Babysitting on Scene....Whiskey Foxtrot Tango

[sirduke]

I searched the forums and didn't find anything that exactly discussed this, so if I posted it in the wrong place or it has been previously addressed, Flame me.

Every service I know of, and from what I've read, has frequent flyers. Those patients you see over and over and over.

Fact of life in EMS I know, but here is the beef.

We have two of our personnel, won't mention levels, cause that just fans the flames, who seem compelled to babysit the frequent flyers.

We will go on-scene to general sickness, or "pain all over" or insert complaint here, only to arrive, check the patient whom we've seen at least twice today already, and find no medical reason for calling EMS.

All vitals within normal limits, no specific complaint, no fall, no fever, no cardiac, no nothing.

Generally speaking, these are older women, who refuse to go to the hospital but just wanted to get checked out.

Then procede to give you their life history, starting with the cooling of the earths crust, and detail every minor ailment from the stubbed toe in 39 to last weeks runny nose. Each attempt to elict a specific complaint or reason for calling EMS launches another round of "History of her World".

These co-workers will stand around, and baby sit these people for up to 45 minutes or longer. One in particular, has been known to make them a sandwich, pour them coffee, assist them with finding their shoes under the bed, and fluff their pillows.

Don't get me wrong, I am aware we need to have compassion, but WTF? We are a 911 service, in a large county with only two trucks.

Not to mention, each time we end up going back, they seem to want us to do more and more, find my bedroom shoes, get me another drink, etc.

And, should you refuse, as I do, they will whine and complain that you aren't as nice as the ones who were here last time, one even asked if she called 911 again, would she get the other crew.

I got caught by scheduling having to ride with the prime babysitter, and we ended up staying on scene for 55 minutes while she chatted up Mrs.X and tidy'd up her living room for her. I got the vitals, she refused transport, and asked me to step out so she and my co-worker could chat. I told my partner we needed to return to station and went out to the truck, started and finished my run report.

Finally, thankfully, dispatch kept calling status checks, until the director called from home to ask WTF, and we got off scene.

When I mentioned this to my co-worker, she got extremely defensive, stating that it was our job to be compassionate, and go the extra mile to accommodate the patient. She accused me of being heartless and ruthless, and finished by saying as long as she was in charge, we would continue to accomodate these people.

Needless to say, this is driving me nuts. We are Emergency Medical Services, not Auntie Em's Personal Care and Cleaning Service.

Am I alone in this opinion

[mobey]

Ok so there is no physical reason to call EMS... How bout a mental problem.

Calling a few times per day sounds like a scream for help. It is fairly clear to me these lady's are lonely to the point of depression.

You say "Old lady's", are they still in charge of thier own finances? abuse maybe??

How about terminal illnesses? do they have any surviving family you could talk to about this? How many of thier friends have dropped dead in the past 5 years??

You seem to be focused on what you see as your partners deficiency, you need to turn the finger around and ask yourself what you can do to treat these women.

I dunno how US mental health works... but I would start with maybe victim services, since they deal with everything from abuse to severe depression, alcoholism, and many other things that could be going on here. Perhaps someone else needs to explain how her community is at risk everytime your put out of service to make tea, but that has to be followed up with that same person finding out what is really going on with this patient.

I agree your spending too much time with these people, and I have used the term "We are an ambulance ma'am, we don't have too much time to spend on these things" when I have been asked to make tea, or the patient wants to change cloths before transport. You can be firm while still maintaining respect and trust from your patient.

[Asysin2leads]

You take your partner aside, and you tell them that if they keep this up, eventually a time will come when there is a critical call, you will not be available to respond, and someone will die. When that time comes, you plan on submitting all of your documentation of the behavior you have spoken to your partner about, including staying on scene for 55 minutes with a patient with no medical complaints, and submitting it to your supervisors, medical director, and state boards in the midst of the uproar there will be when someone was dying and an ambulance isn't there to respond. Everytime she does this, pull out your notepad and start making notes. She should get the hint, and even if not, you'll have CYA when the caca hits the fan.

BTW it should be Whiskey Tango Foxtrot, not Whiskey Foxtrort Tango, and since you're a civilian it really should be William Tom Frank.

[sirduke]

With two exceptions, these are elderly women, living in subsidised housing. We have more than once reffered them to the Adult protection services, who visit them.

