we've all been there what did you do?

[Jon]

I've also seen ammonia inhalants used to some success. Again though, that's bordering on abuse.

If someone doesn't react to a good sternal rub or trapeezius squeeze, maybe they actually have a medical problem. And if they react by faking - then I'll try to talk them out of it.

 

[PotashRLS]

We always transport and try to assess en route for the cause of the unresponsiveness. Proving someone is "crying wolf" isn't worth inadvertantly neglecting a truely sick person. Like said previously, someone faking unresponsiveness is still sick, maybe just not sick in the way ems typically deals with.

I would use the hand drop without worry. I am surprised no one said about starting bilateral large bore IVs.

We never consider NPA in a head injury. Just not a good idea IMO and are contraindicated in our protocol.

 

[Veneficus]

At one service I worked at we had a frequent flying faker and when I called report the doc answered and told me not to come to his ER until I had established 2 IVs 16g or larger.

Her only reaction to it was tensing her eyes a little. So even that is not always useful.

I evolved from getting angry abot fakers to jst making it as little work as possible. Every intervention needs to be documented. Assessment needs to be documented. Then you have to restock. After that reorder from central supply.

While I would never suggest not doing a proper assessment, the more equipment you use, the more work you have. Really, why do more work than you have to?

 

[8jimi8]

Yup....this is why I argue for BLS trucks in emergency services. LOL



Please.....you just have to remember to pick the hand without a ring or at least remove the ring first.

Or try the "Hey, you know there's big money in kidneys and this guy's got two. You get the ice, I'll get the prepaid cell phone!"

Why would you encourage unprofessional behavior?

 

[medicRob]

I feel the same way about this as I do about choosing who is drug seeking and who isn't... It's not for me to decide.

Does it piss me off? You bet it does.

Do I take it out on the patient? Nope.

Whenever I have a patient that I believe to be faking, I might play a game or two like whispering to my partner (making sure the patient can hear me) that this patient must be faking cause a real seizure patient usually urinates. If they urinate on command, that tells me their kidneys are working and that's a good thing.

If they don't, that's okay too. I will transport them unless they decide to sign a refusal of care.

I don't believe in punitive IVs. If the patient needs an IV, I will give them one, sure it will be an 18g or lower (Preferably a 16g), but that is only in case the patient might need blood products down the road in that line. If I don't see any medical reason to have an IV in that patient, I won't start one.

Just my $0.02

 

[usafmedic45]

I don't consider it unprofessional. It's a technique that has its place just like anything else. It's like dropping an NPA. It's not going to hurt 99.999% of patients so it doesn't really matter. I don't necessarily encourage the practice, but I don't see anything inherently wrong with it on its face.

My take is if they're going to lie to me and fake, the "kidney joke" is a great way to see how willing they are to run with the lie.

If I don't see any medical reason to have an IV in that patient, I won't start one.

Technically an unresponsive patient under most protocols would have a "medical reason" for an IV.

 

[medicRob]

I don't consider it unprofessional. It's a technique that has its place just like anything else. It's like dropping an NPA. It's not going to hurt 99.999% of patients so it doesn't really matter. I don't necessarily encourage the practice, but I don't see anything inherently wrong with it on its face.

My take is if they're going to lie to me and fake, the "kidney joke" is a great way to see how willing they are to run with the lie.



Technically an unresponsive patient under most protocols would have a "medical reason" for an IV.

Also, urine output is a fantastic indicator of shock.

 

[usafmedic45]

Also, urine output is a fantastic indicator of shock.

Its the best indicator according to some. LOL


We even "track it" in my medical reenacting unit (talk about attention to detail and realism)*.


*- It's faked obviously and the "catheter" tubing simply comes out from under the blanket covering our simulated casualty.

 

[phildo]

If someone is unresponsive to verbal or light tactile stimuli, they get a modified jaw thrust. It is a very strong stimulus (have your partner try it on you) which serves a legitimate clinical need. No response with that, they get an NPA, then intubated. Fakers come alive with the jaw thrust. I don't accuse them of faking. We don't get alot of fake unconsciousness here. However, if we are dispatched to the mall or Walmart for shortness of breath or chest pain, most of the time it is a shoplifter who got caught and doesn't wanna go to jail. If they wanna go to the hospital, who am I to tell them that they will go to jail (but more likely have a warrant issued, otherwise the PD would hafta babysit them in the ER), when they are through at the ER?

