# con artists



## traumaqueen5

A few months back when I was still a "trainee" my partners and I were paged for a elderly female who had fainted in a local 24hr grocery store. Law enforcement of course was on scene due to the fact it was about midnight and they were bored..... Anyways we get there and the pt is laying on the floor "unconcious" so we proceeded to do what we do... Putting her on a heart monitor... As we do a she slightly states "oh don't touch me there" we have officers standing over us so its not like we don't have witnesses to what we are doing... Then she she becomes unresponsive again.. Load her in the rig another partner decides to put an IV in her not a peep outta her until he flushes the line with saline she asks what are u putting in me? I say oh a lil something to help u... (Which isn't a lie lol) and again becomes "unresponsive". Little do any of the 3 of us know she was a con artist and will sue u for anything she can. She is the pt that u load and go and u sit where ur partner can see u in the rearview mirror at all times you do no vitals on her you do not touch her. We didn't know this due to the fact she wasn't at home and we know her address not her name.... all we could say was it was a good thing that I was there so that there were two of in the back of the rig that night!


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## Jay

This is going to sound awful but when they are playing A&O x Zero, that's what airways are for. I can guarantee with absolute certainty that you will know their true level of consciousness upon inserting an oiled up, non-latex trumpet several inches into ones nose (a/k/a NPA). This seems like the type of PT that you would just know and act accordingly, my philosophy is if your bull :censored::censored::censored::censored:ing me, than a real, sick patient may be your sacrificial lamb and I do not have the time and/or patience to be playing that game because you got tired of suing McDonalds over the temperature of their coffee or don't have a finger tip handy to toss into some of Wendy's chili this week.


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## spike91

Always do the bull:censored::censored::censored::censored: test. Hold the hand DIRECTLY over his/her head, and release. If they smack themselves, its legit (unless they're REALLY sticking to it xD). If his/her hand falls to the side and misses his/her forehead, BULL:censored::censored::censored::censored:.

CYA my friend!


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## medic417

spike91 said:


> Always do the bull:censored::censored::censored::censored: test. Hold the hand DIRECTLY over his/her head, and release. If they smack themselves, its legit (unless they're REALLY sticking to it xD). If his/her hand falls to the side and misses his/her forehead, BULL:censored::censored::censored::censored:.
> 
> CYA my friend!



Yes and if they end up with a broken nose they just cashed in.  Bad move.


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## JJR512

medic417 said:


> Yes and if they end up with a broken nose they just cashed in.  Bad move.



He's not talking about cutting her arm off and using it as a club with which to beat her. He's talking about holding her hand a few inches over her face—her forehead area would do as well—and letting it drop to see if it drops straight down, or conveniently diverts to one side. A hand dropping a few inches shouldn't break anyone's nose.


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## medic417

JJR512 said:


> He's not talking about cutting her arm off and using it as a club with which to beat her. He's talking about holding her hand a few inches over her face—her forehead area would do as well—and letting it drop to see if it drops straight down, or conveniently diverts to one side. A hand dropping a few inches shouldn't break anyone's nose.



Yes I know that technique that is no longer considered appropriate.  Back in the day we used it then we advanced with education.  As to breaking you might be surprised how easy some peoples nose will break.


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## akflightmedic

It is disheartening that an EMT B student, not even in the field is recommending this very old, outdated and highly Unrecommended therapy...

1 step forward, 2 steps back...


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## Lifeguards For Life

medic417 said:


> As to breaking you might be surprised how easy some peoples nose will break.



The OP may also be surprised that a hand weighs a bit more than he may think.


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## Handsome Robb

Eyelashes are a good substitute for the hand drop...any A&O person will flinch when you play with their eyelashes, gently of course...That's the way my preceptor taught me to check for possums...she did tell me about dropping the hand but it was more of a 'this works but don't do it type of thing.'


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## TransportJockey

NVRob said:


> Eyelashes are a good substitute for the hand drop...any A&O person will flinch when you play with their eyelashes, gently of course...That's the way my preceptor taught me to check for possums...she did tell me about dropping the hand but it was more of a 'this works but don't do it type of thing.'



I was taught that to check gag reflex, not so much to check see if they're just messing around...


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## Shishkabob

NPA

I mean, if they are unresponsive, how much control of their airway do they have?




h34r:


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## EMS/LEO505

In NM, we do sternum rub. That will wake them up real quick!


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## Chimpie

Jay said:


> This is going to sound awful but when they are playing A&O x Zero, that's what airways are for. I can guarantee with absolute certainty that you will know their true level of consciousness upon inserting an oiled up, non-latex trumpet several inches into ones nose (a/k/a NPA). This seems like the type of PT that you would just know and act accordingly, my philosophy is if your bull :censored::censored::censored::censored:ing me, than a real, sick patient may be your sacrificial lamb and I do not have the time and/or patience to be playing that game because you got tired of suing McDonalds over the temperature of their coffee or don't have a finger tip handy to toss into some of Wendy's chili this week.





