Faking or not faking? That is the question.

[AKmedik8or]

Have your company by Ammonia Ampules. Pop one under the nose and if they are faking you will no it quickly.

Ammonia ampules BAD BAD BAD IDEA using ammonia at or near an airway in a obtunded person increases your chance of causing respiratory distress 1000 fold. This type of thearpy went out of style just like clam shell restrainting of combative patients.

Don't be "that medic" that causes more harm than good more drawing attention to him / her self by treating people with shock drama type care.

Less is more I agree with the above posts the more subtle you are the more control of the situation you will have; not only that but, if for some reason you miss the fact that the patient is really unconscious and you are bellowing away with " GET UP AND STOP FAKING". You will never be that caught on video tape medic.

[Star09]

I don't think it matters if they're faking it or not. The guy who first introduced me to EMS always had a big problem with fakers. He would get pretty worked up and would say that he was proud of his ability to "pick out" who was faking it.

I personally would rather just do my job to the best of my ability whether they're faking or not. If they are faking then they are doing so for a reason; they obviously need attention if they're desperate enough to call an ambulance, they might be able to get help for that. Of course, on the other hand, frequent flyers become a danger to themselves when they continuously cry wolf.

[Dustdevil]

I agree with you for the most part. Those people who make it their personal mission to harass patients to determine if they're faking just as a matter of personal pride are dangerous and should be fired. In the long run, it really doesn't matter whether they are faking or not, you still have to transport them. So why not just get it over with?

On the other hand, if somebody is obviously faking and you write up a PCR reflecting a serious situation, you're going to look like a total knob to your medical director or QC manager, so you had better stay alert and at least document any inconsistencies you discover on exam.

[Arachne]

I'd rather feel a little stupid for being fooled by a faker than feel like a huge idiot (and possibly hurt someone) by assuming fakery and missing something real...

As for the police situation...When we're called for someone who has acute onset of symptoms after being arrested, I just point out to them that I'm glad to take them to the hospital, but that they'll still be under arrest and still have to deal with the police after release from the ER. Quite often, their symptoms magically resolve, and they don't want to go anymore.

[Ridryder 911]

Ironically, I ran a call yesterday with a pretty impressive actress. The patient was "thrashing about" and family & several friends was all trying to inform us about the patient. Apparently she had struck her foot on a refrigerator and someone had "administered" Lortab.... realizing this was Lortab after the fact, the patient realized she was allergic to Lortab.... a "Paramedic" (turns out to be a person who failed the basic EMT) administered a epi-pen... what a cluster!

During the exam and strange hx., the patient went from thrashing to limp.. even failed the arm-drop test (she has been through this too many times before), but still had eye lash reflexes. We calmly moved into the unit, and I placed a oral airway (without no-gag reflex...hmmm :wink: ) and a nasal trumpet.. in which she resisted slightly, and an I.V. which she had slight reflexes.. all vitals where okay.. Narcan small dose just in case. nothing.... still had cornea reflex though, and eyes when opened would move to avoid direct eye to eye contact.

I informed her, that we knew she could understand us, and that the ER physician would not be too happy on tolerating such behavior... upon arrival to ER, to stretcher she immediately awakened ... wow an instant cure....!

She was + of course for everything on UDS (crank, opoids, cannibas).. my partner a Medic student, was intrigued on how well she maintained her "act" ... and describes as new EMT, he might had bought it..

Like I described earlier, it usually comes with experience, and tell-- tale signs, and treatment was provided, both physical and mental...

I am however nominating her for the next Oscars!..

Be safe,

R/r 911

[AnthonyM83]

Not sure why this thread popped up for me (either it was linked from another thread or it was under recently updated....I go through and open 30 window tabs at a time, then go back and read posts, forgetting how I opened them).

Anyway, wanted to comment on how people act under pain. Some may certainly be having worst pain of their lives, but not show it because they deal with it by going into their heads...dissociating. Sometimes it hurts more to move or groan at all, so one might remain stoic. Sometimes it's a deeper pain (abdominal) that just shuts you down...especially if sick you might not be flailing.

Then again, around here if you flail too much you get the same kind of treatment as if you under-flail. Oh, she's being a drama queen (without even interviewing patient to get a sense of their personality, maturity, likelihood of exaggerating...so they get talked down to or yelled at by EMS). Not that you can't ever tell a patient to pull themselves together...but pick and choose....

[air.stump]

The one thing that stands out here is what the nurse said and the lady that died in the ER waiting room. I can see that one happening again.

There aren't any fakers out there only people that want a ride and people that don't want to train. All of them are patients to some degree or an other.

[fireflymedic]

This has been a topic which I feel has been thoroughly discussed and hashed out as to possible outcomes. As new EMT's or those of us that don't work as often, get caught frequently by the fakers. Hey, it happens, if you treat 'em as real, you'll still be okay. Yeah, the ER doc might go "why did you? They are a frequent flying faker" but my response is them, "I worked too hard to get this cert to lose it to stupidity". Even though I'm on the truck between 3 and 4 days a week, I occasionally get caught. Now granted I'm not going to waste my time and resources as well as my department's money (as these patients usually don't have insurance to reimburse) doing the $10,000 workup on them every time. I will however get an IV on them, put them on a little oxygen and monitor vitals. Easy to do, really doesn't take much time, and will benefit. If they seem to deteriorate, or something presents itself, then I'll get more aggressive as needed. I will admit though, during my tenure of working in an ER in a place known for drug seekers, there was more than once I did inform a patient that was faking unconsciousness that if they didn't become conscious that some very unpleasant things would begin occurring. All it took was a resident or two to start mentioning the phrase intubation and catheter and usually they perked right up ! I've not felt the need to do that since back on the truck, but two very different atmospheres requiring different approaches.

[Happiness]

We have a guy here who we practice our airways on. He was pretty much everyones first (the call is always etoh related). This guy has no gag reflex and when he wakes up he will sit up and pull out the airway. One way I test for this is that I will warn the pt that I will be pinching them and if no response I take my pen and press hard down on the fingernails that normally wakes them up and if not well I guess they are not faking.

[Harold1]

When we have a faker we often push 2cc's of Alcohol 70% up their nose. Nobody can resist that.

HAs anybody else tried that?