Most Unusual "I didn't call 911 then..." situation you've had

[thatJeffguy]

We just got back from the scene of a 59yo female that had fallen out of bed. When we started talking to her, she tells us she fell the night before, in the bathroom, and hit her head. Upon waking, she realized that she'd let go of her bowels and bloody feces was all over the bathroom. She vomited blood tonight, dark "coffee grounds" looking stuff, as well. She was upset that her son called 911.



In my mind, "explosive bloody diarrhea" equals "call the doctor". What's the WORST situation you've heard where the patient didn't call 911, or waited until much later?

 

[JPINFV]

Nursing home. Acute pulmonary edema with severe SOB. Patient's family wanted to go to the home hospital some 10-15 minutes further down the freeway instead of the one 3-5 minutes up the road, so the SNF waited till daybreak to call the contracted IFT company (no paramedics outside of the fire medics, so basics were dispatched by default). Funny enough, paramedics were still called (911 operator gave me a 2 minute ETA with the patient on the second floor of the facility and not packaged for transport) and the patient was still transported to the nearest facility.

 

[Seaglass]

Pt had a swollen mess of a radial fracture, with limited PMS in the hand. When we asked when this happened, the response was "this morning," and I work nights. His housemate had called 911, and he wasn't too happy to see us. Kept asking if we could just "pop it back into place--I'm sure it's just dislocated." Turns out he had no insurance and was scared of the bill. We couldn't get him to come with us, so we did what we could and talked him into letting his housemate drive him to the ER.

 

[WolfmanHarris]

First was myself. Was working outdoor education at a leadership centre in the bush. End of the day I was sitting in my cabin watching a movie and my arm was red and swollen. Thought I'd hit it and iced it through the evening before going to bed. Next morning very swollen, redness had spread and HOT to the touch. Didn't think much of it at breakfast. At lunch it had spread to about my elbow. Last day of a contract before a week off so I decided to wait until the end of the day. By dinner I had streaking up to my armpit and I felt like crap. Went to the hospital (couple hour drive) and ended up admited with iv antibiotics followed by 7 days of homecare IV antibiotics from a presumed spider bite.

As far as calls, I went to an obviously dead pt. once. ~50 y/o M living w/ aged parents. C/o retrosternal CP dinner time the night before. Went to bed saying he'd go to the hospital if it was still there in the morning. Whoops.

 

[Epi-do]

I had my husband drive me the 7 minutes to the closest ER while having an anaphylactic reaction to an antibiotic. The local ambulance service that would respond to my house scares the crap out of me and I refused to let him call them. There is no way I want them treating me.....ever.

 

[Achromatic]

Not precisely "unusual" but "unintelligent". Local skate park, 18-19 yo M... fell and bounced his head on the concrete bowl. Lost consciousness for approx 30 seconds. Brother called 911. ALS response, as you'd expect. PT was adamant about refusing transport after assessment, signed AMA.

Hands up who is surprised when 35 minutes later, "Medic XX respond to an ALS seizure at Local Skate Park"? When arrived he was post-ictal after a 4 minute tonic-clonic seizure... this time his brother made sure there was no refusal nor AMA signed.

 

[thatJeffguy]

Achromatic - Pardon both my ignorance and my slight derailment. Is it commonly accepted that post-ictal patient aren't seen as a "competent adult"? Thanks for the heads up!

 

[Achromatic]

Achromatic - Pardon both my ignorance and my slight derailment. Is it commonly accepted that post-ictal patient aren't seen as a "competent adult"? Thanks for the heads up!

I would say in most cases, they were not. In the case of a patient who lives with seizures, they may well refuse transport because this is a regular occurrence for them, but during that phase they are not particularly cognizant, so you'd twiddle your thumbs a bit.

In my specific example, it was more to emphasize that the brother was now saying "No, he needs to go to the hospital" (which is what we said earlier...) than indicative that the PT wanted to refuse treatment and transport a second time (once he'd come sufficiently back to alert and responsive, he agreed that he needed both).

 

[thatJeffguy]

I would say in most cases, they were not. In the case of a patient who lives with seizures, they may well refuse transport because this is a regular occurrence for them, but during that phase they are not particularly cognizant, so you'd twiddle your thumbs a bit.

In my specific example, it was more to emphasize that the brother was now saying "No, he needs to go to the hospital" (which is what we said earlier...) than indicative that the PT wanted to refuse treatment and transport a second time (once he'd come sufficiently back to alert and responsive, he agreed that he needed both).

