# How Many LEO does it take?



## MedicPrincess (Jan 18, 2008)

As I was drooling on my pillow, really getting to the good part of my dream, I got woke up for an "Echo Response" (our highest priority) call for severe respiratory distress at 0530 last shift.  On the way, our dispatch info is:

_"48 yo F, severe respiratory distress....CALLER STATES I cannot breath and my back hurts."_

I go ahead and get my BS flag out and tell my partner to still make our response time requirment, but don't kill us for a back pain call.  As we pull up on scene, the FD is there and there is 3 SO vehicles around the house.  I look at my partner and wonder out loud what is really going on....like, is her back hurting and she cannot breath because her husband stabbed her and she forgot to mention that?:huh:

As I get out of the truck, another deputy pulls up.  I get into the back, get everything on the stretcher, and as I go to step out of the back, I see a FIFTH deputy pull up.

I ask the deputy standing at the back doors, "What the He** is really going on here?"

He was like..."What do you mean? She's inside crying about back pain x2 days and ABD pain since this morning."

So I ask him..."And why are there 5 of you here??"

His response...

"OH! We knew it was you coming, hadn't seen you all night, figured we'd come say HI!!  Want me to carry your bag for you?"

.....SO....He carried my bag.....


----------



## firetender (Jan 18, 2008)

MedicPrincess said:


> I go ahead and get my BS flag out and tell my partner to still make our response time requirment, but don't kill us for a back pain call.


 
A couple things, Princess:

Maybe back pain only, fine, but WITH shortness of breath in a 48 year old?

You ever hear of an aneurism?

The BS flag remains unfurled until you SEE the patient. Period.

Hopefully, this is not a habit you're getting in to.

If you slow down to make your response time requirement for a dispatched emergency call, then you're in the wrong business.

If, when you get there you immediately accept the casual attitude of the LEO's on tap without seeing for yourself, then you've forgotten that aneurisms can appear chronic for a couple days before someone will call for help.

If coming on to an emergency scene your attention is on deciding whether or not to let the valiant LEO's carry your equipment or not because they're wooing you, then please don't mind me if, as your partner, I immediately go to a good looking, bikinii'd female relative for crucial information and the first thing I ask is "Phone number, please." 

I'll betcha it was in a low-income neighborhood, too. I worked Fla. I recognize the patter.

I'm inviting you to take a good look at what you're revealing, not for us, but for the people that, like it or not, you serve.


----------



## VentMedic (Jan 19, 2008)

Repeat everything Firetender wrote...

Judging calls as B.S. before seeing a patient can skew your assessment and potentially end your career early as well as the life of your patient. 

If there is a heavy LEO response, I welcome it.  They may have knowledge about something that has happened at that location or is happening that I may not be privileged to that information.


----------



## MedicSqrl (Jan 19, 2008)

I do see your humor in this story, but will have to agree in FT's assessment of the situation. Dispatchers are notorious for not giving enough information or the wrong info on calls. If your first thought was to throw the flag up when you not even on scene yet is a shame. It sounds like you let your jadedness get the best of you. 

I work in FL also and know all about the ghetto doctor visits i.e. 911. If there are 5 deputies there, my first thought is scene safety. After then its straight to the patient. Since you had time to talk to the SO, then those are precious seconds not available to the patient. 

Even if it is a BS call, who cares. Every profession deals with stupid stuff everyday. Are you going to get complacent just because the patient "sounds" ok?


----------



## ffemt8978 (Jan 19, 2008)

Sqrl said:


> Dispatchers are notorious for not giving enough information or the wrong info on calls.



More often, it is the caller giving the wrong/insufficient information to the dispatcher.


----------



## MedicSqrl (Jan 19, 2008)

ffemt8978 said:


> More often, it is the caller giving the wrong/insufficient information to the dispatcher.



This is true, which makes it even more important to just woo woo down the road and just sort it out when you get there.


----------



## JJR512 (Jan 19, 2008)

MedicPrincess said:


> ...I go ahead and get my BS flag out and tell my partner to still make our response time requirment, but don't kill us for a back pain call...


Some people are gently chiding MedicPrincess for suspecting that this is was a BS call and backing off on the response priority because of her suspicion. I don't get that from what she wrote. So she suspected it might be a BS call based on something the dispatcher said; so what? Did she change anything she was going to do? Not from what I can tell from what she wrote. We all get suspicions. We all know to take what the dispatcher says with a grain of salt or two (and yes, we know it's really not the dispatcher's fault). We all know to proceed like it's the worst-case scenario anyway. She told the driver to still get there in their time requirement for this kind of response, but to still drive carefully. Isn't driving carefully a good thing?


