Hold your applause, please

Med four, you’re available at Local Hospital?”

Ten-four. My partner is walking out now, we’re ten-eight.”

Ten-four. Copy a 911 at Local ER. Female patient, white t-shirt, blue jeans, leaving the hospital now, wants to go somewhere else.”

…oh…kay…”

Med four, EMS Captain is clear, switch to talkaround.”

Ten-four…Four on Talkaround.”

Hey, guys. I’m clear on the call, I’ll head up there if you need me.”

Okay then. I’m not sure if we will need you yet. Shaq just got back in the truck.”

I’m clear. Just be advised, we can’t transport any patient from the ER from a 911 call.”
“Come again?”

If a patient calls 911 from the hospital, they have to be evaluated at that hospital, then the hospital has to arrange for a transfer if needed. We can’t take a 911 patient off of their property. The patient will have to leave the property before we can transport”

Okay, we’re clear.”

 

“Hey, buddy. You want some of these Oreos? They had them in the EMS room — what the hell is this on the MDT?”

“We got a call.”

“How did we get a call? We just went in service?”

“The call is here. Some gal is going to be walking out of the hospital. Wants us to take her to another hospital apparently.”

“Oh, so this has BLS written all over it, and you want me to handle it?”

“You’re the professional one, Shaq. Now how about them Oreos? Did you get me any milk?”

“Boy, I swear, I’m about to smack you upside your head. That must be her right there” he says, pointing to a woman meeting the description.

“Yeah, let’s go check it out.”

My mouth is full of the aforementioned Oreos as we watch a young, marginally attractive woman shuffle out of the ER front entrance, and shuffle her way over to a bench. We walk over to meet her.

“Hi, ma’am. I’m Shaq, and this is my partner C. Are we here for you?”

“Yeah. Y’all need to take me out of here to another hospital.”

“Well, what’s going on?”

“They are just rude in there, and they won’t take care of me. Take me somewhere else.”

“What brought you into the hospital this morning?”

“Well, me and my boyfriend was having sex, then after, I started hurting and burning.”

“Okay, What did they tell you inside?”

“I’ve been here for like, four hours and they try to tell me that I have gonorrhea or some shit like that. I ain’t got no gonorrhea. Me and my boyfriend are clean!”

“Well, did they do a pelvic exam and take a swab?”

“Yeah, the doctor did all that, then he tried to give me antibiotics, but I’m telling you, I ain’t got no gonorrhea.”

“Well, they are doctors, and those antibiotics are really important for you and your boyfriend to take.”

I ain’t got no disease. Take me somewhere else!”

“Well, I’m terribly sorry, but we can’t take you anywhere else.”

“You have to! I called 911.”

“I understand, but since you are at the hospital, you have to be evaluated and treated here, then the hospital has to have you transferred to another hospital.”

“That’s bullshit. You aren’t going to take me anywhere else?”

“No, ma’am. We spoke with our supervisor, and he says that we can’t.”

“Well what the hell am I supposed to do?!”

“It seems like you have several options. You can go back inside, and get those prescriptions filled. You can call someone to pick you up and either take you home or take you to another hospital, or you can leave the hospital property and call 911 again.”

“I can’t believe this. Y’all are going to make me leave and won’t take me to a hospital!”

“We are happy to take you to a hospital, but we can’t pick you up from this one. You’ll have to leave the property.”

“Fine then, I’m leaving.” she says, after which she gets up and starts shuffling off, down the sidewalk.

I’m still enjoying my Oreos, when Shaq turns to me.

“Let’s get in the truck. It’s gonna take her at least ten minutes to make it to that Citgo. We can probably be at the next post before she calls back.”

Med four.”

Med four.”

Ten-eight again. She’s gonna call back once she leaves the property.”

Ten-four. I’ll show you guys in the area standing by. I’ll let you know when she calls back.”

Shit.

Imagine this

Imagine if you will, an ambulance service decides to make every “patient contact” require either a refusal signature, or a transport. Imagine there is no more “false call,” or “no patient found,” or “no EMS needed” options for call disposition, only a patient refusal or a transport to an emergency room.

