Dumb Calls

[njff/emt]

Had a call last week that confirm my theories that most of our dispatchers have the same IQ of a gerbil., My partner and I were up in Morristown doing a transfer., Went smoothly Pt/family were cool, cleared up and dispatch asks if we know how to get to the base in south Jersey.(red flag #1, We told him no but if he tells us the address we can punch it in the GPS and go, and he says STAND BY., So we figure its gonna be a long one so might as well get something to eat., And of course as soon as I start heading towards food, guess who comes over with the address., He says to light it up down to the base(red flag #2), trade in our BLS vanbulance for a box CC unit, for an emergency out of a psych hospital., So I lit it up (mind you the base is at least an hour away), on the way my partner got the text saying it was a 300lb Pt., We know our Stryker can handle at least 350-400(red flag #3)., At this point it doesn't take a genius to figure out this has BS written all over it., So we get to the base, switch rigs and light it up to the PH., Get on scene, wait for staff to let us in and asked what was going on., Turns out PT HAS A Fx'd KNEECAP!., So my partner starts to get info, I can't make PC, cause according to the nurses the Pt. had a "massive BM"(like I needed to know that)., Finally get in the room(red flag #4) THE PT IS 128LBS!, and the stretcher we have is a POS ferno with the add-on wings for big Pt's, for which this one is apparently not., Asked Pt what happened, Pt said they were trying to change their diaper when the bed rail wasn't up and fell., Ok, but there's one problem, the Pt. is a PARAPLEGIC!, So we load and go cold(I ain't goin hot for this one), get to the hospital and of course the nurses see this small Pt. on a unnecessarily big stretcher., Transferred the Pt to the bed, told the nurse of how the Pt. got the injury(she smelled the BS too), transferred care, and left but not before getting heckled about our ridiculous stretcher.

 

[VentMedic]

Is it not better to be overly prepared than under prepared? Could it be possible your dispatcher thought the weight was 128 Kg and did the math to be approx 300 pounds?

It also seems you were so concerned about the stretcher you failed to notice all the very pertinent medical information about the patient. Or, this is another glaring example of the deficits in U.S. EMT education.

Pt. is a PARAPLEGIC!,

This is significant especially for what little information you did provide.

according to the nurses the Pt. had a "massive BM"(like I needed to know that)

Since this patient is a paraplegic, this piece of information is extremely important since these patients are on very specific bowel programs to prevent life threatening situations. It should have been documented and relayed in the report to the RN/MD at the ED. In some areas where EMS has long transport times, it is not beyond their scope of practice to do a digital bowel relief of the quad or paraplegic patient who may have critical symptoms of Autonomic Dysreflexia.

PT HAS A Fx'd KNEECAP!

Again, another very important piece of information especially for the paraplegic.

What level was his paraplegia? T5 or T6? How often did you monitor vital signs especially the BP? Did you note the patients medications or ask the nurse if there were any changes in BP after the fall and if something was adminstered for the BP? How did you know the patient had a fractured kneecap or was this a pre-existing injury?

Here's a little extra reading for you.
http://www.emsresponder.com/publication/article.jsp?pubId=1&id=8694

the nurse of how the Pt. got the injury(she smelled the BS too),

The nurse probably did not think the patient or his injury was BS but rather the way it was obtained since certain basic safety issues were violated.

and left but not before getting heckled about our ridiculous stretcher.

Why would anyone in the hospital care about what stretcher you used if the patient fit comfortably? Are you more concerned about appearances or the patient?

This is a good call for learning something new about assessment and disease processes or management of long term SCI patients. It definitely was not a BS call.

 

[njff/emt]

I'm still alittle steamed about the thing., I did leave out some info., The PH we were going to was at least a half hour away from base and the hospital., The text message only told us the pickup, destination, Pt. weight, and that it was an emergency., When we got there the staff didn't even tell us., We only found out once we got some info., We also told the staff that we were dispatched for a 300lber., The only reason I mention about the stretcher is the way we had to put it into the rig., I don't know if it was the setup of the rig or the stretcher or possibly both, all I know is I nearly had to nearly lift over my head to get the thing in., As for info my partner was teching and I was driving., He never drove a box before so I didn't care if I drove or teched., The doctor was on the floor and xrays were with the info., I looked at one while the nurses cleaned up the pt., I did see a hairline on the patella., With dispatch I don't know if they got the wrong info from the hospital, or if they mixed up the weights., I know the pts weight because we asked and they told us., After we finally got the pt in the back I was going to let my partner take a set of vitals and the pt refused and he told me to go., The pt. also stated feeling no pain., As with the heckle, they were just joking around and I knew they were., They're pretty nice over there., But the one thing that still gets me is why did a paraplegic pt. try to change their own diaper., I also believe that the injury was at least a day or so old., I think they took xrays once the knee started to swell., By the way thanks for the link, definently expanded my knowledge.