----------



## MedicPrincess (Jan 19, 2008)

You guys are on the wrong person about not liking her job.  I am one of the few I run into that still LOVE what I do.  I don't go into a call looking for a way to "BLS" this one, rather am almost surprised when I don't have a justification to "ALS" the pt.  My partner can attest to not remembering when the last time she had to attend was.  "Old Medics" tease me daily for some of my calls...."Back Pain is ALS, not on my truck"...."ETOH is ALS, not on my truck"....ect.  I just smile and tell them I am ensuring my pts are getting the best care they possibly can while in my care.  To that they usually make some smart comment about kissing up to the wrong person.

Now, I didn't tell to to slow to ''so we make our requirements.''  I told her to continue responding, to ensure we make our requirement, but don't kill us.  My partner is still really really new...ECHO response pushes her adrenaline level way high.  Her driving reflects.  Telling her not to kill us, we still RESPOND...but she is less stressed.



> The BS flag remains unfurled until you SEE the patient. Period.


I did not *throw* the BS flag...I simply had it ready.  If you read, the caller STATES "I cannot breath, and I have back pain."  How many pts not able to breath and still talk. I am sure it happens.....but more often than not, if they are telling the dispatchers "I cannot breath"....thats like CP at the ER window after they have been waiting for an hour....I don't ever throw the BS flag until I am there.  Plenty of my Alpha response sick calls...have NOT been.



> I'll betcha it was in a low-income neighborhood, too. I worked Fla. I recognize the patter.


 
While your ASSuming...This was in the best neighborhood in my district.  The house start at $250,000 and go up.  Median Income in greater than $60,000.  Not to many low income areas in my district.



> Since you had time to talk to the SO, then those are precious seconds not available to the patient.


 
Lets see...park the truck, get our equipment out, walk up to the house, go through the house to the back bedroom where the pts usually are...yep, at least 1-2 minutes before I acutally see the pt.  Am I supposed to not speak to anybody that is at my truck, or around on the way.  OR better yet, should I race to the patient without any equipment at all, leaving my partner to bring everything. Not how I work.



> If there are 5 deputies there, my first thought is scene safety.


 
As indicated by my question to the deputy at the back of the truck of What is really going on here?


----------



## Grady_emt (Jan 19, 2008)

I dont see anything wrong with what you did here Princess.  You still responded in the assigned mode, you just reminded your partner to drive with Due Regard and make it there safely.  If you get into a wreck, thats several minutes at best that that pt is waiting for another unit to arrive, nevermind creating two more patients with your partner.  Personally I do the same thing for many an emergent response. ie: violent psychs, fourth party callers, calls that I'm right on top of, etc where we stage for PD and will arrive before them.  There is no sense risking getting hurt when you are gonna have to stage 10minutes for PD.  Yes I still respond emergent as dispatched, just not at a break-neck rate.

As for the SO issue, what if she had not talked to the PoPo, walked straight in to see her pt and in doing so walked right into a hostage standoff??? By asking the duputy "what is really going on here" she was ensuring her scene safety, and could have still be walking towards the pt at the same time, and knowing that an ALS engine was onscene meant that in theory she was not causing her pt any further harm to take a few seconds getting inside.   
           Personally we go on lots and lots of calls with the Po. around here.  Once I see that the pt is in no obvious distress, the next stop is a cop to find out what happened, and then to ask the pt for the "short version" of what had happened wuz...  Now if the Pt is obviously bleeding, uncon., etc, then as I am tending to the Pt with my partner, I'm also asking any bystanders, INCLUDING the PoPo what had happened thereby obtaining a FULL pt/incident hx.

...My "bull S#*%" is flag is in the holster on my left hip, but the "Oh S#*%" one is in the speed draw on the right hip...


----------



## JJR512 (Jan 19, 2008)

MedicPrincess said:


> While your ASSuming...This was in the best neighborhood in my district. The house start at $250,000 and go up. Median Income in greater than $60,000. Not to many low income areas in my district...


And, in case that doesn't seem like that much to some people, keep in mind that housing prices and incomes are generally lower in Florida than in many other states. For example, that $250k house probably goes for $750k in many Maryland areas.


----------



## ffemt8978 (Jan 19, 2008)

Grady_emt said:


> ...My "bull S#*%" is flag is in the holster on my left hip, but the "Oh S#*%" one is in the speed draw on the right hip...




ROFLMAO


----------



## Airwaygoddess (Jan 19, 2008)

A patients chief complaint can present in so many ways, half of the battle is to no run into tunnel vision. -_-


----------



## VentMedic (Jan 19, 2008)

MedicPrincess said:


> I did not *throw* the BS flag...I simply had it ready.  If you read, the caller STATES "I cannot breath, and I have back pain."  *How many pts not able to breath and still talk. I am sure it happens.....but more often than not, if they are telling the dispatchers "I cannot breath"....*thats like CP at the ER window after they have been waiting for an hour....I don't ever throw the BS flag until I am there.  Plenty of my Alpha response sick calls...have NOT been.