Imagine that the service ignored their definition of a patient, which used to be “a person who is ill or injured who requests, or would request, emergency medical attention.” Imagine if that new definition included:

  • People sleeping in cars
  • Accidental medical alarm activations
  • People in car crashes who didn’t request EMS
  • A guy changing a flat tire
  • Passengers on a school bus which struck a mailbox

Imagine being told by dispatch to chase down a guy in a grocery store who was sleeping in his car, waiting for the store to open.

Now, imagine if you will, the ambulance service issues “report cards” to their employees, and one of the categories in which they are evaluated is their “Transport/Refusal Rate.”

Imagine that your yearly raise is directly tied to your “Transport/Refusal Rate.”

Imagine how angry you might be.

It worked

The drug overdoses (that either aren’t dead, or are awakened) always go the same way: Shaq and I stand around with between four and six firemen, and at least two police officers for upwards of an hour trying to convince this guy to go to the hospital.

And they always wind up going. But we waste a lot of time.

The cops can’t threaten these patients with arrest, because the state has an amnesty law. Basically, if a call for help is made, then a cop can’t arrest for drugs that are found out in the open. I think that is a bit ridiculous, but it is what it is.

Doctors won’t commit these patients involuntarily, so we can’t threaten them with that.

Usually it is just a matter of wearing the person down.

And it gets tedious.

So we ran one of those today. A guy in his thirties relapsed, and shot some heroin after being sober for two years. This guy can’t help that he’s an addict, but he certainly has to take responsibility for shooting heroin into his veins. It turns out his ten-year-old son found him lying in bed, not breathing, then called 911. The son woke the patient with a glass of water splashed on his face.

And enter Shaq and C.

There’s the requisite crew standing around: six firemen, two cops, one shirtless guy with dirty hands sitting on the floor, and one crying mother in the living room. Of course the patient first attempts to deny that he did the drugs, then admits to it when confronted with the full syringe in the bathroom. Then he says he is fine, and doesn’t want to go to the hospital. Shaq and I are standing kinda in the background when he nudges me: “watch this, dude.”

Shaq makes his way to the shirtless guy on the floor, and stands all of his 78 inches over the guy on the floor. Kneeling down to get somewhat on his level, he delivers an excellent oration:

“Hey, dude. Check this out. You’re going to wind up going to the hospital with us today, that’s a fact. You say you don’t want to, but you’re going to. These guys in light blue? They’re from the fire department, and they get off at 7 in the morning. These guys in dark blue, they’re cops. They won’t arrest you, but they won’t leave until we tell them it is okay for them to go. Your mother out there in the living room? She’s calling your wife at work, and she already called your father. They are both on the way over here. Between the twelve of us, we will wear you down like a cheap pencil, and you will walk down those stairs, and you will sit on our stretcher, and you will go to the hospital. So what my partner and I are going to do now is walk outside. We are going to go outside to your front door, lower our stretcher, raise the head of it up, and undo the seat belts. And then we are going to stand there, and stand there, and stand there, until you walk outside and sit on our stretcher. It’s up to you how long that takes, and how much bitching you want to hear from your parents and your wife. When you’re ready, we’ll be outside.”

Then he stands up, turns to me, winks, then walks out.

I’m dumbfounded. I just witnessed a sentinel moment. So, I turn on my heels, and follow Shaq outside.

We barely make it outside before he’s trying to sit on our stretcher.

We’ve been on scene for less than five minutes, and now we’re leaving. On a call that would typically take at least half an hour.

I can’t wait to try that again.

Zero percent effective

“25YOF ABD PAIN” reads the MDT. For some reason we are going lights and sirens. As is a big red truck. I still don’t know why.

Oh, that’s right.

Policy.

Whatever. I’m trying to find a stopping point in this book, Killing Patton before we get there, so my partner for the day drives slow. Without the lights and sirens. Policy be damned.

We arrive on scene to find what appears to be the patient in the midst of what could be a day care, but is actually an apartment. A cursory head count reveals around 8 kids, nope, make that 9, because the lady watching TV is holding another one.

This lady is watching some judge show on TV with the volume at full blast. I don’t know what show it is, and I don’t know what the case was about, because the first thing I did was turn the TV off.

“Hey!”

“Well hello yourself. What seems to be going on?”

“Like I told that lady on the phone, my stomach hurts.”

“Okay. How long have you been hurting?” I ask as the unnamed partner starts to get some vitals.

“‘Bout a week.”

“Hmmm. Okay. Any nausea, or vomiting? Have you had any diarrhea? Has anyone in the house been sick lately?”