 

[njff/emt]

Quote:
the nurse of how the Pt. got the injury(she smelled the BS too),
The nurse probably did not think the patient or his injury was BS but rather the way it was obtained since certain basic safety issues were violated.


that is what I meant, not the injury., I never would think an injury like this was dumb., I'm talking about the fact that the hospital could've simply just call the local squad instead of making the Pt. wait at least an hour/half for medical treatment., Plus they should have called once the Pt. fell out of bed and started showing signs of a possibly injury if the injury was sustained previous days before our arrival., Then again it is a state run institution.

 

[VentMedic]

They're pretty nice over there., But the one thing that still gets me is why did a paraplegic pt. try to change their own diaper., I also believe that the injury was at least a day or so old., I think they took xrays once the knee started to swell., By the way thanks for the link, definently expanded my knowledge.

Because many paraplegics can live independently and are trained to change their own clothes. Some may or may not have indwelling catheters for bladder control for whatever reason. Again, if you find out the level of SCI and whether it was complete or incomplete you will be able to assess the patient more to their specific needs.

The pt. also stated feeling no pain.,

Which is one of the dangers of Autonomic Dysreflexia. You may be trying frantically to locate and solve what is causing them discomfort/pain that creates the stimuli for this condition without the patient being able to offer any information.

The doctor was on the floor and xrays were with the info.,

If this psych hospital is able to do X-Rays and has a doctor available, the patient may not have required immediate transfer...unless something changed. The SCI may have been low enough to where pain may not have been a concern for autonomic dysreflexia. What was the transfer for? There may have been other circulatory concerns with the swelling that weren't an issue earlier. Paralysis patients are very unique for their treatment of both acute and chronic issues.

 

[VentMedic]

Here's another good link.
http://www.apparelyzed.com/index.html

If the patient went through a good rehab program for their initial SCI, they may be more knowledgeable than many healthcare professionals about their condition since the management of these patients is a specialty.

 

[njff/emt]

well the pt was delusional and that's why they refused vitals being taken., As far as the no pain, I think my partner was trying something in the back but I was focusing more in the road., Plus the pt was transported in recovery pos., They were in the same pos on their bed., Granted you make an excellent point that alot of paraplegic pts. care for themselves, but this is a mental hospital, and I don't even know if they try to do something with a pt. like this or what., But still the staff is to mostly blame for the pt. falling., The bed was horizontal against the wall, so we did a head/toe with staff help., But I mean it's common sense not to leave a pt. with that type of condition with the rail down.

 

[VentMedic]

They were in the same pos on their bed., Granted you make an excellent point that alot of paraplegic pts. care for themselves, but this is a mental hospital, and I don't even know if they try to do something with a pt. like this or what., But still the staff is to mostly blame for the pt. falling., The bed was horizontal against the wall, so we did a head/toe with staff help., But I mean it's common sense not to leave a pt. with that type of condition with the rail down.

The local VA hospital has a large psych unit that has many paraplegic patients. Most are independent in their living and to not add further insult to their mental illness, that independence may be respected while they are receiving treatment. The rail may have been down for them to have their own ability to leave the bed at will.

We are going to see more patients like this in the future with the wars we have been and are still involved in over the past 8 years.

 

[njff/emt]

I see what your getting at but this is strictly just a mental compound I should say., It's pretty huge., I think there's at least 4-5 different buildings., I think each has different levels of what kind of psych pt. they house., The one we went to we frequently visit if were in the area., The pt's aren't really that violent and most of them are immobile in some way.

 

[EMSLaw]

I'm a little confused as to how this is a dumb call? You may not have gotten the information you needed from dispatch, but a knee fracture certainly qualifies as a medical emergency that would require an ambulance.

I'm not surprised the patient didn't feel any pain - he's a paraplegic, as you said, and might not feel anything at all below the waist - which can make his condition even more perilous. I'm curious as to why you lifted him manually out of the bed instead of using something like a scoop stretcher, though. Wouldn't grabbing him head-toe and lifting him onto the stretcher possibly cause more damage to his knee, even if he couldn't feel it?

 

[TransportJockey]

I'm a little confused as to how this is a dumb call? You may not have gotten the information you needed from dispatch, but a knee fracture certainly qualifies as a medical emergency that would require an ambulance.

