Killed the Cat. Ok, maybe not. Maybe it was idiocy, or indifference, or… the old standby curiosity.
We’re running with Assumption though.
When people call 911 they EXPECT a fast response. When people call 911 they EXPECT lights and sirens. When people call 911 they EXPECT us to bring them into a ED bed full of nurses, doctors, rad techs, lab techs, admitting, and fancy gadgets. They EXPECT that we will transport them fast–with lights and sirens. They EXPECT me to use complex terms, fancy gadgets, and McGuiver like cleverness.
What they actually GET is an entirely different story. What they get is adequate, qualified, professional Medical Care. Not ER/Third Watch style gung ho Cowboy Medicine.
We are “self dispatched” in that we determine our response based off of what dispatch provides us. It has never faild us and I’m glad we don’t use some of the EMD models that mean every time someone says they are in “pain” they get a Code 3 repsonse(see my posts from internship). If it sounds bad we hurry. If it is a frequent flyer and it sounds bad, we likely still hurry. Our Dispatchers also know when to give us the right information. Some may find this method “dangerous” but honestly I find responding to “eye pain”, “leg pain” and “back pain” at 90 MPH dangerous, so that debate can be had in the comments section.
When I get on scene I grab what I need and walk in. I do not run. I’m fat and running is just going to make me another patient. I need to be collected whether it is serious or not. Hell, sometimes the “non serious” calls are the ones I need to be the most collected for. Keeping using my inner voice from the outside world can be challenging at times.
When I approach the patient I try to calmly assess the situation, but do it methodicly and swiftly. Again, no sense in getting freaked out. If a patient really is sick, they won’t be helped any by me doing things rushed and wrong. The only people who complain that I am not going fast enough are the ones that had no business calling 911 in the first place.
I then move to treatment–often this means I talk to the patient while we head in. Sometimes(less often than ER and 3rd Watch make you think!) I actually start an IV, push a med, give oxygen, or the like. Many patients get a good dose of CYA Medicine. They might get a Nitro/Aspirin/MS/IV/Monitor/Oxygen/12 lead for their “chest pain” or Monitor/Oxygen/IV for the SOB, or a C-Collar/Backboard/Monitor for “neck pain”. Most of these patients do not need any of them, but hoenstly I can’t afford to be out of work because one of them actually did. We aren’t provided a Lab or Radiology department in the back of our fancy dancy ambulance so thus I rarely can rule anything out. I try though. I try hard…
So, we’re enroute with our presumably non-serious patient who is persistent that the apocolypse is near and it brings me to the time for report. If I am going local(I’d say 75% of the time we go local, I have the freedom to automatically divert and head to the trauma centers/stroke center/heart hospital on my own though)I give them a short phone report, Usually Name/DOB/Chief Complaint and if I’m more than a mile out(rarely) I’ll give them vitals. On occasion we do take patients that are more critical local, as a platform for stabilization. Again, this is rare. If I am headed to the big boy toy store then I’ll give age/chief complaint/vitals.
Now the fun part. With those radio reports I often give them a series of words that I find very important. For BS calls I say “Calling in report on a 17 YO male for triage complaining of….” For serious calls they rarely get a full report. I usually give them enough information to determine its serious. I then hang up. If It is actually serious rarely do I have time to chit chat and give DOB/name/etc. Words like “Head on MVC at highway speeds” tends to spark interest. “Possible CVA” works too. Those are both cases that usually end up with special response teams. Few others have that(OB, etc).
What people don’t get is that even if they REALLY are having a heart attack, they aren’t going to get a full code team in their until they ACTUALLY code on us. They really only need 2 nurses to start. Most hospitals have a good CP protocol that will get the ball rolling before a Doc sees you.
The same goes for a patient who is having pretty much any other presumed problem. You don’t NEED immediate attention from 10 over worked, under paid ED staff members. What you NEED is a thorough, detailed, and adequate assessment. You don’t NEED anyone to rush. You don’t need to be pushed infront of patients who have been waiting all day just because you rode in a fancy dancy wahmbulance.
What you NEED is to shut up. You need to answer questions appropriately. You NEED to not treat medics/nurses/doctors/techs like shit because of your percieved emergency. No matter how bad you think it is, I promise somewhere in that hospital there is someone whose problems are far more severe. I also promise you that IF they are capable of talking, they aren’t being a huge pain in the ass to their HCPs.
Grow up. Don’t assume that you are more special than everyone else because you “feel like death”. Just get a grip. If you aren’t happy with the way healthcare works I think the Happy Hospitalist has some great tips.
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