Stupid policy #73,893

So a local assisted-living facility called our service directly today. Usually not a big deal, it’s something that happens quite routinely, as matter-of-fact. But it was the notes in the call that were strange:

M subj fell/No inj/No comp/Facilty req code-4 chk/No RLS/Prvt req/

So, deciphering the jargon, some guy fell, isn’t injured, doesn’t have a complaints, but the facility wants us to “check him out.” Which is complete bullshit. They don’t want us to “check anyone out.” They just want to pawn off some perceived liability.

“Med two.”

“Go ahead.”

“Your subject will be outside on the porch, smoking. White male, khakis, red sweater, approximately 70 years of age. Patient is aware you are responding, but states he does not want an ambulance.”

“Two clear.”

What fresh hell is this? So some guy fell, says he’s okay, isn’t hurt, doesn’t want an ambulance, and decided to go outside for a smoke break, yet we still have to go “check him out.”

“This is probably the dumbest thing I’ve done all year.” Smokey says.

“Don’t count them chickens just yet, buddy, we still got almost a week left in this year.”

Sure enough, there’s some old guy in a red sweater and khakis, sitting in a rocking chair, smoking. He looks pleasant.

“Hey there, feller!”

“Well howdy! I told them ladies in thar not to call all y’all, but they done did!”

“You hurt?”

“Naw, I don’t reckon so.”

“You want an ambulance?”

“Wouldn’t have much use for one of them.”

“You want to go to the hospital?”

“I really wanna finish that puzzle I got goin’ inside.”

“Cool. You mind if I smoke with you for a little while?”

So we sat down for a few minutes, Smokey had his smoke, I worked on my crossword puzzle for a bit, then an employee came out. I did my best to keep my mouth shut, and I let Smokey do all the talking.

“Hi, guys. Sorry to bother you. We just have to have him checked out.”

“Y’all can’t do that here?”

“No, we have to call the ambulance to do it.”

“Then why do y’all have nurses in the building?”

“Nurses can’t have him sign a refusal.”

“Well, we can’t neither.”

“But he has to.”

“No, he doesn’t.”

“Our policy says he does.”

“Good thing I don’t work here, cuz that policy makes about as much sense as a trapdoor on a canoe.”

 

And that’s the story of the second incident report I had to write in less than two weeks.

Just when I thought I was out…

…they pull me back in.

And like that, I’m back in an ambulance.

The escape plan worked, but was short-term. It was fun to take a break, and do something else for a little while. I learned a lot, and met a lot of neat people.

But now it’s back to the ambulance.

I guess that’s okay, though. I was asked to come back full-time to Local Ambulance, and we negotiated some fair terms. I’ve got the schedule I wanted, on the unit I wanted, and with a new partner, Smokey, that I wanted.

Smokey comes from some part of northeastern Tennessee, somewhere he calls ‘tha hollers,’ whatever that means. He describes his hometown as having lots of pet chickens and rusted pickup trucks in yards. He should be interesting.

Our first day was sure interesting. Got a complaint and had to write an incident report in the first 4 hours.

Welcome back, huh?

Genius

Some lady attempted suicide.

The MDT notes say she left her car running all night in her garage, and was found on the floor of the garage by a neighbor. It’s 6 o’clock in the morning, and she’s been there all night, and the car was still running when the neighbor found her.

The neighbor only found her because he thought the red light glow coming from her garage was strange. Apparently she left her headlights on. Neighbor broke into her house, opened all the doors and windows, turned the car off, and somehow dragged the lady outside into her driveway before calling us.

Somehow, she’s still breathing.

Brave man. Now he’s over in the bushes throwing up breakfast.

No, it wasn’t an accident. The note she left in her car removes all doubt of that.

Shaq and our supervisor are getting some stuff done while I gather information before we leave.

One of the fireman comes out of the garage and walks over to the ambulance. “Hey, do you know which hospital you’re going to go to?”

“Yeah, we’re gonna go to Saint Catholic’s. They have that hyperbaric chamber there they can put her in.”

“Cool. Good deal. Make sure you tell them the readings we got from our meter is six hunnert and fitty parts per million.”

This guy is speaking some language I don’t understand. But whatever. “Sure thing, dude. Six-fifty parts per million. Got it.”

He looks over my shoulder at my supervisor and nods “How is she doing? She gonna be alright?”

“I don’t know, man. She looks pretty sick. But her O2 sat is at one hundred percent, so at least that’s good.”

Fireman and I make eye contact and neither one of us have anything to say.

And Supervisor McDipshit wasn’t trying to crack a joke, either.

 

I looked it up later. At 400ppm, a normal adult will have headaches within 1-2 hours, and it is life-threatening after 3 hours. 800ppm is nausea, vomiting, and convulsions within 45 minutes, unconscious within 2 hours, then death. And this lady’s garage was over 600ppm, and she spent the better part of 9 hours in there.

Nobody could figure out how she survived. But she did.

The O2 sat of 100% is probably what saved her.

History major

We are taking care of some incredibly old lady from the local nursing home. Like, really old.

She fell out of bed and has some skin tears.

Remarkably for being her age, she is sharp as a tack.

We load her up, and I am sitting behind her in my confessional while Shaq hooks her up to the monitor.

“Ma’am, can you tell me how old you are?” I ask her.

“I was born one week before the Titanic sank” is her reply.

Like I know when the hell that was. I’m a grumpy, hungry paramedic, not some history major.

Shaq catches me looking at him with a confused look on my face.

“Oh. April eighth, nineteen-twelve.”

“What?”

“That’s her birthday.”

“How the hell did you figure that out?”

“The Titanic sank on April fifteenth.”

“Where did you just pull that fact nugget from?!”

“I started watching Downton Abbey yesterday. It was in there during the first episode.”

 

Someone should write a blog this guy.

It’s our choice

So some pretentious jackwagon comes up to Shaq and I at the hospital after we dropped off a patient.

“Why didn’t you transport that patient emergency?”

I’m dumbfounded. Plus hungry.

“Wait. What?”

“That last patient, the ER wants to know why you didn’t transport him emergency.”

“…because I didn’t feel it was necessary?…” (seriously, where is this going?)

“Well, in a stroke, time is brain, and every second counts, so…”

“Indeed.”

“So why didn’t you transport him emergency?”

“Because I didn’t feel it was necessary.”

Then we left.

What I left out was that the patient was last seen around ten o’clock in the morning by his son, at which point his son noticed his face was drooping and he ‘wasn’t talking right.’  Nobody had seen the patient since after dinner yesterday, when his daughter brought him food. At some point, the patient went to bed, then was found more than 12 hours after being seen normal. Oh, and the son that saw him with the droopy face at ten a.m.? That son called 911 at 4 P.M.

So much for that window.

I’ve always had this personal policy: We transport everyone to the hospital non-emergency, unless:

  • there is an impending airway failure, or we are unable to control the airway for some reason
  • there is a limb presentation in a pregnant female
  • any time my partner feels it is necessary

My partner and I make decisions together, and our safety is in our minds first. Since driving with the lights and sirens is inherently much more dangerous, we reserve them for cases when it is absolutely necessary. Hell, it’s dangerous enough with two people up front, but it’s even more difficult trying to clear these intersections by yourself,  and trying to deal with a distraught family member.

I’m willing to listen to suggestions as to when I should use the lights and sirens for transport, but unless my management or my medical director wants to put it on paper, I won’t take criticism.

We decide.