This just pisses me off.

[RuralKSEMS]

So, I get home from football standby last night just getting ready to change (already have boots off) and the pager goes off for an unresponsive pt. Toss some shoes back on and head back out the door. Get to the station, get in the rig, we get 10-22'd because family requests an ambulance that is nearly 30 minutes away as opposed to our 15 minutes or less. Not to mention this is in our call district and we can transport to pt's choice of hospital. I'm wondering who has lost their minds because this pt is unresponsive and if he's coding, he's going to be dead by the time the other service gets there. My director comes over the radio, tells us to disregard dispatch because we are less then half the distance so we hit lights and sirens and head out.

I radio the first responders about 5 minutes later asking for pt information so I know whats going on. First responder comes back across saying its a HOSPICE situation and family has declined first responders. We then go non emergent. Our boss calls on the cell and says to continue and if other service gets to the scene first, we 10-22, if not, offer whatever assistance until they get there. We get a mile away and other service gets there. We 10-22 back to the station. My boss is pissed because A: somebody gave/ got the wrong information and it went out as unresponsive and not as a HOSPICE transfer. He's also mad because the other service director called and crawled up his ass because he had us disregard the original 10-22 from dispatch because we were thinking we had a dying pt.

Who does the ultimate blame (mess up, what have you) lay with? Dispatch, the other service, the family (I admit, incredibly stressful time if you've got a family member on hospice) or us for going ahead to the scene to provide care.

Opinions and points of view appriciated.

[Arctickat]

The System.

I just can not fathom a system that has multiple ambulance services serving the same geographical area. This ambulance can do dialysis runs but can't do 911 calls, or it can do transfers to this hospital, but not to that hospital. If I were to call 911 I would be seriously pissed off to watch an ambulance drive past my house on its way to pick up the dialysis patient down the block because it can't do emergency responses.

Our EMS system involves one EMS service providing care to a particular geographical area. These EMS services respond to all the calls within their assigned boundaries regardless of....well, anything. Unless all of our ambulances are out of the area and another has to respond we do everything.

[paramedicmike]

No idea what 10-22 means. Especially since 10 codes went out the window years ago with the whole NIMS thing.

Why so interested in pointing fingers to blame someone? Did the patient get the care s/he needed? Did the family get the support they needed? So your boss is pissed. Tell him to act like an adult and follow up accordingly to ensure something like this doesn't happen again.

[RuralKSEMS]

10-22: Cancelled.

Not so much in pointing out blame, more interested in why this fell through the cracks and turned into such a cluster.

We never made it to scene but other service did so I'm under the impression that the pt got the care they needed. Boss is more pissed because other service boss called him on his personal cell phone and bitched him out for sending us to the scene even though dispatch cancelled us. I don't care who's "fault" it is really, just more frustrated with the situation and looking for a place to vent. Apologies if I put this in the wrong place

[Arctickat]

I'm having a little trouble with the timeline here...the other service was 30 min away and you were 15. How was it they managed to beat you to the scene? Was there a dispatch delay? Why was the other boss so pissed with your boss? Did he lose money or something? Seriously, it pisses me off that patient care is taking a backseat to money and ego.

[RuralKSEMS]

There apparently was a gap between when first reponders went and other service was dispatched and when we were dispatched according to my driver (he can hear more dispatch frequencies on his handheld/ pager then I can). I've not got the county wide channel on my pager, only local. We downgraded response when we found it to be hospice pt and the family requesting other service (about 12 miles out still). They only got ahead of us by about a mile. Other boss was pissed at my boss because my boss had us responding anyways even though other service was requested and we were canceled. My boss had us respond despite being cancelled because we were under the impression that it was an emergency and not a hospice pt that just needed a non emergent transport from home to the hospital. He (other boss) felt his toes were stepped on because we went anyways despite his service being requested. It's a small area, so it's not unheard of for egos to be involved. I was worried at first that the family didn't understand that if it were truly an emergency, that their loved one would possibly suffer by waiting double the time for the other service to arrive instead of the one that was closest. 15 minutes, as we all know, can cost a life several times over. To my boss it wasn't about money (fairly sure anyways) it was about what was best for what was thought to be an emergency.

Our EMS system involves one EMS service providing care to a particular geographical area. These EMS services respond to all the calls within their assigned boundaries regardless of....well, anything. Unless all of our ambulances are out of the area and another has to respond we do everything.

That is how it's supposed to be. If it's in our area, we go, period.This was in our area geographically. Doesn't matter if it's transfer or transport. Unless, for some odd reason, another service is requested. This is the first time in six years that I've had it happen. I'm guessing the family requested the other service to respond because it is in the town that the hospital that they were wanting transported to. We have the ability to transfer to any hospital in the area (rural hospitals) or to any of the city hospitals should we deem it medically needed to go there.

