Guidelines for laymen for requesting a medical response.

[DwayneEMTP]

It's kind of hard to explain...here is the biggest issue where this is concerned.

Most times, based on their cultural difference and expected level of medicine things aren't deemed serious enough to need a medical evaluation. Fainting, car accidents where they 'just have neck and back pain' or an eye swollen closed, no need in the opinion of local staff. Though I have been able to educate a little bit of fear into them I believe.

Any time someone calls in an emergency, like recently, a buss roll over, 7 patients, 30 minutes down the road. Security is sent to make sure that there is actually an emergency. Yeah, 30 minute delay before the possibility of my being dispatched. If they believe that there is an emergency, then they call in. To the Safety supervisor.

On the rare occasions that they do call it in, they call into the Safety supervisor, who then decides if it needs medical attention. His answer is almost always no, as he's afraid that he's going to send me and my ambulance out to work on a local national at the exact moment that an expat (read 'white person.')might hit the ground. And he'd rather allow others to suffer than chance having to explain that.

If he finds that the situation is emergent enough that he can't find a way to ignore it and cover his ass at the same time, then he gets the advice of a local national nurse. Their level of training is well below what you would normally expect of a competent EMTBasic. They will listen to the symptoms, but still without calling me most times, as calling me admits that they need my help and they are really opposed to doing that if they can help it.

If they hear the s/s and can't ignore it and cover their ass at the same time, then they call me via pager, cell, or radio and tell me that "I'm needed at the clinic for a consult." Sometimes that means a very ill clinical patient, or other times it means a critically injured patient out on the road that they'd like me to speak to on the phone to determine whether or not I believe they need an ambulance or if Security can just drive them in.

Yeah, see? It's a mess. But to fix it you have to find some way of doing so that allows each level of bullshit to pretend that they aren't adding bullshit to the mix, otherwise I just get shut out completely and they will 'forget' to call me even for emergencies, in fact refuse to work with me on anything. Yeah, I know from experience.

So my goal is to create a protocol, that I'm going to do today, that will allow Security, with no medical training to make autonomous decisions on whether or not to call for a 'medical evaluation' (I started out with 'medical assist' but quickly found out that they won't use that as it, once again, implies that they need 'assistance.'

As you can see, there is very little logic, and very little accountability in the system. I once stood up in a meeting of managers and yelled, "Ok, enough! Do you see that people are going to die because of this system? Do you see that our PNG brothers and sisters are going to be laying on the side of the road suffering while I sit in my office typing up another stupid report, because of this system???"

The response, "This is how it's always been! It's fine! Do not ever mention that at this meeting again!" (You think that I'm aggressive? Papuans when they get all tribal are friggin' aggressive!)

So I didn't bring it up at the meeting, but instead brought it up with the Security training coordinator/manager, Safety manager, and the ER coordinator, and came up with this idea. To allow Security to bypass them all together and just call for dispatch for a medical assessment based on certain criteria, which should make them look, and feel powerful (As they get to do so without supervisor approval) and more likely to use it, if I can make it simple enough and get it pushed through. (Yeah, I don't have real high hopes.)

Unfortunately they can't call me directly because that will irritate those that have ranks above mine, which in medicine is none, but clerically is many, each demanding to be shown the proper respect by not being left out of the loop.

Yeah, its going to create a shit storm, but if I can leave it in place then something good will have happened from my being here...

And that's.....the rest of the story.....

I'll post when I get something together...

[DFIB]

We have a similar situation south of the border. People don't call the ambulance unless there is an MVC or MCI.