2014 = ems hell

[Handsome Robb]

A short list of reasons for a higher call volume in 2014.....OBAMA CARE......FLU SEASON....A lot of the country is in a deep freeze ( more homeless people calls).....You can't fix stupid when it comes to those who call EMS for silly reasons like "i have a headache" ......

Unless that headache is a bleed. Not a silly reason now...

 

[9D4]

What Robb said. Got told a story by one of our instructors about the lady that runs our cadaver labs. She was acting really interested in our classes and wanted to watch some drills. Instructor finally asked why and she stated that "she had lost faith in EMS, because her husband had a sub-arachnoid hemorrhage that the FD passed off as a normal headache that wouldn't require him to go to the hospital at all".
You may think it's silly, but :censored::censored::censored::censored: happens. As the saying goes "you may think of horses when you hear hooves, but it could very well be a zebra".

 

[NomadicMedic]

That's just a poor assessment. Certainly not a zebra.

 

[9D4]

That's just a poor assessment. Certainly not a zebra.

I would argue that for both ways. I wouldnt typically expect a subarahnoid hemmorrhage with a headache. My 2 cents.

 

[chaz90]

Proper assessment of any patient will include more than a simple complaint of "headache" (or anything else for that matter). It may be a zebra in the sense that it's not the most common cause of a headache, but it had better be on your differential list until proven otherwise.

 

[mycrofft]

Hence why dispatch doesn't diagnose.

 

[emt11]

Hence why dispatch doesn't diagnose.

As far as I'm concerned, dispatch gives me an address and a made up reason as to why I'm going there in the first place until proven otherwise. Had entirely too many times where we get complaint "A" upon being dispatched and on the MDT and show up and it's actually complaint "M"(no where near what we were told".

 

[Tigger]

What Robb said. Got told a story by one of our instructors about the lady that runs our cadaver labs. She was acting really interested in our classes and wanted to watch some drills. Instructor finally asked why and she stated that "she had lost faith in EMS, because her husband had a sub-arachnoid hemorrhage that the FD passed off as a normal headache that wouldn't require him to go to the hospital at all".
You may think it's silly, but :censored::censored::censored::censored: happens. As the saying goes "you may think of horses when you hear hooves, but it could very well be a zebra".

Actually the quote is ""When you hear hoofbeats, think of horses not zebras."

That said, a sub-arachnoid bleed is probably not going to present the same as a garden variety headache.

 

[usalsfyre]

I would argue that for both ways. I wouldnt typically expect a subarahnoid hemmorrhage with a headache. My 2 cents.

You sir, have not been bitten in the @ss badly enough to do a thorough assessment on every patient .

Remember the words "thunderclap headache"

 

[NomadicMedic]

I'm going to be honest, when someone calls 911 for a headache, my index of suspicion goes up. Now, obviously this is not the case in an urban 911 system where everybody and their brother calls just for transport. But it's pretty obvious to me that something is going on when a patient is dialing 911 for something seemingly innocuous… unless you're totally burnt out or at the end of your shift and in the "I'm getting out of here in a couple of minutes" mode. It is my opinion that the paramedic should be working them up and most likely doing some pain management and anti-emetics. Now, also having said that… If all the vital signs are stable, it's not a thunderclap headache or "the worst headache they've ever had" and I don't see anything immediately ALS specific, there's nothing wrong with sending a headache in BLS.

 

[mycrofft]

Had a neighbor's daughter sent home from the hospital ED with a bleed and died overnight. She had Battle signs, both anterior(raccoon eyes) and bilateral (ecchymoses behind the ears), ℅ nausea/vertigo and HA (headache, sorry).

 

[unleashedfury]

You sir, have not been bitten in the @ss badly enough to do a thorough assessment on every patient .

Remember the words "thunderclap headache"

We don't carry CT machines in our trucks,, nor do I have a radiologist on speed dial to tell me that "that's just a headache"

OTOH, Whether my patient states he/she has a headache, or is having a MI I wouldn't know unless I do a solid assessment.

Generally my headache assessment generally spiels into a few questions.

What made you call 911 today?
A - I have a headache.

Ok, well if you had headaches before whats the difference between today and other headaches?

A- Well this one is a lot worse, or I have other things going on with it. Like blurred vision, nausea vomiting, etc. etc.,

OF course I keep questioning patient as the assessment continues, looking for root causes (Oh I fell and hit my head, Or hx, of Migraines I have a hangover) etc. etc.

And I keep going with it. Some days your going to just transport a run of the mill headache, some days your going to be transporting a bleed. Most ED Docs that I have met will do a CT scan if a patient complains of a headache

Theres nothing wrong with a assessment that proves normal and appears as a run of the mill headache going in BLS.

 

[usalsfyre]

We don't carry CT machines in our trucks

Cop out. CT has only been in common use since the mid to late 1980s. They could tell bleeds from "run of the mill headache" prior to that.

nor do I have a radiologist on speed dial to tell me that "that's just a headache"

You DO have assessment skills.

OTOH, Whether my patient states he/she has a headache, or is having a MI I wouldn't know unless I do a solid assessment.

Very true

Generally my headache assessment generally spiels into a few questions.

What made you call 911 today?
A - I have a headache.

Ok, well if you had headaches before whats the difference between today and other headaches?

A- Well this one is a lot worse, or I have other things going on with it. Like blurred vision, nausea vomiting, etc. etc.,

OF course I keep questioning patient as the assessment continues, looking for root causes (Oh I fell and hit my head, Or hx, of Migraines I have a hangover) etc. etc.

And I keep going with it. Some days your going to just transport a run of the mill headache, some days your going to be transporting a bleed. Most ED Docs that I have met will do a CT scan if a patient complains of a headache

Theres nothing wrong with a assessment that proves normal and appears as a run of the mill headache going in BLS.

So what's your deciding factor between ALS and BLS? What makes it a "run of the mill" headache?

 

[abuan]

Our call volume in Honolulu has increased significantly especially with AMR not taking cold calls (Deemed BLS by proQA) as of late.

 

[Restless]

System wide, we have seen an increase on those calls who are just for rides. Not to turn this into a political discussion but many people think that now that they have insurance, everything is free. Unfortunately most insurance providers in their haste to sign up people seem to have inadequately explained the concepts of deductibles, co-pay and fees for services. I see some people have a shocked expression on their face when the ER asks them for a co-pay upon discharge and they are like "It's free, I gave you my insurance card." Sadly, once again, lack of public education is straining the EMS system.

>snipped<

...and these are the same people who will be calling their Insurance Companies complaining about the bills they're going to be receiving. Once they get the bill they call and complain and force an Insurance to open an investigation into either the hospital or Ambulance for billing for service not rendered. I see this all the time in my line of work unfortunately.

Have a good nights guys-n-n gals

 

[Handsome Robb]

That said, a sub-arachnoid bleed is probably not going to present the same as a garden variety headache.

That's what I was thinking. Headache doesn't mean ALS but I'm with DEmedic. I get suspicious of headache patients.