con artists

[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).

 

[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.

 

[Tincanfireman]

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.

 

[Aidey]

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

 

[EMDispatch]

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...

 

[Aidey]

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

 

[EMDispatch]

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.

 

[fortsmithman]

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.

 

[JPINFV]

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.

 

[EMDispatch]

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.

 

[ffemt8978]

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/

 

[CAOX3]

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.

 

[Veneficus]

Some perspective

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.

 

[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.

 

[TransportJockey]

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.

 

[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.

 

[LucidResq]

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.

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.

 

[CAOX3]

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.

 

[traumaqueen5]

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....

 

[Veneficus]

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