One-Sided: EMTs Should Not Make Assumptions

[Canadian Caesar]

I went to a call very similar in character to this one on my practicum. A "man-down" in the local transit center.

I'll tell you, the crowd I dealt with probably has nothing on the crowd in a New York subway station at rush-hour.

But after pushing through the crowd, your patience gets a little frayed. Sometimes the best way to control a crowd like that is to yell, not to quietly mutter "excuse me."

We quickly checked LOC, ABC's, (He was ignoring people for the most part and reluctantly obeyed verbal commands without opening his eyes. He was breathing fine, strong pulse, wanted to sleep, etc.)

Ruled out C-spine. (Patient and bystanders both agree that he laid down in the middle of the transfer site and refused to move when asked. Not signs of trauma, etc.)

By this point, we were so irritated with the crowd that was forming and that the transit police were trying ineffectively to control. (Having to ask people repeatedly not to touch the equipment.) We worked very quickly to move him to the stretcher and get into the ambulance and off scene, continuing assessment and treatment in the ambulance.

Our hasty departure was apparently noted by the bystanders. Which invoked the opposite response from the story.

As we loaded our patient into the back, I heard the hysterical voice of a female bystander yelling "Oh they are hauling ass, he must be dying! Oh good Lord!" As she groped for support from her fellow rubberneckers.

I can only imagine what they thought as we drove away at a leisurely pace without activating our lights or sirens.

That being said, bystanders will make their own assumptions, no matter what your actions are.

And in such an emotionally charged situation, they will NEVER assume the best. Things will always be "worse" than they are.

P.S. Patient turned out fine, some ETOH, but mostly just wanted to sleep and was sick and tired of people bugging him and chose to ignore the people who were asking him to move. Shelters wouldn't take him due to his history of physically abusing staff. Protocols didn't allow us to cancel on him, so he spent the night in a nice, warm, hospital... waiting room.

[Bullets]

We had a MVA, two sets of kids racing down a higway in NJ, light turned red, one car made it through, the other wasnt so lucky. 5 kids in that car, two in front and three in the back. We got there and the two kids on the outside in the rear seat were dead, as was the front passenger. The impact with the back of the seats and dashboard at 65 mph liqufied their bodies. We dragged the two in the back out and laid them under a sheet on the side of the road while we extracated the two with vitals. Bystanders went crazy because we didnt work on the two kids in the back. In order to get the front passenger out, we flipped his feet onto his shoulders because his bones didnt exist. Got a lawsuit out of that because a bystander was "traumatized" by our lack of care for the two DOA's. Perception and lack of training can lead to assumptions that end poorly all around. The two that were alive when we got thater were saved, the driver is in jail right now.

[mrmeaner]

We all looked at each other, dumbfounded.

It's quite possible that this is the only honest part of the story.

Tonya Plank is a former criminal appeals attorney and an amateur Latin ballroom dancer. She is currently a freelance writer in New York and authors the blog, SWAN LAKE SAMBA GIRL, where she journals her often pathetic, at times triumphant, hopefully always humorous experiences learning to dance as an adult, and gives her opinionated, chatty take on the NYC dance scene. She recently completed her first novel, SWALLOW.

Perhaps she isn't the best unbiased judge of proper medical care in the prehospital setting.

[Chief1C]

Could we blame this attitude on the part of the EMS personnel, as an effect of EMS abuse? Calls for intoxicated persons, and homeless laying in the streets; basically taking those out of the view of the society that has forgotten them. Helping people, that won't help themselves and go through the cycle dozens to hundreds of times. I can see where that may eat away at the ability to be a compassionate provider.

[VentMedic]

Could we blame this attitude on the part of the EMS personnel, as an effect of EMS abuse? Calls for intoxicated persons, and homeless laying in the streets; basically taking those out of the view of the society that has forgotten them. Helping people, that won't help themselves and go through the cycle dozens to hundreds of times. I can see where that may eat away at the ability to be a compassionate provider.