“Naw, I ain’t been sick. Just hurting.”

“Okay then. Any chance you could be pregnant?”

“Well I don’t know.”

I am always intrigued by the “I don’t know if I’m pregnant or not” answer. Understandably, I don’t have a uterus, but most women I come in contact with know if their period is late, early, or whatever.

“Well, when was your last period?”

“Like, maybe October? Or maybe September?”

“Have you been pregnant before?”

“Yeah.”

“Okay…how many times?”

“I don’t know. I gots 2 kids.”

How in the name of Sam Hill do you not know how many times you’ve been pregnant?

“Um, have you had miscarriages, or abortions?”

“I ain’t never had no miscarriage. But I had five abortions.”

Pulling out my calculator, I plug in the equations and deduce she is gravida 7.

“Well, let’s take a quick look at your belly” I say as we lay her down on the chaise. “So has anything else been strange lately? You said you haven’t been sick, but have you felt weird or anything?”

“Yeah. It’s weird. I’ve been craving chicken and pickles lately.”

“Yeah. I like chicken and pickles too. Are you sexually active?”

“Well, duh” she scoffs, as if I should be surprised.

“Fair enough. Do you use birth control?” I ask as I do some quick Leopold maneuvers. There is definitely a baby up in there.

“Some times. But not all the time. But I do take my pills. I can’t be pregnant because I’ve been taking my pills.”

“Well, if you want to put your hand right here on top of mine, you can feel the baby in your tummy.”

She does as instructed, and I push with my other hand, making the baby kick. She obviously feels it. This baby is good sized, probably 20 weeks or so, probably more, which jives with a missed period in September.

“But I can’t be pregnant!”

“Well, I don’t have an ultrasound machine, but the fact that you haven’t had a period in five months, and this fetus moving around in your belly tells me you are.”

“But I’ve been taking my pills!”

“Pills don’t always work. What kind of birth control pills do you take?”

“I don’t take birth control pills.”

I feel like I’m being set up.

“Okay then, what kind of pills do you take?”

“Haldol.”

Holy shit.

“…”

I’ve got nothing.

“…”

“What?!”

“Haldol isn’t birth control, and it wont’ stop you from getting pregnant.”

“For real?”

Write-up

One hospital requested an ambulance to travel emergency to transport one of their patients to another hospital. Why? It doesn’t matter. And no, the patient was not ready.

“Hi, could you give me a brief report on this patient?”

“I already called the other hospital, they are waiting on him.”

“Okay, but could you tell me a little bit about him?”

“Like what?”

“For example, why he is here, what his history, medications, and allergies are, why he is being transferred? Stuff such as that.”

“I don’t understand why you would need to know that. I already called the hospital.”

“Well, I see that you have dopamine hanging. Perhaps you could let me know why you have dopamine hanging?”

“Because his blood pressure was low.

“Yes, I understand what dopamine is used for. Do you have any paperwork that I can take a look at? Maybe his chart?”

“No. The other hospital has access to that on the computer system, and I can’t let you see the chart.”

“Mmmkay. Why not?”

“Because of patient privacy.”

“Yeah. Okay. There’s no breach of his privacy rights here. I am a healthcare provider, so you can tell me stuff.”

“But I already told the other hospital.”

“Yes, we discussed that.”

“Why do you want a report? Why can’t you just take him? They are waiting on him.”

“Because you are transferring care, and I need to know how to take care of him.”

“Put him on your bed and drive him there. Isn’t that what the ambulance does?”

“Well, kind of. We also take naps and watch Bosch on Amazon Prime. Occasionally we throw footballs when the weather is nicer. Do you think you could give me that report now?”

“No. I already told you, I gave report to the other hospital.”

“Indeed. Indeed you did. I have an idea; how about a little role-playing scenario? It won’t take but maybe thirty seconds. Whaddya say?”

“Umm, okay, I guess.”

“Okay. Let’s pretend you are a nurse at another hospital, and you just got on shift. I walk in with Slimm here, and a patient on a Levophed drip, with some propofol hanging, on a vent.”

“Okay.”

“This is where I say ‘Hi, ma’am. Can you sign my computer for me so I can put this patient on your bed’?”

“What do you mean? Why is he here?”

“I don’t know. Some bitch at the other hospital wouldn’t give me a report.”