BS calls

[Paramagic]

Ahhh, I just didn't think that one through!

[HERBIE1]

Addressed to Doc- I know that sometimes even altruistic physicians get fed up with the BS. Some years ago an ER doc in a BUSY urban hospital here was working shorthanded, impossibly backed up with patients, and a full ER. He began going through charts that were triaged, pulling out the clearly nonemergent patients. He had the nurse call them into a room, the doctor came in, and in about 15 minutes had "treated" and released about 20 people. The vast majority were URI's or uncomplicated cases "fixed" by Ibuprofen or Nyquil I think. This doc was treated as a hero by the staff that night, but I see the obvious danger in what he did. This guy was pretty high strung and burned out, but I understood his frustration. The myriad of BS cases were taking time, staff, and bed space away from a bunch of seriously ill patients. Unfortunately this was before they had a Fast Track/Immediate care area. I believe he soon left for a sleepy little rural ER shortly after that.

[ERDoc]

Thanks Herbie. I like to think I'm altruistic but I think 10 years of EMS beat that out of me before medical school, lol. I work at a level 1 trauma center/academic site as well as a rural community hospital. All I have to say is, never underestimate those little rural ERs. You have to be good to work there. You don't have every specialty to back you up when the shit hits the fan, you actually have to be a doctor.

Edited November 10, 2011 by ERDoc

[Krysteen]

All I have to say is, never underestimate those little rural ERs. You have to be good to work there. You don't have every specialty to back you up when the shit hits the fan, you actually have to be a doctor.

Nice! and true! I have worked under some fantastic rural ER docs. Have no clue how they do it though, I will see them up all hours of the night only to have to work clinic in the morning. I have brought in some pretty nasty stuff and you're right. There is no trauma team, pulmonary team, surg team at their disposal. I also have the privilege to be able to have one as my med director. Always nice to be able to have a close working relationship with your director and receive feedback immediatly on your treatment decisions.

[HERBIE1]

Thanks Herbie. I like to think I'm altruistic but I think 10 years of EMS beat that out of me before medical school, lol. I work at a level 1 trauma center/academic site as well as a rural community hospital. All I have to say is, never underestimate those little rural ERs. You have to be good to work there. You don't have every specialty to back you up when the shit hits the fan, you actually have to be a doctor.

How about realistic? LOL I know what you're saying about the rural or "slower" ER's. Years ago- when there actually WERE slower ER's, I worked in one of them. Slower, smaller, but it was still urban. It would often go from zero to insanity in about 2 minutes. As a "tech", I learned a lot from the docs there. Much of it was by necessity- they needed all the help they could get since staffing was generally minimal as I always worked 11p-7a. I learned how to drop NG's, Ewalds, Foleys,12 leads, administer meds, put on posterior molds of all shapes and sizes, even assist with suturing and other minor procedures. I used to love watching how the docs handled things when all hell broke loose, and would apply what I saw- good and bad- in the field.

The one thing I did learn was how often the docs would verify a diagnosis, do some quick research on a drug or disease- throughout the course of their shifts. This was before the internet, which meant lots of reference books. Obviously the majority of patients were routine, but this was also back in the 80's when HIV and AIDS were first appearing, the ER was in a gay area, so we were seeing all those bizarre cancers and respiratory problems. Fascinating stuff.

[Bullets]

A couple of you guys mentioned taking people who called 911 back to their house. Is this something that you guys do regularly? In my services the ambulance has 3 possible destinations and they are never another residence.

We have drunks who call its in the winter and want rides to the soup kitchen, but we won't take them

[PCP]

• Taking someone home is something that is not done on a regular bases but it does happen depending on the paramedic you are working with and the situtation. Another thing would be it depends on what station you work at. For example if you work at a rural station it would happen more often than if you worked in the city.
  

[Just Plain Ruff]

I was one of those who mentioned taking someone back to their house. it has to be a very special circumstance to get that treatment.

I also was involved in a incident where a family from overseas were involved in a auto accident on their way to the airport. Their rental car was totalled. Reports filed. No way to get to the airport. Involved the supervisor and discussed options and he said "Why don't you guys just take em?" We said "Can we do that without getting in trouble" He said "I'm approving it so No you won't get in trouble".

We packed them up in our ambulance, seat belted mom and dad and the two kids in the back of the ambulance and off to the airport we went. At the time of this special transport all the ambulances were in service and we had extra crews on duty. It was a great help to this family, I learned a little german and they got to the airport safe and sound.

but like I said, it has to be a very special set of circumstances to get that type of service.

[Richard B the EMT]

With my VAC, I sometimes took a patient back to residence, if close by. FDNY EMS? No way, against regs.

[HERBIE1]

Occasionally we take someone back home- but as was mentioned- under very special circumstances. Is it against policy? Of course.

The other day, for example- little old lady fall down, go boom on sidewalk. Tripped on a crack. Sustained SMALL- 1/4 lac to her eyebrow thanks to her glasses frames- MAYBE needed a suture, steri-strip, or Dermabond. Shook up and upset more than anything. Vitals fine, no significant PMH, no loss of consciousness- absolutely refused. Couldn't afford the ride or the ER bill. Cleaned her up, called her grandson who she lives with- just a couple blocks away, and explained what happened. We said we would take her home if grandson would take her to her family doctor for at least a tetanus and follow up. He agreed, and both were very appreciative of our extra effort. Documented everything- except the part where we took her home. It was just a routine refusal of transport- except for the taxi ride home.

Not too concerned if someone wants to nail me for what we did. I'll gladly take the punishment- and would do it again in a heartbeat. I would hope someone would do the same for my mom in a similar situation.