Having been through GEMS recently, I am more than aware of the dangers of abuse/neglect, and their new buzzword, Ageism, which I believe is what my partner is implying that I have.

BUT, understanding their problem, they are lonely, is one thing, but my point is we cannot or should not spend so much time on scene. And the catering to them is only making the situation worse.

I'm not a heartless bastard, regardless of how I sound. I have sympathy for their plight, but my point is, this is not a emergency.

As for mental problems, one of them insist that she has an earring lodged in the lobe of her ear, and has been seen 5 times at the ER, x-rays and CAT scans at least 3 of those times with nothing found. Yes, I believe she has a mental problem, but it apparently isn't enough to have her placed in a group home. She can drive herself to the grocery store, and the beauty shop, so why do I have to get up at 3 am to hunt for a non-existant earring, and then wait at least 30 min minimum for my partner to fetch her coffee and fluff up her bed?

[Just Plain Ruff]

truly, 10-20 minutes extra on scene after a refusal is ok but 55 minutes and making sandwiches not this medic.

but.... this sure sounds like some of the patients I took care of. When I approached their physician he agreed that this was a major issue and he ended up putting the ladies in the assisted living home(ALH). Every time I saw them they remarked how much happier they were at the ALH rather than at home.

Not sure if this is what's happening to you and your crews but it might be a start to discuss this with their docs.

[sirduke]

Yep, got it out of order there Asysin, but for the record. US ARMY Cav Scout, 82-92. Need me to send you a copy of the discharge?

[reaper]

Here is how I handle these calls. Do your assessment. If she is not going to be transported, then have her sign a refusal.

Now you go 10-8 on scene. You take a little time to talk to them, help them with something they may need. Get them a drink or make them a sandwich. It may be all they have had to eat today! If you get a call, you leave.

There is no reason to run back to the station, to watch TV. Take some time to talk to someone that may not have anyone else. It makes their day and that is a big deal.

This is community service and that is part of EMS.

We used to have one that called everyday. She just wanted someone to talk with and help her out. All of us knew what she needed. We setup a plan. everyday someone from the crew would stop by on their way to work. They would spend 20-30 minutes talking with her or helping her with something. Guess what, she quit calling 911 everyday.

It was very little time out of our day, to help someone out. I even took my son there on my day off, to cut her grass. This old lady died a year later, but she was happy when she went.

I guess I am rambling. What I am trying to say, this part of EMS, you just need to find a way to work it out. Find a way that your partner can help, without tyeing up the system.

[Arizonaffcep]

There are 2 ways this (in my book) can play out. As you said there are only 2 cars for the county, being in-service on a BS call is a high priority. So...are the medics in question staying on scene and are not in-service once they determine this to be a refusal? I can see staying...if its agreeable between you and your partner, but ONLY if its done IN SERVICE, available for calls. Anything else is unacceptable, and a huge liability.

The other way to play it out...get APS (adult protective services) involved (you did say you've tried this), or if it gets "bad" enough...involve PD. Calling 911 repeatedly with no complaint (at least here in AZ) is a crime, and PD will get involved. For this to happen though, usually they need to be calling MULTIPLE times A DAY. The last person I got PD involved in was calling 911 4-6 times a day saying she was too drunk to drive and need to go to the grocery store (presumably to get more ETOH, but who knows...).

Of course, a creative 3rd way would be...if she's a regular caller, eat nothing but chilli the day before a shift, and fart your brains out, loud and smelly like. Negative reinforcement, AND she'll get disgusted (hopefully she's not into poo stuff).

[sirduke]

Of course, a creative 3rd way would be...if she's a regular caller, eat nothing but chilli the day before a shift, and fart your brains out, loud and smelly like. Negative reinforcement, AND she'll get disgusted (hopefully she's not into poo stuff).

Now that is a thought !!!

[Dustdevil]

There is a very good reason why psychologists and social workers are required to have a minimum of six years of entry-level education before practising. Because, just like physical medicine, amateur attempts can fark a person up. Basically, your partner is practising without a licence, and an "education" (using the term very loosely) measured in hours. It's time to pull the protocol card. If her actions are not in any protocol or policy manual, she is operating out of her scope of practice, and should immediately be reprimanded and ceased. If she is serious about saving the world, then let her demonstrate it by going back for the proper education to do so. Otherwise, shut up and drive.