Waste of time, or what?

[chappy]

Please don't misunderstand. I don't mind doing my job. And, yes, as restrained my chuckles, I was compassionate to the patient. However, I am very frustrated with the staff at the sending facility. That was the point of my rant. This woman is in hospice because she is dying. She is taking numerous opiates and she may have been using some form of cocaine. To that, I say SO WHAT! I don't generally endorse drug abuse, but this lady is dying. Who cares is she is a little high or a lot high. My frustration is that an ALS unit was tied up so she could go for a pee test. What would the pee test show us - maybe she's using crack in addition to all the other prescription narcotics? Therein is the waste of time.

[Just Plain Ruff]

Please don't misunderstand. I don't mind doing my job. And, yes, as restrained my chuckles, I was compassionate to the patient. However, I am very frustrated with the staff at the sending facility. That was the point of my rant. This woman is in hospice because she is dying. She is taking numerous opiates and she may have been using some form of cocaine. To that, I say SO WHAT! I don't generally endorse drug abuse, but this lady is dying. Who cares is she is a little high or a lot high. My frustration is that an ALS unit was tied up so she could go for a pee test. What would the pee test show us - maybe she's using crack in addition to all the other prescription narcotics? Therein is the waste of time.

does your service have a bls truck that was or is available for this type of transfer? Does the Hospice center have a transfer service they use?

Remember this, the hospice service often has no control over transportation of the patient - the physician orders the transportation. She was being transported for a medical related issue and the physician was the one who ordered the transport I'm pretty sure. So beating up on the hospice team is counterproductive.

Now if this hospice service can make the decision to transport for this type of call, then you can beat up on the hospice but I'll bet if you looked at the paperwork, you would see ordering physician on the transfer paper and I'm sure he's the one to place blame.

I'm also pretty sure that you would be raising holy hell if there was a 911 call that had to wait for your transfer to be over but you aren't so I'm pretty sure that your EMS resources were probably NOT overtaxed that day.

I'm sorry that you are pissed off that you had this transfer to do, but it's part of the job and I'm sorry if you don't like it, but what really pisses me off more than anything is providers who complain about transfers. It's part of the job and if you don't like them, then do something else, find another job where you don't have to do these scut work type transfers. But you are probably not going to get a lot of sympathy here for having to run a transfer.

Edited April 16, 2014 by Ruffmeister Paramedic

[Emergency Laughter]

Dear ClutzyEMT and ERDoc,

Clutzy, first of all, thank you for posting about your patient. It's a good reminder to all of us that we cannot judge people. Bad things happen to good people and there but for the grace of God go I...or however it goes. Believe me, I know, I've been on both sides of the knife. We can't judge people because you just don't know. Compassion and good naps are the order of the day.

NOW...I personally, don't think ERDoc was disrespecting his patient at all. I agree with him totally about the end of life thing. Let her do what she wants. The facility is the one that's full of shit and wasting resources. Hell, he even sat behind her so he could chuckle TO HIMSELF. Just my opinion.

ERDoc, THANKS A *!##*ING LOT!!! That kittyfrog picture scared the hell outta me! Now I got coffee in my keyboard....DON'T YOU THINK BEFORE YOU POST? scared the bajesus outta me....

[ClutzyEMT]

Emergency Laughter,

It wasn't ERDoc's patient and I think we were pretty much on the same road in regards to patient care.....

My reply wasn't JUST to "chappy" but to EMS providers in general regarding attitudes....

This problem is more of a Nursing home or Assisted Living Facility abusing the EMS system and unfortunately, a patient that got stuck in the middle of it.....

I'm pretty sure from the sounds of it, Chappy did his job and did it with compassion, well done Chappy and thank you for showing compassion to someone who probably had no choice in the matter in the first place. No offence meant to you and I apologize for not understanding the frustration~

My reply came out my frustration from reading it and thinking how a provider "with an attitude" (Okay, I'll say it.... a Paragod) could read it and not see the intent of the post, just as I missed it, and think that taking frustrations out on a patient with a less than profession attitude is okay...

Once again, I see now that Chappy did not do that...and I apologized....I am fortunate in that I live in a more rural community and when the Nursing Homes, or Assisted Living Facilities start abusing our EMS system by using the ambulance for non-emergent transports I know who to contact and can usually get a handle on it. I know it is NOT that way in the larger cities, and understand the frustration...........

[scubanurse]

I have to agree with ruff. Basing on NH nurses isn't always the answer. The facility I work has mostly BSN nurses so we aren't idiots. I have fought time and again on the phone with doctors when they just want to send a patient out for no good reason, but ultimately, I have to listen to that physician. If they give the order for the resident to be sent out then we have to send them. An example: I call physician to get haldol orders for a combative patient. This is common for the patient and the regular doc has decided to just rely on on-call for orders when they get like this instead of a standing prn order for IM haldol. I get some random on-call doc who was not with the program and refused to order IM haldol and told me to send the patient to the ER emergent for altered mental status. I tried to get different orders, but ultimately I had to send this guy out. It sucked. I called the ER and talked with the charge nurse and explained the situation, patient rolled in combative, ER doc gave IM haldol, wrote an order for 48 hours of IM haldol q6h and called it a night sending the much calmer patient back to us within an hour. We have a great relationship with our local EMS and ER's so this worked out.

I know my facility isn't like most LTC facilities though as we have PICC lines placed and have several patients on vents, but sometimes it isn't on the nursing staff.

[ERDoc]

I'm sorry for lumping all NH RNs together, because you are correct Kate. Not all are like that. The problem is that most are and it unfortunately creates a stereotype for the good ones. I totally understand when a doc says you have to send it also, that is totally out of your control. The problem for me is, that this particular NH is one of "those types" and they even have a vent unit. A large number of pts come in and we get told they couldn't get in touch with the doc so they had to send the pt. The ones that actually need to be in the ER they will call ahead about, the dumps they don't call ahead.

[BJrdn754]

Having retired from a town owned and operated "9-1-1" system I can truly feel your frustration when having to do a simple transfer ties up your ALS resources. We have a local "care facility" owned and operated by a hospital from the another state (ie 15 mles away). It often seemed like when they needed a patient transferred and the "private" service they generally use had a long wait for time they would call our system to do the transfer. This would leave our town temporarily unprotected and reliant on "mutual aid" from another town.

[scubanurse]

No worries. I know the good facilities are few and far between. I just like to remind people that there are still some decent NH/LTC nurses out there

[Just Plain Ruff]

I've made no secrets about my at one time dating a Nursign home charge nurse. A couple of things she said when we were dating

1. When you come to the NH you aren't like any of the other EMS Crews, you are at least nice.

2. It's not their fault when the patient is sent out.

3. She said some of her nurses and CNA's are truly freaking idiots and dont' deserve a job but she can't fire em because they can't replace em with better nurses but she did say that they all love their patients.

4. She said also that they have absolutely zero control over when the patient get's sent out. And she is truly sorry when a doctor sends a patient to the ER for a problem that can be managed at the NH

5. And her final one was she asked me what we in EMS called medics that thought they knew what was better for a patient than what that patients personal doctor, the nurses in the NH and the actual patient and I told her what that word was "paragod" and she said most everything she has witnessed in many of her EMS crews was exactly that, Paragod.

But she really was apologetic at times when she had to send someone out. She said she didn't like doing it.

That's what I can remember her telling me.

[scubanurse]

It's true ruff. I had one medic argue with me over what the patient's baseline was... I have only cared for this patient 36 hours a week for the last 6 months, and you just spent 2 minutes with them. I think I would know their baseline better than they would.