done many interesting things.  I have comforted children who were sick or injured.  I have helped a family member who has lost someone and I have held the hand of an elderly patient with Alzheimer’s as they were taken to the hospital.  But by far the neatest thing I have ever done is deliver a baby into this world. 

The other night I got to deliver my second baby.  It is such an awesome experience.  You are literally the first person to touch this brand new human being.  He is clean and without imprint.  The potential this child has is unlimited.  To witness his first breath, his first cry and the first time he opens his eyes is just amazing. 

With this post, I am also going to post a blog I wrote years ago after my first field delivery.  As I said in that blog, I wish this new baby all the best.  He was a first for his mom. Not a first child, but the first to be born in her bed, and the first to be born without benefit of an epidural.  He came very quickly and without problem.  I hope from this auspicious beginning of firsts that Baby Gavin will also make his life about firsts. 

Days like this are the upside to being a paramedic.  You get to see something special and wonderful and this is by far what keeps me going.  May everyone be blessed in their life to witness something as profound as I have had the pleasure of doing twice.  





The Walking Stroke

21 04 2011

Being in EMS, I have seen hundreds perhaps even thousands of people throughout my career.  Some of my patients have been seriously ill or injured and I have done my best along with my co-workers to save a life and help those in need.  Others however have become some of the funniest anecdotes I have ever witnessed.  For instance….

 One night my trusty partner and I were dispatched to a residence for a possible stroke.  The female in question was in her mid 40s and per dispatch was unable to move her entire right side.  During our somewhat lengthy response (we are in a rural area) I debated on whether or not to see if a helicopter was available to fly.  Time is brain and such a young woman might benefit from the much faster scene to hospital time, however, in this day and age a paramedic must also weigh the other pros and cons of using a helicopter.  Will the cost of this flight be worth the 5 to 10 extra minutes one might have saved if transporting by ground?  I decided to wait and see how the patient presented.  After all I was only 30 minutes from the hospital.

On arrival at the residence, my partner and I were ushered into the home.  This was after carefully picking our way thru the dogs, chickens,  horses and God knows what other items might have been on the ground. (As I said above, rural…)  We make it inside unscathed and my partner says to woman standing in front of us, where is the patient.  The woman proceeds to tell us she called 911 for herself.

Now, I have of course heard of TIAs (mini strokes for the lay person).  But this lady had full make-up on, her hair was perfect and she was dressed in a lovely robe and walking around her house.  We immediately take her over to the couch to sit down and start questioning her.  What are your symptoms, when did they start, etc… she proceeds to tell us about the problems going on in her life.  She also tells us that her left arm is numb all the while pointing with it to her right arm.

We agreed to take her to the hospital to make sure as she put it, “that she wasn’t about to die.”  At this point, she jumps up from the couch, runs into the kitchen to grab her purse and vaults down the stairs of the porch towards the ambulance.  Trying to keep up with her and not step on any dog, chicken or horse poop, in the process, I am approached by the woman’s husband who wishes to speak with me.  My partner continues on with the patient and I stop to speak with said husband.  He informs me that his wife is “high as a kite” and has a habit of calling 911 if she farts sideways.  My eyes wide, I back away, wondering how to relay this message to my partner who is in the back of the ambulance with the patient.  And hoping against hope that the woman is not going to fart in the ambulance.  I inform the husband we will do our best to let the hospital know what he has told us.

 We transport the patient to a local facility.  She is treated and released.  Needless to say she did not have a stroke and all turned out well.  On a run later that night we saw her as she was actually getting in a taxi cab, to return home. 

See, and you thought all runs were blood, and gore.  Some of them are dog, chicken, horse poop and farts.

Ah…the life of  a paramedic~





First Blog – getting a few things out of the way

21 04 2011

I see so many funny and interesting things in my career that I have wanted to blog and share them for a long time.  However, due to patient privacy rights I was never sure how to do it.  After 20 years in the business, I believe I have finally found a way.  I can tell stories without mentioning places and actual dates. My stories might be from a run that occurred years ago or they might be from last night. 

I hope you enjoy my musings and meanderings.  I hope to keep things light and funny.  I have seen enough pain and suffering during my time as a paramedic and I prefer not to dwell on those things.  Instead I try to remember the good things that have happened.  EMS is not all tragedy.  Babies are delivered, people are saved and occasionally one gets told thank you.  

Paramedics, and EMS workers in general are an interesting group.  We are the people who can talk about blood, guts and gore while eating dinner and it doesn’t phase us.  However, what most don’t realize is that the way we make it through the bad calls is by laughing and finding good in other runs.  Although I can’t speak for everyone, many EMS workers get burned out and get tired of the feeling of being unappreciated (believe me it happens on a daily basis,) but for me I try to find at least something happy in each shift and one can’t deny that human beings as a whole are pretty entertaining.  Anyone who has checked out “people of Walmart.com” knows that.

Upfront I want to make it clear that nothing in my blogs should be attributed to any company I work for or have worked for.  I also want to say that any resemblance to persons or areas is coincidental.  Also, I am in no way making fun or light of any serious problems or injuries that someone might have I’m just giving my perspective of working in the EMS field and trying to make you see through my eyes what it is like firsthand to respond to a 911 call.  By the way, I am not a professional English major, although my grandmother was.  So, please excuse my errors.   

I hope you enjoy my meanderings and musings and that they bring a little bit of laughter to your day.