Linuss said:


> NPA
> 
> I mean, if they are unresponsive, how much control of their airway do they have?
> 
> h34r:



That's the first thing that came to my mind when I started reading this thread.  And being vocal about it.  Asking your partner for the 'nasal cannula and lube'.  :lol:  If you don't get a reaction to the words, slide it in.


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## TransportJockey

EMS/LEO505 said:


> In NM, we do sternum rub. That will wake them up real quick!



Some of the drunks in ABQ are so used to it they don't even flinch any more. But an NPA will always wake em up


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## EMS/LEO505

jtpaintball70 said:


> Some of the drunks in ABQ are so used to it they don't even flinch any more. But an NPA will always wake em up



Haha, I wish they had a narcan for alcohol...boy we'd have a lot of people moving back to gallup :lol:


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## FLEMTP

i like the NPA idea... i use it often on questionable BS. But.. before I insert it, I say in a loud voice "Ma'am(or Sir) if you can hear me, i need to insert a tube into your nose to protect your airway, its very uncomfortable, if you can understand me, please let me know, otherwise im going to insert the tube now"

Sometimes thats enough... sometimes it takes inserting the tube.. before they realize you mean business and "wake up" suddenly cured.


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## FLEMTP

Something else i just thought about.. we had a patient who was a "regular" faker when I worked in Pinellas County here in florida. She actually made the news.. she was so good at faking a seizure & other medical conditions that she has been trauma alerted in the past.. been flown via helicopter to the ER, and yes, even took an ET tube (with no meds mind you) completely conscious, while "faking" her condition. I will look for a news story related to this if i can. 

I once encountered something similar. The patient "passed out" on the sidewalk along a very busy road during rush hour.. flooding our 911 center with calls. We arrived on scene, and during the placement of an NPA she "woke up". I asked her if she actually passed out, or if she simply laid down on the sidewalk and waited for a passerby to call 911. She INSISTED she passed out. 

So i kindly informed her that ALL of the light poles in the city have traffic cams on them hidden to catch speeders and red light runners and the sort. I told her i had just contacted the DOT for the city and they were reviewing the tapes..and that if she had indeed simply laid on the sidewalk to get attention, she would be on her way to jail with multiple charges (PD was standing next to me) she sat there a minute.. stood up and said.. ok .. fine.. you got me.. im sorry.. i just want to go home now. The look on the police officers face was PRICELESS as well as the fire crew who informed me prior to talking to her that I might as well transport her because she will NEVER admit to faking it. 

Sometimes you just gotta use your head B)


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## CAOX3

One of the best one was for a woman unconscious, we get there she even pisses her self.  Package her get her in the truck, we know her, shes got a history of laying it on thick.

Partners getting vitals, I pick up the mic A45 enroute with a 30ish yo female ONGT 10/10 ETA of 5.

My partners finishes up and is getting out of the back of the truck and with a sinister smile says to me "hey pick up her money shes dropping hundred dollar bills out of her pocket"  Eyes open and she sits up "where".  

Me: Good morning M'am how you doing, " 

Her: You butt holes, well at least I fooled you"  

Me: You did?

Her: Yeah, you already called it in 10/10 ONG something, something.

Me: M'am thats stands for the Ocscar nomination goes too, and the 10/10 was your performance and I didnt call anything in.

Her: Multitude of expletives about me, my partner and, I think are families.

Me: M'am I started this job in the morning, Just wasnt this morning. Now is anything truly bothering you today?

Drop her off at the ER

Have a nice day.


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## CAOX3

We then like to politely give them the talk about taking an ambulance out of service when it may needed for a truly sick person.

But most of them could care less.


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## Sparky21

EMS/LEO505 said:


> In NM, we do sternum rub. That will wake them up real quick!



Ive met several people that no matter how hard you do your sternum rub they have the self control to take it without a flinch...though we still use it.h34r:


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## Lifeguards For Life

Sparky21 said:


> Ive met several people that no matter how hard you do your sternum rub they have the self control to take it without a flinch...though we still use it.h34r:



I don't think the sternum rub was intended to check if a "patient" is faking it. Why do you care if they are faking it or not?


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## Shishkabob

Why make my job harder?

I'm not going to injure my back for someone who can just as easily, and without being in any pain or danger, move themselves to my cot.


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## EMDispatch

Lifeguards For Life said:


> I don't think the sternum rub was intended to check if a "patient" is faking it. Why do you care if they are faking it or not?