Cool, thanks! It really is amazing how many people refuse EMS because of the cost.

In Wyoming, just out side of Grand Teton National Park, a good buddy of mine was out mountain biking. He fell head-over-heels over his handlebars and rolled down hill a few times. A park visitor called the ambulance and they met him at the bottom. He was certain that he'd broken his wrists (plural!), yet he didn't want to pay the transport and hospital fee's. So, he doesn't give his name, he doesn't give his DOB, he doesn't even speak with the EMS, other than to tell them he does not want or need medical treatment. They leave, he wraps his wrists, tightly, with duct tape. Calamity ensues.

 

[Seaglass]

Achromatic - Pardon both my ignorance and my slight derailment. Is it commonly accepted that post-ictal patient aren't seen as a "competent adult"? Thanks for the heads up!

For us, we can't involuntarily transport if they're fully A&O, legally competent, not dangerous to self or others, and generally behaving rationally aside from the refusal.

History is also important. We're not going to push the matter with a patient who has a history of epilepsy; very often, it was a bystander who called us in the first place and there's no reason the patient needs transport. Epilepsy cases vary widely and the patient usually knows their own history and symptoms better than we do. Often epilepsy patients will be a bit fuzzy while post-ictal, but it usually doesn't take long for them to recover. We'll often wait around for a few minutes to see how that goes, especially if they have a history of going into status epilepticus or aren't fully oriented when we arrive.

A patient with no history who starts seizing after a head injury is a very different animal, and much more cause for concern. There's not enough information here to tell whether we could've taken that patient involuntarily, but we would've tried as hard as we could to persuade him. Although it's not long enough to qualify as a status seizure, 4 minutes would also be an extra cause for concern. Some studies have found that it's not likely to stop once it reaches 5 minutes, so 4 is a bit close for comfort.

 

[Thindian]

19 year old male crashes his motorcycle riding Angeles Crest (A long windy mountain-like road, motorcyclist favorite). He's riding with his buddies, and he high-sides over one of the bikes (while it's low-siding) and is thrown into opposing traffic where his body is side swiped by opposing traffic.

He ends up concussing himself, as his helmet came off when he hit the ground, and he hit his head multiple times after being hit by traffic. He fractures his pelvis in more than one place and ends up bleeding internally. His symptoms match obvious blunt trauma injuries to specific organs.

What does he do? He asks one of his buddies riding shotgun in the care behind him to ride his motorcycle (which is a mystery to me, since this thing does not look operational) and take him home.... ON THE BACK OF HIS MOTORCYCLE. His buddy rides him home (60 miles+ on the highway and other bumpy roads), and once he gets to his house, he tries to park the bike in a hidden part of his garage so his mother wouldn't notice.

His mom called 911 when her son wasn't able to walk, breath or answer questions properly.

The kid tried to run away from his house when his mom called 911, and ended up getting about 3 houses down where he just collapsed, dropping in and out of consciousness. That's where we came in.

What was his reason for avoiding EMS? He smoked a joint the night before and was afraid it would come up on a drug test in the hospital.

There are so many holes in this story, but this has got to be the most ridiculous display of teenage resilience I have ever seen.

 

[Achromatic]

A patient with no history who starts seizing after a head injury is a very different animal, and much more cause for concern. There's not enough information here to tell whether we could've taken that patient involuntarily, but we would've tried as hard as we could to persuade him. Although it's not long enough to qualify as a status seizure, 4 minutes would also be an extra cause for concern. Some studies have found that it's not likely to stop once it reaches 5 minutes, so 4 is a bit close for comfort.

Yeah, we had no grounds to involuntary transport, PT was fully alert, rational, cognizant - he just didn't want to go. The medic actually had him read the AMA sheet, aloud, to us, and then say 'this is what I want to do' before we had it signed and witnessed.

Le sigh.

 

[Onceamedic]

So my husband wasn't feeling well. He knew he had some emphysema going on and quit smoking about 3 years before. He made an appointment to see his doctor at the VA (about 1 1/2 hours away) got in his car and went. I was working and I get a phone call. The man has a pneumothorax, a lung abscess and pneumonia. His primary care doctor was calling me because the doc wanted him admitted to ICU and my husband wanted to come home. My husband said he'd come back in a few days. :unsure:

I talked the old fool into staying at the hospital.