[DwayneEMTP]

No offense, but I guess the part that bothers me the most is that this is suddenly considered an unimportant, non life threatening call because it's just a hospice patient. You have a patient that is dying, at least it appears so if they are in the hospice system, and for some reason it's less important to get there because they're going to die anyway?

I'll tell you what...after rereading it really, really bothers me that you use, "If it was really an emergency", "This was just a hospice patient" over an over. Either you've not been doing this long, or you need to really, really rethink why you're in this business. These patients are not only some of the sickest, most emergent patients that you'll see, but also, they and their families have normally been suffering for a really long time, in some really humiliating ways. I would rather provide comfort and care to this family than the kid that just crashed his motorcycle and has just started suffering 15 minutes ago. My care will be more meaningful and appreciated here.

And if they called for a non emergent transport, why were there first responders there anyway? Once you've dealt with some of these patients and their families you will understand why they would want a particular service (Most often because their loved one had been treated kindly by that service before), and would NOT want a bunch of first responders running around in their house trying to pretend like they had something to offer.

It's after the football game, so I'm guessing, what 10:00pm or so? Maybe later? When was the last time you heard of a non emergent transport that involved a "well" person at that time of night? Your boss did the right thing. At least until he started eating shit from another wanker that prioritized call volume over patient care and safety.

I'm not busting your balls/ovaries, I'm truly not, but I don't really get this either. We've all been caneled a bazillion times, and I'll bet that less then 1/3 of the dispatches that I've responded to were a good representation of the patient present upon arrival. (Not bashing dispatch. They report what they're told, they're just simply are rarely talking to calm, rational people.) And if you were really frustrated because it might have been something really important, like a sexy arrest instead of a boring hospice patient, then you'd accept that even at 15 minutes out that you had nothing to offer the arrest either, right?

It sounds to me like a low volume area where there aren't enough calls to keep folks entertained so they look for things to fight about...

[RuralKSEMS]

I apologize for what you view as a negative statement. It was not in any way ment to come across that way. I've had family members that were in hospice. He was no less deserving of any form of treatment. We were down graded by my director after having already being cancelled by dispatch. We were continuing to the scene to offer assistance as we could until the chosen ambulance company could get there to assist the family in this person's care. We just did not reach the scene to offer assistance before the other company got there. I've been canceled more time then not and I can understand the families point of view also. I probably could have explained myself better in the OP. My frustration was more to the point that dispatch more then likely f'd up for the upteenth time which gets extremely frustrating. We'd have gone to the scene no matter what it was, arrest, hospice (which I've transported several times), cut, splinter or to pick a drunk ass off the floor. We (or at least I) was more worried that a pt was not getting the most appropriate care by choosing a company that was twice the distance from their home. I could care less about the money, I did it for years with out getting paid and what I do get paid now doesn't amount to want somebody makes working for minimum wage at Mcds. It's not why I do it.

Sorry again if I've been offensive, it wasn't meant to come off that way. Just more frustration then anything.

[Emergency Laughter]

It's pretty rare that a screwy situation is the result of a single error. It's usually a succession of things that hop on the back of each other.

Like if you tell 10 people "epistaxis" by the time it gets through the tenth person, it's a rhinocerus loose in the backyard and there's blood everywhere.

First you have the caller, they got a hospice patient, someone they love is dying and like you said, that's really stressful for the family and all involved. At some point in the conversation someone says, "Yea, he's unresponsive," So being an old dispatcher myself, "unresponsive" was always a key word that I zero'd in on, thinking, "Hmm, well that's not a good thing."

Bottom line is what's everyone all worked up about, a few gallons of gas? Your super told you to keep rolling on it, sounds like a good plan to me since it's all about the patient anyway. You can never go wrong with too many people with the right resources offering assistance to someone in need.

If it blew up in everyone's face, at least you'd still have a unit heading in the right direction. Plus, nobody ever REALLY knows what's going on until you walk through the door. It could have been a rhinocerus on spice, who knows?

It kind of sounds like the other supervisor who was having a cow needs a transrectalencephalectomy.

As far as you guys in the rigs, unfortunately you gotta do what the radio tells you to do. Can't let it get to you. You have enough stressors on the job, discard the little ones so they don't become big ugly ones.

The patient always comes first.

That's my story, and I'm sticking to it.

Mike

[Emergency Laughter]

To Paramedic Mike:

WHAT? No more 10 codes? You gotta be 10-13ing me? Are you 10-57’d up in the head? What 10-42 made that 10-28ing decision? That’s just 10-89ing wrong man. What’s the 10-77ing world come to?

10-9 10-1,

Mike-The Big 10-4

Edited October 9, 2012 by Emergency Laughter