 

[MrBrown]

!

I(I like you a lot, Brown, and I intend to see how this Aussie system works in real life one day. Care to pitch in for the plane ticket?)

Brown is not an Aussie, so buying a plane ticket to Australia is not going to do ya much good except if you wish to swim to New Zealand from Sydney.

*Seeing as how Brown has been trained so well, Brown goes to ask Mrs Brown permission to spend money on Browns credit card which Brown handed over to Mrs Brown long ago

 

[Lady_EMT]

Yes, these people piss me off. Yes, they usually decide to go "unconcious" at the worst hours of the night. But, I'm not going to risk my license by assuming they're actually faking.

I'd start off with a sternal rub, and if that doesn't rouse them, then they've been practicing

But they obviously need something at the hospital, because why would they want to spend the money on an ambulance and hospital bill just for giggles? They probably think that the issue they're actually having isn't "important" enough for transport. There's always two sides of the coin.

 

[Veneficus]

Yes, these people piss me off. Yes, they usually decide to go "unconcious" at the worst hours of the night. But, I'm not going to risk my license by assuming they're actually faking.

I'd start off with a sternal rub, and if that doesn't rouse them, then they've been practicing

But they obviously need something at the hospital, because why would they want to spend the money on an ambulance and hospital bill just for giggles? They probably think that the issue they're actually having isn't "important" enough for transport. There's always two sides of the coin.

Are you sure they spend money on these bills?

 

[TransportJockey]

If they do not react to sternal rub or me squeezing the web between thumb and forefinger, a CBG lancet stick without warning might make them wake up. And that's one of the first things I'll check on a down and out anyways.

 

[Ghando14]

I ran a call where the "unconscious" pt woke up the second we shut the doors to the Ambulance. She was a younger woman around 16 who was being abused at home. For some reason she couldn't make a call to Social Services or the police, but in the privacy of the ambulance, she opened up to me and the paramedics. She felt like she would be safer going this way.

So, I've seen the side of life that makes it "reasonable" to assist faking patients, but, I also know the feeling of the attention seekers who call you out in the middle of lunch, because of whatever. The only thing we do is if we think there might be trickery, we sternum rub to check responsivness, and transport quickly, so we can be available for a real emergency.

 

[firetender]

Pt. on gurney, placed in back of ambulance. You get in. Partner SLAMS rear doors shut.

YOU: Pssst!! Hey? You!

NO RESPONSE

YOU: Hey, you made it, Okay? You're in...we're on our way. I'm not gonna do anything to you because there's nothing to do. You wanna go hospital; here we are. But listen, ya gotta help me; WHAT DO YOU REALLY NEED?

Sometimes your job is to make it so you can ask the obvious.

Just sayin".

 

[8jimi8]

Is everyone that is referring to a sternal rub just deferring to what they learned in school?

The standard of care has been updated.

A vigorous sternal rub can cause skin tearing. Think about granny on coumadin before you start smashing your knuckles on your CUSTOMERS.

Think about peripheral vascular disease, or peripheral neuropathy when you start squeezing peoples distal extremities.

People, please stop abusing your patients. Use a trap squeeze, or just play along and take them to the ER.

 

[Veneficus]

Is everyone that is referring to a sternal rub just deferring to what they learned in school?

The standard of care has been updated.

A vigorous sternal rub can cause skin tearing. Think about granny on coumadin before you start smashing your knuckles on your CUSTOMERS.

Think about peripheral vascular disease, or peripheral neuropathy when you start squeezing peoples distal extremities.

People, please stop abusing your patients. Use a trap squeeze, or just play along and take them to the ER.

While I agree and see your frustration, EMS isn't the fastest evolving job ever. We should be thankful these patients aren't put on a LSB "just incase."

 

[JPINFV]

Well, why wouldn't you backboard an elderly patient with a skin tear from a sternal rub? After all, it's a trauma now!

/sarcasm

 

[8jimi8]

I just figure as long as I keep pointing it out, the lifers who actually care, will slowly realize that evolution is one detail at a time.

I really am a socially normally individual... i only turn into a nitpicker when I see medical professionals setting up for the fail.

 

[8jimi8]

i really wanted to make a joke about anterior AND posterior LSB.... but i just can't