You gotta check LOC, personally I wouldn't use it just to check if they're faking, but I have to check for painful stimulus response.


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## fortsmithman

At my service we don't use the NPS we use the OPA instead.  One of our senior EMTs told us about the arm test and another is insert a OPA to see if they are faking.


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## MTEMTB

Best one I heard from a paramedic friend. Got called to the county jail, inmate having chest pain.
They pick him up and take him to the ER. Busy night so the guy gets up and walks out.
Police picked him up a block away and right back to jail.
While later paged again for an inmate having a heart attack. 
same guy.
Friend does the eyelash trick. Knows the guy is faking it.
Inserts a nasal dry. No response. Pulls it out and does iit in the other nostril. Nothing.
Take him to the ER where a doctor is waiting.
Doc pulls out the nasal and trys it on the other side too. No response.
Doc breaks open a couple of amonia tablets and puts both up the guys nose.
he sits up and asks to be taken back to jail.

didn't have too many faking inmates after that.


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## akflightmedic

And the resulting chemical burns to the skin and mucosa from the ammonia...how were those explained/treated???

I only ask to make you think because I do realize they did not remain there long enough to cause a burn (unless he really wasn't faking) but this was a sad lesson I learned very early in my career.

We had done the ammonia trick many times, I thought it was effective and then I saw a medic tape one on the cheek of a "faker" cause he had more important things to do than sit there and hold it for a few seconds. It left quite the mark...


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## EMS/LEO505

I remember FD responding to a faker call and the "pt" was "unconscious" anyway they knew she was awake but played along and wrote down starting vitals on her forehead with a sharpie. Then she started regaining consciousness and the Lt. told her that if the doctors didn't find anything wrong that she will get charged every penny with out insurance coverage...she got up and walked away with all the stuff still on her face haha


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## helicub81

MTEMTB said:


> Best one I heard from a paramedic friend. Got called to the county jail, inmate having chest pain.
> They pick him up and take him to the ER. Busy night so the guy gets up and walks out.
> Police picked him up a block away and right back to jail.
> While later paged again for an inmate having a heart attack.
> same guy.
> Friend does the eyelash trick. Knows the guy is faking it.
> Inserts a nasal dry. No response. Pulls it out and does iit in the other nostril. Nothing.
> Take him to the ER where a doctor is waiting.
> Doc pulls out the nasal and trys it on the other side too. No response.
> Doc breaks open a couple of amonia tablets and puts both up the guys nose.
> he sits up and asks to be taken back to jail.
> 
> didn't have too many faking inmates after that.




How come u guys didn't go directly for an opa?  The opa's a better airway anyways and if he accepts an npa, drop an opa too?  O :censored::censored::censored::censored: then ud have vomit to clean up nvm lol


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## reaper

An NPA can be placed with a gag reflex intact. A OPA cannot!


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## akflightmedic

EMS/LEO505 said:


> I remember FD responding to a faker call and the "pt" was "unconscious" anyway they knew she was awake but played along and wrote down starting vitals on her forehead with a sharpie. Then she started regaining consciousness and the Lt. told her that if the doctors didn't find anything wrong that she will get charged every penny with out insurance coverage...she got up and walked away with all the stuff still on her face haha



Yeh this is great, let us keep laughing and perpetuating this stupid *** bull :censored::censored::censored::censored:. And people wonder why we are not considered professionals...you know how many "fakers" docs and nurses deal with every single shift...do you think we are alone in this? No we are not, so why do we feel the need to write on, torture, and prank on these people??


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## Aidey

That sounds like something from a frat party.


My issue with people faking ALOC is that GCS is part of our trauma activation criteria. The hospitals do not appreciate EMS calling a trauma on some guy who turns out to be faking it. We have had more than one case where a guy puts his car in the ditch while drinking, or gets into an argument in a bar and then plays unconscious to get out of trouble.


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## Emtpbill

akflightmedic said:


> Yeh this is great, let us keep laughing and perpetuating this stupid *** bull :censored::censored::censored::censored:. And people wonder why we are not considered professionals...you know how many "fakers" docs and nurses deal with every single shift...do you think we are alone in this? No we are not, so why do we feel the need to write on, torture, and prank on these people??



Dude, you are wound up a little too tight. Every other comment from you is slamming someone for not being unprofessional. If someone doesn't have a vent/release/prank, they are gonna go postal.


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## akflightmedic

Emtpbill said:


> Dude, you are wound up a little too tight. Every other comment from you is slamming someone for not being unprofessional. If someone doesn't have a vent/release/prank, they are gonna go postal.



If you knew me, you would think otherwise. However, the jokes should not involve your patients, safety gear or food. Outside of that, enjoy but it need to be done not while in the public eye, not driving, and not on scene.

