Babysitting on Scene....Whiskey Foxtrot Tango

[Richard B the EMT]

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).

Unfortunately, that works only if the partner agrees to do the same, otherwise, the partner might complain against you being stinky. Furthermore, what about any other patients (and their families/friends/bystanders) you might handle during your tour? How are you set for gas masks for all of them?

[Arizonaffcep]

Unfortunately, that works only if the partner agrees to do the same, otherwise, the partner might complain against you being stinky. Furthermore, what about any other patients (and their families/friends/bystanders) you might handle during your tour? How are you set for gas masks for all of them?

That's what the Vic's is for...

[Doczilla]

One of the big challenges in emergency medicine is focusing the disorganized patient into a concise statement of why they came to the ER (or called 911). At least some of that seems to be occurring by your description of the long life histories she is giving, and so you need to try some methods to focus her. It's okay to interrupt the speaking patient if they are giving you nothing relevant, and I usually do so with a gentle, "I'm sorry, but it sounds like you have a complex history. Can you tell me what is different today that brought you here?" I sometimes have to rephrase and repeat this question.

Your coworker probably has some issues of her own, and while I wouldn't go as far as to say she needs her paramedic card pulled (this really isn't a medical director issue), I will say that she needs a chat with the service director or supervisor.

I agree that a certain amount of nonmedical community service is part of the job of EMS, but these ladies are clearly taking advantage of your compassion and generosity and putting you in a difficult position. On the one hand, you are required by law to assist them in the case of a medical emergency or perceived medical emergency, but on the other hand, it is inappropriate for EMS resources to routinely be tied up for that which is clearly outside the scope and intent of your charter.

There is nothing wrong with you leaving once you have determined that no medical emergency exists (I recommend that this process include a physical exam and vital signs). You may have to put the patient to a choice: "We have been here several times in the last few days to examine you, and you have declined transport to the hospital. Our exam is not a replacement for examination by a physician and further testing. I'm going to have to insist that you come with us to the hospital or refrain from calling unless you feel that you need to be taken to the ER." If she refuses transport then politely excuse yourself and say that you have to be back in service for emergencies. You can do this politely, tactfully, and firmly. The patient will be disappointed, but you do have to set limits. To not do so is neglectful of the other patients and potential patients served by your EMS.

I agree with the recommendation for APS or Social Services referral to determine if the patient is able to meet her needs and perform her activities of daily living.

In the ER, for our abusers who come in for their narcotic fix or a warm place to sleep, etc., we enact what we refer to as a "Care Plan". This is a contract which specifically states what will and will not be done for the patient, and sets expectations for them. You can do the same for these ladies, writing out a care plan that states when she calls for a 911 ambulance, it will be because she perceives a medical emergency exists and that she will be transported to the hospital. The care plans are reviewed by our attorneys. Care plans do not set the stage for a refusal of emergency medical care, but state that if the patient has a specific complaint (i.e., their recurring one, like migraine, or back pain, or sickle cell pain, or nontraumatic extremity pain, etc.), then they will get certain treatments and should not expect anything more. If it is one of our homeless looking for a roof over their head, it says that they will get a medical screening exam and if no medical emergency exists, will be discharged and expected to leave the ER. This gives us some legal backing for politely refusing the patient's request for IV dilaudid or their request to stay in the bed and sleep, or our performance of a limited workup when it appears that a more extensive one is unnecessary.

'zilla

[Just Plain Ruff]

ROCK ON Zilla Care plans for EMS the wave of the future.

[Richard B the EMT]

I think I have heard of a service, possibly through Social Services, that offers a "Wellness Check" telephone call on a daily basis. If the patient is using 9-1-1 for someone to talk with, perhaps this type service could be arranged to call the person, and then the "Patient" shouldn't be calling 9-1-1.

I'll also say, I don't know if this type service is available in my own area, so can anyone tell us if they have it in their area(s)?

[defib_wizard]

I agree with reaper, get the refusal and go in service on scene. Inform her from the beginning that you will leave if another call comes in. Another option is to get a local senior center involved. A lot of communities have volunteers that will go out a few days a week. To visit with them. Another option is find out if it is legal to bill for refusals in your state. If it is then get her billing info and have your co bill her base rate and stand-by. As far as I know medicare doesn't pay for refusals. This may sound cruel but the fuel and other cost to drive over there has to be considered. All non revenue producing calls keep me from getting a raise. She may think twice about calling if she has to write a check for someone to make her a sandwich.

Good luck.

[Dustdevil]

Yeah, but I also agree that it isn't always as easily done as said. Some patients have full intention of going to the hospital, and there is a medical reason for taking them there. But even though they called 911 for an emergency ambulance, they still don't think twice about making you wait half an hour or more for them to pack a suitcase, iron a blouse, feed the cats, and call a few relatives before agreeing to get on your cot. In some true 911 EMS systems, this is not a problem. You hand them a card with the phone numbers to all the non-emergency ambulances in town and leave. But with so many services these days doing this idiotic "public utility" nonsense, and trying to milk every dollar from the taxi industry that they can, allowing no competition for such transports, many of us are just plain stuck. Emergency or non. Medical or not. You call, we haul. And then, of course, the administration of the system that creates the problem holds the field personnel responsible for the delays it creates. And yes, that's a different scenario from the one in the original post. We should, however, be careful to distinguish between those patients who actually needed a ride -- even if it is non-emergency -- and those who just wanted someone to come visit them.

[defib_wizard]

If only the taxi's accepted medicare assignment.

[aluraceleste]

I think everywhere has these little lonely people. We have a lady that will call us, about once a week, and we all know nothing is wrong she's just lonely. She'll often even tell us when we walk in, "Hello! I'm fine, just wanted to chat!" I run with a volunteer crew... so we're nice and chat while we check her vitals and have her sign a refusal, but we can't stay on-scene without dispatch thinking we've died, so we have an excuse. Last time I was there, I suggested that she get to know her neighbor, who is another elderly lady that she had *never* talked to. She hasn't called in awhile... so hopefully she has a new friend!

[CBEMT]

At my former private service job we used to get similar patients, but they would always go. The reason we had them is because the local FD one day got fed up with taking them, and handed them the phone book open to the private ambulance pages and said "Pick one and call them from now on."