HOSP-ITALITY ABUSE

[VentMedic]

Vent perhaps you are in the wrong field, maybe you should go be a become a social worker.

Did you also not get the meaning of a team effort?

Some just want to bitch about the repeat calls while others want to see what can be done to prevent. Again, why do some in EMS criticize those who want to make an attempt to fix a problem? We could also use education and EMS as an example. There are reasons why EMS has the problems throughout the country when it comes to education, standards and certifications. Many of those problems lie with the lack of motivation amongst some of the providers. Some just believe if they keeping defending the way things are even though it could be better or ignor what isn't, everything will be just fine. Some are just afraid to extend themselves alittle or get involved with issues that aren't directly in their protocol book.

[wrmedic82]

This is my take on the topic. Agree or disagree its all good with me.

We have the same problem in our system. Its very easy to become jaded after constant runs for the same guy over and over again. There are some people even that we know who it is before making the scene just based on CC.

We had a crew almost 6 months ago pick up a homeless guy that everyone in the company knew. A known alcoholic, and known 911 abuser who would get drunk, and call complaining of CP. Well this call started with the typical routine. Nothing appeared out of the ordinary, except for his 12-lead showing massive AMI. He ended up coding en route to the hospital, and pronounced dead at emergency room.

I like my partners stance on this which is treat each patient as if its the first time you have ever met them. I know that repeat abusers are as the little boy that cried wolf. But regardless we cannot let our guard down until we have the technology,and training, to actually R/O life threatening events. I understand some services do, while others don't. I don't like running on calls on people I see more times than my own family for the same complaint or lack there of. But I also like working towards being successful in my job. I would hate to loose what I have worked for, just to find myself trying to be successful somewhere else, or in a profession outside of EMS.

Point is we, as much as we would like to, cannot call a spade a spade just yet. I look forward to the day that it would be possible. However I see that day being far off, and not in the near future. I could be wrong.

[CBEMT]

We had a crew almost 6 months ago pick up a homeless guy that everyone in the company knew. A known alcoholic, and known 911 abuser who would get drunk, and call complaining of CP. Well this call started with the typical routine. Nothing appeared out of the ordinary, except for his 12-lead showing massive AMI. He ended up coding en route to the hospital, and pronounced dead at emergency room.

We had a similar patient, except she wasn't homeless and there were no 12-leads on the trucks at the time. Since it was the 55450345895834985903485th time she'd been to the ED for chest pain, those highly-educated, caring, better-than-EMS providers in the ED parked her against the wall. 'I'd love to send a doctor over there right now so he can tell her she's not getting pain meds and you guys can ship her right back home, but they're all going to be busy for quite awhile."

Eventually, their crack assessment skills revealed that she expired while holding up the wall, most likely of the MI nobody thought she'd ever have.

Except my partner, who gave her a full workup and treatment, like he always did when she complained of chest pain, "Because you never know." (Silly medic, following silly protocols. What was he thinking?)

[subliminal]

Vent, my advice to you is to go and volunteer time at a homeless shelter or soup kitchen. You will then have actual experience and will see that 90% of these people just want a hand out not a hand up. They have no desire to get better at all.

Would you treat a patient if the patient refused to let you attend to their injuries? I sure hope not. It is the same principal if they dont want help you cant give it to them. No amount of you being there for them is going to make them open up their eyes and realize the self destructive path they are on and make them want to change.

[Richard B the EMT]

OK, KNOCK IT OFF!

Stop attacking each other, and face that we are going to have different opinions, as some will feel that a frequent flyer needs social services, others think they need the return of the "drunk tank", others feel the need to find some common middle ground that will keep ambulances available, or keep the ambulances available for the "real calls".

There are probably more opinions, and I won't state which one I mentioned is mine, or if I'm one with a yet unpublished opinion. I have heard many, both here, and from my working comrades, and know we won't solve them for an undetermined time from now.

[Happiness]

DITTO

[VentMedic]

Vent, my advice to you is to go and volunteer time at a homeless shelter or soup kitchen. You will then have actual experience and will see that 90% of these people just want a hand out not a hand up. They have no desire to get better at all.

Do you honestly think I haven't? I have also help set up shelters to protect the homeless during hurricanes and have seen the new homeless had shelt afterwards.

Again, enough of your stereotyping of the homeless.

Would you treat a patient if the patient refused to let you attend to their injuries? I sure hope not. It is the same principal if they dont want help you cant give it to them. No amount of you being there for them is going to make them open up their eyes and realize the self destructive path they are on and make them want to change.

Geez! How many of those that call 911 are going to refuse treatment or at least a ride to the hospital?