Every other profession has their jokes and pranks too, I get that, I have done many great ones myself...but there is a time or place for everything.

It is people like me who care about the job, trying to make it a professional organization, trying to elevate wages and standards of living that is constantly beat back down by the "hey man, you are a tight ***...just relax" crowd. But those people will be the same one's complaining they have no respect or have low wages and can't support their families, blah blah blah.

And I get so tired of hearing about how we need releases...hear this: EVERYONE in EVERY job gets stressed and deals with BS and needs a release. Are the stressors the same? No, they aren't, but they ARE stressors none the less and it is how we choose as people to deal with them that makes the difference.

Being EMS or Fire gets us no special pass on life's adventures and stress. Are you saying because we are pranksters that is why it is called "going postal" and not "going EMS"? So maybe if the USPS played more jokes they would never have had those work place shootings and acts of violence which coined the term "going postal" probably before you were born.

But then there have been many similar outbreaks, EMS places of work included yet the going postal term has endured...so maybe your theory is flawed.

Just maybe, if we eliminated the hero complex that we drill into student's brains, maybe if we eliminated a student's way of thinking that it is funny/cool to torture a patient, then just maybe we can move forward as a profession and also educate people on how to have balance in their work, so they will seek proper vents/releases and not go postal.

For the record, what set me off in my response was the fact that it was a STUDENT who made the joke and laughed about shoddy patient care and did not see anything wrong with that. If you personally think a student has the right to be taught poor patient practices and has the right to laugh and think they are acceptable "within the club" which will allow him to continue to do those practices over the years and teach others, then you have no business in my profession.


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## Lifeguards For Life

akflightmedic said:


> If you knew me, you would think otherwise. However, the jokes should not involve your patients, safety gear or food. Outside of that, enjoy but it need to be done not while in the public eye, not driving, and not on scene.
> 
> Every other profession has their jokes and pranks too, I get that, I have done many great ones myself...but there is a time or place for everything.
> 
> It is people like me who care about the job, trying to make it a professional organization, trying to elevate wages and standards of living that is constantly beat back down by the "hey man, you are a tight ***...just relax" crowd. But those people will be the same one's complaining they have no respect or have low wages and can't support their families, blah blah blah.
> 
> And I get so tired of hearing about how we need releases...hear this: EVERYONE in EVERY job gets stressed and deals with BS and needs a release. Are the stressors the same? No, they aren't, but they ARE stressors none the less and it is how we choose as people to deal with them that makes the difference.
> 
> Being EMS or Fire gets us no special pass on life's adventures and stress. Are you saying because we are pranksters that is why it is called "going postal" and not "going EMS"? So maybe if the USPS played more jokes they would never have had those work place shootings and acts of violence which coined the term "going postal" probably before you were born.
> 
> But then there have been many similar outbreaks, EMS places of work included yet the going postal term has endured...so maybe your theory is flawed.
> 
> Just maybe, if we eliminated the hero complex that we drill into student's brains, maybe if we eliminated a student's way of thinking that it is funny/cool to torture a patient, then just maybe we can move forward as a profession and also educate people on how to have balance in their work, so they will seek proper vents/releases and not go postal.
> 
> For the record, what set me off in my response was the fact that it was a STUDENT who made the joke and laughed about shoddy patient care and did not see anything wrong with that. If you personally think a student has the right to be taught poor patient practices and has the right to laugh and think they are acceptable "within the club" which will allow him to continue to do those practices over the years and teach others, then you have no business in my profession.



hear, hear!


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## Lifeguards For Life

EMS/LEO505 said:


> I remember FD responding to a faker call and the "pt" was "unconscious" anyway they knew she was awake but played along and wrote down starting vitals on her forehead with a sharpie. Then she started regaining consciousness and the Lt. told her that if the doctors didn't find anything wrong that she will get charged every penny with out insurance coverage...she got up and walked away with all the stuff still on her face haha



Evil shenanigans! [YOUTUBE]http://www.youtube.com/watch?v=KvY2CAnEd-o&feature=related[/YOUTUBE]


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## LucidResq

EMS/LEO505 said:


> I remember FD responding to a faker call and the "pt" was "unconscious" anyway they knew she was awake but played along and wrote down starting vitals on her forehead with a sharpie. Then she started regaining consciousness and the Lt. told her that if the doctors didn't find anything wrong that she will get charged every penny with out insurance coverage...she got up and walked away with all the stuff still on her face haha



I am shocked, nauseated, sad and angry all at the same time.


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## Shishkabob

LucidResq said:


> I am shocked, nauseated, sad and angry all at the same time.



How much of that is your current ailment?


