Frequent Flier Question

[EMT Foose]

I've transported one woman in particular many times that kinda sticks in my head. I've picked her up from many places, including her home, typically on a code 2 response.

She's had many back surgeries due to injury from MVA, and the most recent procedure didn't have a good outcome. She is addicted to pain meds, and always goes in for the same reason- back pain. The ER staff is usually not too happy to see her.

I think this lady is really nice. She has a family, a job, and many things going for her.

My question is this-

How appropriate would it be to start a conversation about her addiction and any possible alternatives? I would like to see her get the right help, but it just doesn't seem to be happening. I'm sure her family is under strain from her addiction, and it's not fair to anyone. I really don't even know what the right help would be, but this cycle is a downward spiral.

Comments? Experiences? Advice?

[Eydawn]

You might ask her if she's ever seen someone specifically to address the pain medications and how they are working for her... you might ask if she's ever heard of becoming addicted to the pain meds, and that this type of addiction results in it not working as effectively for pain... and if she had ever considered seeing a specialist to evaluate that since you hate seeing her in pain like this...

I mean... if you know her fairly well and have a rapport with her, you might try asking questions about what else is being done if anything... and then make small suggestions. Make sure you're not letting the emotion of "oh god, I'm taking YOU in again" filter into it, or she'll just think you don't want to deal with her, instead of being concerned the way you are.

It's a risk... she might take it the wrong way. But then again, if you have a good rapport with her, it might just be the input she needs to get her going.

Poor lady! I hate it when stuff like this happens.

Wendy

CO EMT-B

[itku2er]

Unless she is willing to admit she has a problem there really isnt much you can do. You can passively mention this but more than likely she isnt going to be receptive to the ideal. Is the only reason she goes to the ER is to get pain meds or because the pain in her back is interferring with her daily functioning?

[EMT Foose]

Is the only reason she goes to the ER is to get pain meds or because the pain in her back is interferring with her daily functioning?

That's the question of the day right there. I think she's going in for meds, and the ER nurses think the same thing.

She takes enough opiates and muscle relaxers every day that a horse would be knocked out..

[Richard B the EMT]

I have had a similar patient. She lived in an apartment building, and when she'd call 9-1-1, and the ambulance would respond, she would ask to be taken to a hospital 2 counties, and perhaps an hour's travel time, away. Neither of the local hospitals in the isolated section of the county where she lived, carried the pain med she "needed".

I suspect she had run out of her prescription, or was using too much.

Point: I remind everyone that this is in a city of multiple counties, where almost all calls handled are within 15 minutes travel time of AN emergency room, and closest Trauma Centers to the call in question are roughly a half hour.

Point: Any call where travel time, other than "specialty" centers like Trauma or Burn, would be more than 10 minutes past the actual nearest hospitals, provided the patient is "stable", has to be approved by the on line medical control doctors. If unstable, a patient would have to go local.

Different doctors at the OLMC would grant, or deny, going past that "10 minute rule". One team got into trouble for taking her without asking permission.

She wouldn't say no to the local Emergency rooms, if the OLMC declined her going to the hospital 2 counties over.

When she moved to a skilled facility, which was so close to one of the 2 hospitals, you could sneeze at the facility, and someone at the ER would say "gesundheit", we still got her, but, of course, she wanted to go to the further away ER, which did, and does not, require OLMC contact.

However, when we started getting calls on her floor for her, and the nursing staff was confused why we were there, but she'd stroll up and say, "Here I am, let's go", as she had called from the pay phone for 9-1-1, she became the facility's "administrative problem", and she was soon transferred to somewhere outside of my station's usual response area. We've lost touch, but I am not looking for her.

I hope she gets the help for the pain med addiction, if indeed that is what it is.

[Don1977]

Time to pull out the hole puncher and punch the "frequent flyer" card.......2 more punches and she wins a free ride....

I have used that term to doctors and RN's about patients and they got a kick out of it...

Its about the truth too, some of these frequent flyers should get GOLD member cards.....

[WelshMedic]

Man, you seriously need a no-send policy for this sort of stuff. It is tragic that such a nice person is addicted to her pain medication. It is, however, not an EMS problem.

WM

[air.stump]

I say don't confront her. Instead, talk to her. The difference is that confrontation will make her throw up a barrier and close down all communication. Friends talk. It sounds like you have a decent rapport with this patient and a casual conversation about how she has gotten to where she is might help seek help else where.

When I transport patients with an abuse issue, after about the third or fourth trip, I usually ask them why. Sometimes they get mad and refuse to talk about it. In most cases, they want to tell you how they got addicted. When they finish their story, I take the opportunity to advise them that there are alternatives to their life style.

If you are wondering if it works, well........ Of all the times I have done this, I only know of one person that took steps to make a change.

For what its worth.

[under-dreaming]

I believe that there is a serious misunderstanding for these people with addiction to pain medications. Many of these people have become addicted without even realizing that they did. Some even think that they can't become addicted to prescription medications. I know, the notion is foolish... but I have met quite a few people that have such a high respect and appreciation for their doctors that they simply can't grasp the idea that anything from the hospital can actually be harmful. So, it seems that a big part of the problem is as usual: education. Unfortunately, in our profession we really don't have the venue required for intervention with our patients. All we can do is watch and offer helpful suggestions.

[fireflymedic]

If you know this patient REALLY well and have a pretty decent idea of how she will react, perhaps ask if she has seen someone in pain management and if not suggest she try someone. Pain management specialists are trained to detect addictive behaviors and also provide non medication relief such as bio feedback, relaxation, etc which work just as well in some cases. If pain meds are needed, they can prescribe something that works longer or doesn't require such a high dose. They really are a beneficial resource to patients.

As far as addressing her otherwise, it's not really your place to do so. The only thing you can do is prevent additional addiction by providing her with further pain meds (ie she calls you to obtain narcotics). However, keep in mind that pain is difficult to rate and what may be tolerable to you, may be intolerable to someone else. Everyone's pain threshold is different. It's frustrating indeed because you never want to see someone in pain, yet you don't want to feed an addiction. Since the ER is so familiar with her, you may suggest they try coordinating with her regular physician to find alternatives to having to go to the ER. Also, it never hurts to go ahead and contact med control or your supervisor regarding taking someone out of county. The one excuse I have used for patients that request going out of town EVERY time is that if they are severe enough to request an ambulance via 911, that I will take them to the local hospital, let them get stabilized and then transfer them if needed. After doing that a few times, I have found that reduced the amount of times I was called. Perhaps give this a try and see how it goes. She may not be happy with you, but it will reduce the time spent on the road and wasted resources.