Addicts are not the most easily treated but at least we can do enough patch work each time we do see them so that they don't need the ICU. Do you know how many medical problems the homeless addicts face and how many hospital days they do require if they problems are ignored.

If you don't want to do anything then don't. I definitely wouldn't want someone with negative attitude on a team that is trying to make a difference. So please don't think you have to do any more than what your few protocols state. You and herbie have made it clear that not all patients are worth your attention. I am just glad I don't have the same jaded outlook as you after all these years. Yes I do want to make a difference and through my roots in EMS and advanced education, I have and I will continue to. If you have a problem with that then maybe you should re-evalutate why you are in a profession involving patient care.

[WolfmanHarris]

I was reviewing some of my CREMS resources today (find the best stuff during an office clean-up) and thought I'd share a few more details on the resources accessed through our program. Remember that these are not provided by the service, we have a referral program that allows Paramedics to facilitate access to a Community Care Access Centre or Community Crisis Response Service.

Community Care Access Centre (CCAC) provides:

- Information and referral for

- Meal delivery program

- Adult day care programs

- Respite care

- In home health care

- Nursing

- Person Support/Homemaking

- Physiotherapy

- Occupational Therapy

- Social Work

- Speech and Language Pathology

- Nutritional Counseling

- Long-term Care Placement

- Short Term Care Placement (for recovery from illness/injury or caregiver respite)

- Case Management

Community Crisis Response Service

- 310-COPE 24/7 access line

- As assessed by the phone contact other services include

- Mobile Crisis Response Team

- Mental Health Support Team

- this is specific to situations with police involvement. A crisis worker and plainclothes LEO respond to assist.

- Short term crisis beds

- Access and referral for long and short term support

Both program are free government programs.

While there is nothing that prevents them from being used to help/support the homeless, these programs are not designed for them specifically. It's a start though.

I may not have gotten in this to be a social worker, but I still think a holistic approach is incredibly important. Not for selfless reasons either; the hospital emerg is not often the right spot for these patients. I can either continue to take them there and bitch, or I can use the resources available to try to make my professional life a bit easier. Same reason I like doing public education and community programs. If I can get even a few more of my patients/their families to keep legible lists of meds/history I won't have to keep bringing rubbermaid containers of pills with me in the truck unnecessarily.

[fireflymedic]

I learned early on, don't dismiss your patient, because they are the one that will kick your butt and make you lose everything you've worked for.

My second shift on the job, sparky new EMT riding a BLS only service. We get a call from a frequent flying lady who always complained of not feeling well and difficulty breathing. Everybody groaned and well, being the newbie, I got the run. Went out to her house and first thing she said is I don't feel good and I'm having a hard time breathing. We put her on the stretcher, took her out to the truck, I hooked her up to O2 and started doing a decent assessment. My partner hands me a slip of paper with the words "she just wants attention" written on it. It made me angry. I did the best I could and treated her with dignity and respect. We got her to the hospital who also knew her well and fortunately she landed under a new doc in the ER. He did a 12 lead and boom an MI - boy was I glad I had treated her as I did. It was a learning experience. My partner quit EMS altogether shortly after.

We see patients of every type and fashion in EMS, some needing acute help, some needing long term help, some needing help beyond our expertise. FOr each you do the best you can, refer them to the proper sources, encourage them to get help, and pray the next time you pick them up it's not going to be their last. I'm not a "bleeding heart" and I'll be the first to say there are a good chunk that frustrate me to death some days with their frequent calls. I just keep reminding myself, we may be the only help they can get and they don't know how to ask any other way. They just might be looking to you to help them get what they need, and then again they may be hardened abusers of the system that don't care. Either way, treat with respect and you'll always be fine. Lose that and you need to walk away from this field, it's no longer for you.

[ladybear]

<a href="http://www.nypost.com/seven/07122009/news/regionalnews/hosp_itality_abue_178789.htm?&page=0" target="_blank">Read the Full article here</a>

ILLNESS-FAKER BUMS TREAT ERS AS HOTELS - ON YOUR TAB

These bums are costing you a fortune.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.

I have four I know by name. EMS gets called, they bring them in to the nearest hospital which happens to be us. We put em in a gurney and tell them to sleep it off until morning. One usually gets a loading dose of Dilantin too because otherwise he will have seizures. If the others start to get the shakes, they get a mg of Ativan PO, then back to sleep until the morning when they are offered the services of the social worker.

The only shelter is in downtown LA, which we KNOW they aren't going to go to. They end up walking out and come back within a few nights for another bed and breakfast treat.