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## EMDispatch

akflightmedic said:


> For the record, what set me off in my response was the fact that it was a STUDENT who made the joke and laughed about shoddy patient care and did not see anything wrong with that. If you personally think a student has the right to be taught poor patient practices and has the right to laugh and think they are acceptable "within the club" which will allow him to continue to do those practices over the years and teach others, then you have no business in my profession.



One of the first discussion our class had on patient care and advocacy was the hypochondriac and the frequent flier.  The medic teaching our class told us the story of a regular. The first unit was looking for an excuse to get out, and just dismissed the guys complaints. He arrived on scene and noticed something just wasn't normal...Low and behold the pt was having an MI.


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## TransportJockey

MCERT1 said:


> One of the first discussion our class had on patient care and advocacy was the hypochondriac and the frequent flier.  The medic teaching our class told us the story of a regular. The first unit was looking for an excuse to get out, and just dismissed the guys complaints. He arrived on scene and noticed something just wasn't normal...Low and behold the pt was having an MI.



Exactly. Just because someone might have abused the system in the past, they still deserve a full and thorough assessment, since something might actually be wrong with them.


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## LucidResq

You know what, never mind the boy who cried wolf syndrome. Even assuming a patient NEVER has an actual physical ailment when they call, they still deserve to be treated with respect. Most of the time they are calling for a reason - perhaps true mental illness, profound loneliness, fear, etc. In which case you should count your blessings and be glad you are not in such a position. 

 And even if their intent were truly malicious... which is hard to imagine, or you simply lack the compassion to ponder why they may be calling and empathize...  the last thing a professional should do is "stoop to their level" by humiliating them and trying to get some kind of revenge.

 At the simplest level, bear in mind that these people usually communicate with the outside world. The way you treat them may not effect their perspective of you or willingness to call for you help again, but if others catch word of you treating them poorly, you'll certainly be looked at as unprofessional at best, and perhaps someone who really needs it will be reluctant to call someday.


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## Shishkabob

Until, of course, the faker causes a delay in care for someone truly needing an ambulance, like what happened to me the other night.

We were sent for someone faking an injury (to the point where the doctor even wanted them out of his ER due to the faking).  Problem?  Had we not been on that call we were posted literally right next to a location where someone called in for an MI, and instead of us being promptly there in less than a minute, they had to bring another unit further away.



I have little tolerance for someone obviously faking, regardless of why the are faking, if their faking causes harm to others.  I'll treat them with respect, but it's not beyond me to say things such as "You're taking an ambulance away from people who truly needs it" and letting that tidbit sink in (Not that I did on this patient).


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## LucidResq

I'm not saying what they are doing is harmless, but I think we can both agree playing pranks on them and writing on their faces is not a productive or acceptable way to handle the situation.


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## Tincanfireman

traumaqueen5 said:


> you do no vitals on her you do not touch her.


 
Just wondering if your instructors even mentioned standards of care.  Withholding treatment to the accepted norms for a similar patient could easily be considered (or argued by an attorney) as failure to treat (read: negligence) in a jury trial.  That would be the one where you're the defendant, along with your service.  I've spent too much time trying to figure out and decide who's playing me and who's in need of care.  I treat them all the same; we have standing orders and protocols, and none of them begins with "if you think the patient is faking, it's your call whether to treat."  If they appear unconcious, treat them that way.  Diagnosis is a physician's responsibility, and playing parlor tricks on people in the back of an ambulance is no way to be a caregiver. In the interest of full disclosure, yes, I have done many of these same things in the past and I'm not particularly proud of them as I look back over my career. I like having a good time at work as much as anyone, but cutting up with co-workers and dropping someone's hand on their nose are two entirely polar opposites.  Sooner or later you'll do something that you'll regret; let's hope it's your conscience that takes you to task, and not a lawyer.


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## Aidey

If you have sued your local ambulance company/hospitals so many times they won't touch you, you are the problem, not them.


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## EMDispatch

Aidey said:


> If you have sued your local ambulance company/hospitals so many times they won't touch you, you are the problem, not them.



And if the ambulance company and hospital won't touch you their violating federal law...


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## Aidey

EMTALA does have exceptions. If you are disruptive, violent, etc the ER does not have to put up with you.


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## EMDispatch

Aidey said:


> EMTALA does have exceptions. If you are disruptive, violent, etc the ER does not have to put up with you.



Just curious, can you point me to a link with that? I'm not as knowledgeable as I should be on these things.


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## fortsmithman

reaper said:


> An NPA can be placed with a gag reflex intact. A OPA cannot!



My service doesn't use the NPA even though its use is allowed in our protocols.


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## JPINFV

MCERT1 said:


> And if the ambulance company and hospital won't touch you their violating federal law...