Time for a little Respiratory 101 lesson.  

There is a BIG different between ventilation and oxygenation.  Both can have the symptom of "I can't breathe".  If the person is able to exchange gas throughout the airways but can not oxygenate, then they may be able to speak those three works. That is until other organs such as the brain and heart are affected. There may be several causes including cardiac. It a patient has severe obstructive abnomalities that prevents adequate ventilation, then their speech will be difficult.   I also see patients, usually elderly nursing home patients, scream that they can not breathe and then respiratory and/or cardiac arrest. This is usually due to a metabolic acidosis. 

Never ASSume a patient is breathing well because they can talk. Review Ventilation/Perfusion mismatch.  

Unfortunately the CP at the window of the ED after waiting for an hour happens way too often. It is called denial. People do not want to admit it might be a heart attack. Women also exhibit very vague symptoms which are misunderstood.  

The word B*&*S*^* needs to disappear from the medical vocabulary.  It just gives people, lay or other professionals,  the impression that *you think *you know more than you actually do about a patient, thus, credibility is lost.   Even those 0300 drug seekers or alcoholics are usually way more sick than the medical system can fix.  We however must release them from the hospitals as quick as possible and often refers for other treatment is lost in the paper shuffle. 

I if had a dollar for every "BS" patient I have intubated, either as an RRT or EMT-P, that another truck got a "refusal of care" signed because they didn't think the patient warranted transport or every "BS" pt as stated by EMS in the ED, I would not be working today.  You have limited diagnostic equipment on an ambulance.   The hospitals are full of patients with chronic and acute ailments that were some EMS workers "BS" calls.   And yes, many are truly sick.

No apologies from me for this rant.  I just keep reading the same "BS" stuff from some people that I often wonder why they ever chose a healthcare profession or if they didn't realize they would be dealing with "patients" when they signed up for the class.  So yes I sit in judgment of those that over use the word "BS".  My view may also be as skewed as your assessment of your patient. 

So, Princess, run the call how you want. Just keep an open mind with the "BS" attitude so that your assessment will be thorough without bias.


----------



## Luno (Jan 19, 2008)

*Wait, is that paramedic princess now...?*

Hahahaha, funny story...  Some people do take everything you say too seriously...   So, how is FL?  I haven't been back to the south since 2005...  Incase you run out, I've got a duffle bag of BS flags on hot standby...  ttyl -luke


----------



## MedicPrincess (Jan 19, 2008)

Hey Luke!  Florida is WAAAY to cold today!!! FLURRIES!!!!  Freakin Flurries!!!  I did not move to Florida to see any of the white stuff falling to the ground!!

And YESSIR...that is Paramedic Princess now.  IT has been a long time....but I think I am getting the hang of this EMS thing now.

Thanks for the stand by on the flags......with the temps reaching wind chills of 17 tonight, I might need a few more of those around 4 am.

And thanks to you VentMedic....a review is always nice.  I will continue to ensure a complete assessment prior to actually tossing out the BS flag....however...it is still in my pocket


----------



## MMiz (Jan 20, 2008)

Holy crap people.  I can't count how many people totally skipped the total [humorous] intent of the post and really started throwing punches on a small detail.

If you've been in EMS and never flown the BS flag based on a call, then you're a flat out liar.  If you're in EMS and you respond to every call like it's the fate of the world depends on your response, you're a liar who doesn't belong in EMS.  

I truly can't count the number of times I responded to the local jail for "chest pain."  I can't ever remember a response to the jail that actually required the lights/sirens and priority we were always dispatched.  My BS flag often went up for those calls, and I can only hope that yours would too.  I always try my best to trust me instincts, while at the same time being professional, competent, and compassionate.

MedicPrincess tells her partner to respond, but not to kill us (insert humor here), and all of a sudden the entire forum, and many respected users, jump on the "OH NO SHE DIDN'T" bandwagon.

Wow.  Just wow.


----------



## JJR512 (Jan 20, 2008)

Thank you, Matt...I tried backing her up, but you did it much, much better.


----------



## MedicPrincess (Jan 20, 2008)

Thanks Matt.


----------



## firetender (Jan 20, 2008)

MMiz said:


> MedicPrincess tells her partner to respond, but not to kill us (insert humor here), and all of a sudden the entire forum, and many respected users, jump on the "OH NO SHE DIDN'T" bandwagon.
> 
> Wow. Just wow.


 
Thanks, Matt and all who came to Princess' defense (and I'm sure will keep coming) but just so my point is not missed (and maybe softened a little) the great part of this forum is that we get to see ourselves reflected through other mirrors than our own. This certainly includes me. 

