Policy vs. Policy

“M – HIGH BG” reads the notes on the MDT. The address takes us to an inpatient alcohol rehab clinic in an outlying area of the county. Think Betty Ford Clinic, without the money or celebrities, and with country music.

I’m working with Joe again.

Sure enough, this dude has high blood sugar. So high, that the glucometer says “HI.” I say “hello” back to it, but it doesn’t reply.

This guy is a known insulin-dependent diabetic, and for some reason, the nurse behind the counter isn’t allowed to give him insulin unless she has an actual, numerical, reading.


The patient, myself, Joe, and the 3 dudes from the fire engine all realize how silly this is.

“He isn’t discharged, so one of our staff members will have to ride with you” informs the lady with her butt glued to the office chair.

“Okay, that’s no problem” Joe replies, uncharacteristically chipper. His caffiene intake is significantly higher than the last time we worked together.

We wheel the sugary sufferer to the ambulance and begin to load him up.

“You can go ahead and have a seat in the front, I’ll be there in just a few minutes” says Joe to the gentleman that is apparently accompanying the patient. “Just make sure to buckle up.”

“I have to ride in the back with him” is the reply.

“I’m sorry, but you will have to ride up front.”

“Our facility’s policy is that I ride in the back of the ambulance with him to the hospital.”

“Well, our company’s policy is that riders are welcome to ride, as long as they ride up front, with their seatbelt on.”

“But I have to be in the back.”

Joe is getting either mildly irritated or mildly entertained, I’m not sure which. “Look, dude: you can either ride up front with me, or watch us drive away. You ain’t ridin’ in back, dude.”

Next thing I know, Joe and the rider are both up front, and Joe is playing Zydeco music on the way to the hospital. I think three people were introduced to Zydeco music that day.


  1. People are funny about that. They really think that THEY get to decide what we do. We never had a firm policy on this, but for the most part family, friends, staff, or whatever rode up front. Exceptions were made for kids for the most part.

    I’ve had people insist that they were the brother, cousin, sister, uncle of the patient and HAD to ride in the back. The only problem is that they didn’t know the name of their brother, sister, cousin, uncle, which sort of undercut their claim. Or the equally drunk friends of the drunk patient. More than one of them got a ride in the back of a totally different sort of city owned vehicle than they were expecting.

  2. When I was a director of a wilderness program I made sure that our procedures stated that staff would try to accompany the student, and if not able to would make their way to the hospital another way. We never had a refusal to accompany because the students we worked with where minors, but sometimes crews wanted us up front and we always did as told.

    In my new job as an EMT we routinely fly critical patients 45min to a trauma center. We know not to promise families that they will be able to fly with the patient. It is the heli crews decision, they try to take a parent if it is a child. Some of our local doctors however, forget this then we look like the bad guys telling people no you can’t fly with your mate.

  3. Flash Larry says:

    The idea that it is the job of the EMS unit to be a taxi for anyone who wants to ride along is an endemic problem. Generally, I don’t mind if one family member rides along, maybe even two.

    Our company’s policy is, as with most things that our company does, deliberately vague. Essentially, it says, “Riders are a the discretion of the crew.” This means that if we deny someone the opportunity to ride and it creates an issue with the customer -“customer” being defined by our company as either the entity that pays the bill or the entity that called us and provided us with the opportunity to make money – that the medic will be held responsible and disciplined. The worst possible offense in our company is to cause issues with the aforesaid “customer.”

    I have looked at this more along the lines of a. what’s best for me and b. what’s best for the patient.

    The problem for me is either means or volume or both.

    An example: the family is dependent on public transportation and have arrived at the facility by that means. And the public transportation does not go to the receiving facility or it is very difficult and complicated to make the connections. They expect the ambulance to serve as the taxi. Example: the woman who came to an inner city hospital with four children and two big bags. Her child was to be transferred to a children’s hospital. Both the woman and the facility expected us to transfer both the patient, the woman, the three other children, and the baggage. Supervisor’s answer: see what you can do. Meaning, “I’m not going to make the decision and get in trouble.” Confounding variable: State law requires that children be secured in car seats properly installed. That was the hook that I used to keep from having to transport all these people – and the calling hospital agreed that children shouldn’t be endangered. I forget how it was all finally worked out.

    Second example: a teenager being returned home after a six-week stay in the hospital. He was being transferred to home which was about 2 hours away. The family had quite literally moved into his hotel room, with bags and boxes of belongings, a walker, a special wheelchair, etc. The caller (customer) had notified our dispatcher that there were a great deal of personal belongings to be transported. Meaning of course that we were expected to transport the patient, two family members and all these belongings. We had to summon a larger ambulance and took 45 minutes just to load it all up.

    As far as other facilities’ policies, some time ago Large Public Hospital took me to task in the ER because I hadn’t done some procedure (I forget what it was) that they wanted done. Basically because I hadn’t made their job easier for them, I’m sure. It happened often. They said, “It’s our policy that this be done on all patients.” I said, “I don’t work for you so your policies don’t apply to me.” That pissed the nurse off immensely.

    As did my failure to agree to transport the patient from the ER to another unit. I said, “Once you take over care, that’s why you have transporters.”

    I could do that then. Different service.

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