I don't believe that EMTALA says anything in regard to prehospital care currently (IIRC, there was initially an issue with hospital based systems and destination that has sense been ironed out). In hospital care all that is required is a medical screening exam. Negative exam, send them packing. Provided that the patient isn't immediately going to die or give birth, there is no requirement that emergency departments provide care.


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## EMDispatch

JPINFV said:


> I don't believe that EMTALA says anything in regard to prehospital care currently (IIRC, there was initially an issue with hospital based systems and destination that has sense been ironed out). In hospital care all that is required is a medical screening exam. Negative exam, send them packing. Provided that the patient isn't immediately going to die or give birth, there is no requirement that emergency departments provide care.



Still you have to perform an exam first. EMTALA doesn't necessarily effect us, but can depending on how an ED is acting and our duty as patient advocates. As for the ambulance agency... you'd violate duty to act if you refused to "touch" or deal with a patient. So my first statement wasn't quite correct.


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## ffemt8978

MCERT1 said:


> Just curious, can you point me to a link with that? I'm not as knowledgeable as I should be on these things.



http://www.emtala.com/


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## CAOX3

LucidResq said:


> You know what, never mind the boy who cried wolf syndrome. Even assuming a patient NEVER has an actual physical ailment when they call, they still deserve to be treated with respect. Most of the time they are calling for a reason - perhaps true mental illness, profound loneliness, fear, etc. In which case you should count your blessings and be glad you are not in such a position.
> 
> *And even if their intent were truly malicious... which is hard to imagine*, or you simply lack the compassion to ponder why they may be calling and empathize...  the last thing a professional should do is "stoop to their level" by humiliating them and trying to get some kind of revenge.
> 
> At the simplest level, bear in mind that these people usually communicate with the outside world. The way you treat them may not effect their perspective of you or willingness to call for you help again, but if others catch word of you treating them poorly, you'll certainly be looked at as unprofessional at best, and perhaps someone who really needs it will be reluctant to call someday.



You seem a little naive to inner city EMS.

Hard to imagine? It happens every day over and over all over this country.  These people cost taxpayers millions, they could care less about taking an ambulance out of service.  Its all about them they lack the ability to realize their actions have consequences.

I would love to work in an area where I could believe everyones intentions were true, this job has made me skeptical of everything and everyone.

As far as disrespecting them, I choose not to lower my self to their standards but these abusers can cripple a system and they need to be dealt with.


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## Veneficus

*Some perspective*



CAOX3 said:


> You seem a little naive to inner city EMS.
> 
> Hard to imagine? It happens every day over and over all over this country.  These people cost taxpayers millions, they could care less about taking an ambulance out of service.  Its all about them they lack the ability to realize their actions have consequences.
> 
> I would love to work in an area where I could believe everyones intentions were true, this job has made me skeptical of everything and everyone.
> 
> As far as disrespecting them, I choose not to lower my self to their standards but these abusers can cripple a system and they need to be dealt with.




I understand both sides of the argument, and I think you and Lucid have valid points. 

I would like to offer that the problem is not the patients, it is the fault in the system. 

These people do need help. They do cripple the system. But not because they are abusing it, because they have no other alternative of seeking help. Often the level of help they need is not even medical in nature. 

But here is really the rub. On our best day we cannot help them. EMS and infact the entire emergency system often doesn't have the knowledge, funding, or resources. 

It creates an endless loop of people seeking help and us not being able to recognize their needs to offer help. So they keep calling. We keep doing what we do. Nothing ever gets done or changes.

As for "educating" them in when to and when not to call 911, it is like throwing stones in the ocean hoping to affect the current. Try if you must, but eventually the frustration fades when you realize the problem is bigger than them or us and even working together, the change we both need comes from society, not our efforts.


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## Aidey

I think there are some that abuse the system and know they abuse the system. Case in point the guy who "can't walk" who gets picked up 2 miles from the homeless shelter where he lives. Taken to ER 1. 5 hours later calls 911 from ER 1 and asks to be taken to ER 2. 3 hours later calls 911 from ER 2 asking to betaking ER 3. He got the police that time instead of an ambulance.


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## TransportJockey

Aidey said:


> I think there are some that abuse the system and know they abuse the system. Case in point the guy who "can't walk" who gets picked up 2 miles from the homeless shelter where he lives. Taken to ER 1. 5 hours later calls 911 from ER 1 and asks to be taken to ER 2. 3 hours later calls 911 from ER 2 asking to betaking ER 3. He got the police that time instead of an ambulance.



Taken from one ED to another? I've always used 'closest appropriate facility' as an excuse to just drop them back in triage at ED1.