My point was that in the midst of the scenario she was a part of, Princess got distracted by her interpretation of PAST experience AND things going on OTHER THAN what she was seeing with the patient. 

The action ALL happened BEFORE she even got into the room. 

In this business, the moments that matter most are the moments driven by what you see in the patient at the time you're with him or her.

(I offer my comments with no intention of judgment and I hope you all read what I write as such.)


----------



## MedicPrincess (Jan 20, 2008)

firetender said:


> My point was that in the midst of the scenario she was a part of, Princess got distracted by her interpretation of PAST experience AND things going on OTHER THAN what she was seeing with the patient.


 
What makes you think I got distracted?  I would say I was not "distracted" as my first thought as we arrived on scene to the heavy LE presence was "What is really going on here?"

Generally, if there is LE on scene, it is only 1...maybe 2....but for there to be 3 and still more coming...it would seem that there was something else going on.

By one just chillin' at the back of my truck...that is an obvious indicator its not what it "appears."

The LEO's in my area have this very distinct dance they do when its "bad" and getting worse in their opinions.....eyes wide, knees slightly bent, either both arms will be raised over head, flailing back and forth frantically....or one arm will be extended towards the scene, the other will be waving me in, and this will alternate with both hands/fingers pointing down motioning for the exact spot they feel the truck should be parked.  Then the person at the back of the truck is opening doors, attempting to pull out the stretcher with my partner, while another has me by my arm leading me towards the pt.


----------



## ckrump (Jan 22, 2008)

I work in 2 different areas - one where LE response is great and another where LE practices their ABC's - Ambulance Before Cops!  That many LE on scene would make me wonder too what is really going on!:unsure:


----------



## daedalus (Jan 24, 2008)

MedicPrincess, I enjoyed your post. The responses of others, too, got me thinking. It is good to see our selfs' "reflected through other's mirrors". It offers another point of view of our care, even when it is seemingly mundane.

I see the humor, and of course have heard many medics in my system wake up for a sketchy call and think out loudly what BS its going to  be. Usually turns out that they are right, and a few times they are wrong. I remember a patient (c/c of CP) the medic wrote off as BS or a panic attack because nothing showed up on the 12 lead and it was his gut instinct. Brought the pt. to a hospital without cath lab or thrombolytics. Dispatch later calls out to transfer a pt from the same hospital to a STEMI hospital 20 miles out. Turns out to be the same guy. I realise that the medic did the correct thing by taking pt to closest ER but he was still much to quick to judge.


----------



## EMTBandit (Jan 28, 2008)

I like it when our officers help out. They're usually more than willing to help us out because we got our hands full. The more the better. Unless they get in our way which rarely happens. I don't know if that's what happened to you or not.


----------



## MEDIC213 (Feb 2, 2008)

I've been a magnet for cardiac arrests lately, and I've had officers help me on every one of them. I love having them on scene most of the time. I've also had one that almost let me get my butt whooped because he believes in that old "people are inherently good" adage. I had to get kicked in the "twins" before he did anything about it, and then they wouldn't arrest him because they said he was "impaired" (drunk) and didn't know what he was doing.


----------



## Grady_emt (Feb 2, 2008)

MEDIC213 said:


> I've been a magnet for cardiac arrests lately, and I've had officers help me on every one of them. I love having them on scene most of the time. I've also had one that almost let me get my butt whooped because he believes in that old "people are inherently good" adage. I had to get kicked in the "twins" before he did anything about it, and then they wouldn't arrest him because they said he was "impaired" (drunk) and didn't know what he was doing.



Around here that would have gotten drunk in pubic at the least, then if you were feeling like it the associated assault/battery on public safety official charges could be tacked on the citation/arrest ticket


----------



## MEDIC213 (Feb 2, 2008)

He was at home and unresponsive when we got him. Put him in the truck and he becomes very responsive when I start the IV. D-stick was 40. Gave him the Thiamine and D50 hoping that the combativeness is due to the hypoglycemia. It wasn't. He was just an *******. He was threatening all of us, and we were less than half a mile from my house.


----------



## Topher38 (Mar 18, 2008)

"Talk too fast", not "talk to fast"


----------



## Outbac1 (Mar 18, 2008)

I have a question for you. Whats an ECHO or ALPHA response or a code 1,2,3,4???   Here we have two responses. Code 1 is with lights and siren and code 2 is without. Anything with SoB, cardiac. maybe a severe bleed. unconcious etc. or all unknown generete a code 1, (L/S) response from us. How do you respond inbetween a lights and siren response and no lights/siren?:unsure:


----------



## ffemt8978 (Mar 18, 2008)

The ALPHA through ECHO response levels are part of the NIMS which is supposedly supposed to categorize the priority of response based upon the information that the dispatcher is receiving.


----------