Wow! So EMS is the only service that gets abused? Guess where you transport all of those that you hate to have in your ambulance? But, others in the healthcare professions are expected to deal with whatever for alot longer than 15 minutes. They are there not only for the drunkedness but all the DTs and the patients' other healthcare problems. Also, one healthcare professional may have several of these patients to take care of at the same time. And, they are expected to deal with any and each patient with a professional manner. Yes, it may eventually get to these professionals but they also know why they entered a healthcare profession. Too many in EMS enter the field and then realize it is about patient care rather than just the pretty trucks with L&S. If you don't like dealing with people and the good or bad they present with, any aspect of healthcare is not for you.

[mrmeaner]

Wow! So EMS is the only service that gets abused?

I must have missed where he said that. Hmmm. Did it get deleted?

[VentMedic]

I must have missed where he said that. Hmmm. Did it get deleted?

No but here it is again. Other professions as a whole do not blame their problems on the patients. They also do not as openly judge those who can not care for themselves.

Could we blame this attitude on the part of the EMS personnel, as an effect of EMS abuse? Calls for intoxicated persons, and homeless laying in the streets; basically taking those out of the view of the society that has forgotten them. Helping people, that won't help themselves and go through the cycle dozens to hundreds of times. I can see where that may eat away at the ability to be a compassionate provider.

[Arizonaffcep]

No but here it is again. Other professions as a whole do not blame their problems on the patients. They also do not as openly judge those who can not care for themselves.

Just to stur the pot a little...I don't think it's a "can not" care for themselves thing, as opposed to a "choose to not" take care of themselves. Again, just to stur the pot.

[Chief1C]

I didn't delete anything, didn't pose a judgment about anyone, didn't say I hate patients, didn't bash anyone. ..and I certainly do not condone this attitude. Didn't say anything about those that can't change their situation. Won't (Will Not) and Can't (Can Not) are two very different words.

What my over all goal was, maybe continued abuse of the system is burning them out. That's not an excuse to treat patients like this. If you can't be a good provider for every patient, then you should not be a provider at all. People shouldn't regret calling an Ambulance.. When it gets to the point, mentioned in this article, maybe those providers should be removed from the field.. if not let go altogether?

Whatever terrible thing you read into my post, isn't there.. I certainly did not mean to imply it's the fault of the patients who are not physically or mentally able to do for themselves.

[Dragoon]

That article has got my blood boiling. I work in NYC and there is so much wrong with it that I don't know where to start. From description of how the man fell "he lurched slightly left, then fell forward, straight to the floor, crashing head first into the metal gear box under the seats." Not possible, the man would have had to somersault between his legs to make contact with any "metal gear box" that does not exist anymore. (They used to be on the old "redbird" subway cars that haven't been used for 30 years) To the first responder nurses placing a bystander's nail file in his mouth. BS!! And if this man was homeless no one would have been within 10 feet of him let alone sitting right next him. The smell is horrible.

Her description of the EMT's turns my gut. NYC has its problems, but they are bureaucratic and rooted in the administration(s) and management, and can make working in the city a pain in the ass. The 3,000+ EMT's and paramedics that respond daily are professionals. Now I'm not saying that we don't have our share of bad apples and skells but her portrayal of us is insulting. Subway jobs suck. Especially real jobs. You are down three stories on average with no comms and its usually just you and your partner. Maybe you'll have the lone transit cop waiting with the aided. You make patient contact, assess, start life saving treatments and package. When you get back to your bus, you reassess and go. (Refer to Urban EMS: Why do urban EMS fear on-site treatment?) There is no hanging out on the platform joking and smoking. The last place I want to be is in the subway with an unstable or stable patient. You do feel like you are an exhibit at the zoo and commuters are coming and going in all directions. We maybe curt to bystanders if they are in the way, but my colleagues and I are always professional. This call could have easily been one that I was on.

As stated by many already, a lot has to do with perception and for some perception is reality. The author gave her point of view of a medical emergency (with much dramatic license). It unfortunately paints those of us that serve NYC's citizens in a disreputable light. That article is very scary for those who read it and are unfamiliar with NYC, EMS and NYC*EMS. Please don't believe all that you read.