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## LonghornMedic

It's pretty sad that some of you who provide patient care aren't doing so at all. Who are you to demean another human being? Are you God? Do you think you are? I suggest you wise up or get out. It's clowns like you who hold EMS back. We are not back in the days of Mother Juggs and Speed and we are not the real life comparisons to Super Troopers. Don't give me the line of "you haven't worked inner-city EMS" crap. I have on and off for 8 years. I've picked up more drunks that I can care to remember. You know what? I treat them the same as the rich, whiny woman with great health insurance. I treat them the same as an active MI. I treat them all the same. When you don't, is when you don't belong in EMS.

Several years ago a crew I know went out on a "man down" call. The patient is a frequent flier we all known by name. He calls so much that we know his date of birth. And this is a system in a major city with over 100,000 calls per year. That many calls a year and we all know this patient's vital info. So this crew goes out and finds the patient unresponsive at the bus stop. Nothing new as we always find him this way. The crew loaded him on the gurney, did one set of vitals and transported. Turns out that when the patient got to the ER, where they actually did a proper assessment, he was suffering from a major CVA. He ended up surviving the episode. He ended up successfully suing the company and winning an undisclosed amount of money. The crew both were fired. They both had their Paramedic license permanently revoked. Their careers in EMS were over. All because they didn't want to "touch the stinky drunk" and "system abuser." I have many more stories of Medics doing similar things. Some managed to keep their jobs and some didn't. Two of them went to jail because they didn't want to transport a self inflicted GSW to the head because "he wasn't going to make it." 

The pain in the butt patients are not going anywhere. They live in the hood and they live in the wealthiest neighborhoods in the country. You were hired to provide care to everyone who calls. If they complain of back pain from a bogus slip and fall in the store, I put on a c-collar, on a backboard, start an IV and give them pain meds. It's not my medicine. I'm not paying for it. I'm not God and I can't tell if you have legitimate pain or not. But no attorney in the land is going to win a lawsuit against me for following protocol. Just as soon as you start deviating from your training and your protocols is when you open yourself to losing your job and much more. You may think I'm some pain the *** person to work with. Far from the truth. I just believe we are professionals and should act as such. Until we do, we will always be the basement dwellers in pay and benefits compared to police officers and firefighters.


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## LucidResq

CAOX3 said:


> You seem a little naive to inner city EMS.



I may not be on the front lines, but I take the calls. I work 911 for a very large city that has a reputation as "the ghetto" in this state, with higher poverty levels than other suburbs. Lots of gang violence, especially as of late... somewhat of a gang war going on honestly. In the last month... 3 homicides, 4 attempted homicides (serious inj), and two suspects shot and seriously injured while robbing a liquor store at gunpoint. I also live here. I'm not saying it's the worst of the worst by any means, but I'm definitely not working/living in some white-bread town of gated communities.

I was furious when I saw someone who is fully capable of walking and has a bus pass (knew this due to recent call history), call 911 for an ambulance to take her to hospital 5 blocks from her home to get stitches removed from her hand. 

Is that person_ inherently bad_? No. Does she deserve any less common courtesy than the middle-class patient having an MI? Hell no. Is she calling with the sole intention to cause the responders grief or harm? No. 



Veneficus said:


> I would like to offer that the problem is not the patients, it is the fault in the system.
> 
> These people do need help. They do cripple the system. But not because they are abusing it, because they have no other alternative of seeking help. Often the level of help they need is not even medical in nature.




Veneficus really hit the nail on the head. It is an extremely frustrating problem, but don't fall in to the trap of thinking you are somehow morally superior to those calling for your help. Yes, there are some really, really bad people out there. But please don't tell me you think most of these patients are inherently bad people. Drunk/drugged, maybe. Suffering from mental illness, maybe. Uneducated/illiterate/slow, maybe. 

You don't know what kind of cards they've been dealt, or how you would have ended up having been dealt similar cards. Children do not choose to be raised in impoverished, unhealthy, illiterate, drug-addled, violent environments... and being able to rise out of that, when it is all you've ever known, is not an easy task. I am not saying that people aren't responsible for their poor decisions, but you have to take a look at the influences causing them to make those decisions.


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## CAOX3

LucidResq said:


> I may not be on the front lines, but I take the calls. I work 911 for a very large city that has a reputation as "the ghetto" in this state, with higher poverty levels than other suburbs. Lots of gang violence, especially as of late... somewhat of a gang war going on honestly. In the last month... 3 homicides, 4 attempted homicides (serious inj), and two suspects shot and seriously injured while robbing a liquor store at gunpoint. I also live here. I'm not saying it's the worst of the worst by any means, but I'm definitely not working/living in some white-bread town of gated communities.
> 
> I was furious when I saw someone who is fully capable of walking and has a bus pass (knew this due to recent call history), call 911 for an ambulance to take her to hospital 5 blocks from her home to get stitches removed from her hand.
> 
> Is that person_ inherently bad_? No. Does she deserve any less common courtesy than the middle-class patient having an MI? Hell no. Is she calling with the sole intention to cause the responders grief or harm? No.
> 
> 
> 
> 
> Veneficus really hit the nail on the head. It is an extremely frustrating problem, but don't fall in to the trap of thinking you are somehow morally superior to those calling for your help. Yes, there are some really, really bad people out there. But please don't tell me you think most of these patients are inherently bad people. Drunk/drugged, maybe. Suffering from mental illness, maybe. Uneducated/illiterate/slow, maybe.
> 
> You don't know what kind of cards they've been dealt, or how you would have ended up having been dealt similar cards. Children do not choose to be raised in impoverished, unhealthy, illiterate, drug-addled, violent environments... and being able to rise out of that, when it is all you've ever known, is not an easy task. I am not saying that people aren't responsible for their poor decisions, but you have to take a look at the influences causing them to make those decisions.



Fall into the trap?

How I would have ended up?

Im talking about people who abuse the EMS system and the eventual consequences it can have.  Im not talking about sick people,  Im talking about people knowingly deceiving the system for personal gain.

As far as the rest of the moral guidance, thank you, I have been in EMS along time, everyone is treated the same and that doesnt change based on socioeconomic status.


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## traumaqueen5

Tincanfireman said:


> Just wondering if your instructors even mentioned standards of care.  Withholding treatment to the accepted norms for a similar patient could easily be considered (or argued by an attorney) as failure to treat (read: negligence) in a jury trial.
> 
> im not sure if you quite understood what i was saying... sorry, I'll clarify... when i say "you do no vitals and you do not touch her" I mean in the back of the ambulance... since you have no witnesses in the back.. unless you have a trainee, like i was at the time... you still treat the pt on scene like you normally would... and besides we are normally within 5 minutes of the receiving ER as well...  my first time dealing with this pt i went to have them sign a form and when i walked in i thought the nurse was going to have a come-apart since i was in there alone with the pt... this is when i learned of the prior incidents....


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## Veneficus

Is it really abuse if the intent isn't malicious?


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## Aidey

Yes. They are not mutually inclusive. 

While I'm not sure the word malicious is right, I do believe there are people out there who deliberately take advantage of the system for their own gain. The people who call 911 to take an ambulance to a certain part of town because they can't afford a cab; Those that get pain killers to sell. Those under arrest and trying to get out of it. 

On the other hand, I believe there are people who abuse the system out of ignorance, fear, impatience, and poverty among other reasons. I would guess that over 90% of system abusers or misusers fall into these type of categories. The people who don't know what resources are available and go to the ER for everything; Those that assume their toe pain is a blood clot (true example, unfounded fear); Or don't want to wait to get an appointment at their GP; Or who call 911 because they don't want to wait in triage; Or those without insurance who know they can get their costs written off as charity care, something private docs don't usually do.  

Maybe misuse is a better term than abuse, but that is semantics. My point is that I think it is possible for someone to be inappropriately using the emergency medical system without having malicious intent, though there are some exceptions.


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## LonghornMedic

Aidey said:


> Yes. They are not mutually inclusive.
> 
> While I'm not sure the word malicious is right, I do believe there are people out there who deliberately take advantage of the system for their own gain. The people who call 911 to take an ambulance to a certain part of town because they can't afford a cab; Those that get pain killers to sell. Those under arrest and trying to get out of it.
> 
> On the other hand, I believe there are people who abuse the system out of ignorance, fear, impatience, and poverty among other reasons. I would guess that over 90% of system abusers or misusers fall into these type of categories. The people who don't know what resources are available and go to the ER for everything; Those that assume their toe pain is a blood clot (true example, unfounded fear); Or don't want to wait to get an appointment at their GP; Or who call 911 because they don't want to wait in triage; Or those without insurance who know they can get their costs written off as charity care, something private docs don't usually do.
> 
> Maybe misuse is a better term than abuse, but that is semantics. My point is that I think it is possible for someone to be inappropriately using the emergency medical system without having malicious intent, though there are some exceptions.


 
Those are are true and frustrating. But it is still our job to take them to the hospital and treat them with respect. It isn't our job to judge people. I'm pretty sure I've given pain meds to drug seekers. But with little resources available to me in the field, if someone complains of pain, and protocols call for meds, then they get them. It's up to a physician to determine if they should get more at the ER or a script to take home. I had a partner who refused to give pain meds to a patient with a kidney stone just because she was having a bad day and this patient rubbed her the wrong way. That is jacked up in my opinion. We as professionals have to learn to put our feelings and bad days aside and do our jobs.


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