I'm not surprised the patient didn't feel any pain - he's a paraplegic, as you said, and might not feel anything at all below the waist - which can make his condition even more perilous. I'm curious as to why you lifted him manually out of the bed instead of using something like a scoop stretcher, though. Wouldn't grabbing him head-toe and lifting him onto the stretcher possibly cause more damage to his knee, even if he couldn't feel it?

Not everyone cares a scoop. I know back when I did IFT we didn't. But since the pt is in a bed you can always do a sheet lift.

 

[Jon]

NJ: I realize that the state has silly laws, so it might be LEGAL - But how is it responsible for you or your company to do a 30-minute emergency response as a BLS unit? If it is truly emergent, they need to call 911. If they accept an hour ETA... they feel the patient is stable. There is NO justification in my mind to run emergent on that call at ALL.

As for transport - if it isn't a threat to life or limb, why would you need to go emergent?

It is a HUGE red flag to ME that it sounds like you had someone operating a Type III ambulance emergently that had never driven one before! WHAT? It doesn't handle the same as a van, and it is going to take more distance to stop. It is irresponsible to run hot in a truck you aren't familiar with.


As for the stretcher - The FERNO ProFlexx is their top-of-the-line stretcher. That is what the LBS ("wings") is supposed to be used with. Further, the LBS platform is designed to go under the mattress, and be removable - so if it wasn't needed, why wouldn't you just remove it? My service uses the Stryker bariatric cots, and yes, I've had to take skinny patients on them, because it made more sense than returning to base to swap stretchers. It isn't a big deal, and you know - it's rare that someone even notices that I'm using the "big boy" stretcher.

Not everyone cares a scoop. I know back when I did IFT we didn't. But since the pt is in a bed you can always do a sheet lift.

It is required equipment in NJ to be a OEMS licensed ambulance. Of course, the First Aid Council thinks otherwise

well the pt was delusional and that's why they refused vitals being taken., As far as the no pain, I think my partner was trying something in the back but I was focusing more in the road...

If the patient is delusional/confused, how can they "refuse" to have vitals taken? Seems to me that you just justified that they don't have the competency to make an informed refusal. If you used it as an excuse to not fully assess your patient - sounds lazy to me.

I am NOT trying to be hard on you... but the story you are presenting really doesn't sit well with me...and not because I think the call was BS.

 

[VentMedic]

NJ: I realize that the state has silly laws, so it might be LEGAL - But how is it responsible for you or your company to do a 30-minute emergency response as a BLS unit?

There is some confusion with the terminology between emergent and emergency. Generally when facilities states they want an emergent transport it means they don't want to be placed on a list which might mean several hours before a truck can take them. A patient with a fever may not necessarily be an emergency now since the change in VS were picked up quickly. As well, we even use these terms differently for ALS and CCT transfers. We may have someone who is emergent that does not need L&S but does need to get from point A to point B in a reasonable amount of time.

 

[exodus]

There is some confusion with the terminology between emergent and emergency. Generally when facilities states they want an emergent transport it means they don't want to be placed on a list which might mean several hours before a truck can take them. A patient with a fever may not necessarily be an emergency now since the change in VS were picked up quickly. As well, we even use these terms differently for ALS and CCT transfers. We may have someone who is emergent that does not need L&S but does need to get from point A to point B in a reasonable amount of time.

That's considered Code 2 here, which is high-priority, non emergency. Crews can be taken off of break / out of lunch for code 2 calls, and they take precedence over non-SCT scheduled calls.

 

[Jon]

There is some confusion with the terminology between emergent and emergency. Generally when facilities states they want an emergent transport it means they don't want to be placed on a list which might mean several hours before a truck can take them. A patient with a fever may not necessarily be an emergency now since the change in VS were picked up quickly. As well, we even use these terms differently for ALS and CCT transfers. We may have someone who is emergent that does not need L&S but does need to get from point A to point B in a reasonable amount of time.

Vent - I understand... however, the OP says dispatch directed him to "light it up" for a 1-hour run to BASE to switch units.

Jon

 

[VentMedic]

Vent - I understand... however, the OP says dispatch directed him to "light it up" for a 1-hour run to BASE to switch units.

Jon

Yes I know what the OP stated. However, between dispatch and the facility, the terms get confused. We used to get ALS trucks used for IFT running L&S all the time to the hospital believing it was a response that required them to be there within 4 - 6 minutes. It took awhile to get across that the hospital needed the truck as soon as possible but not ran as an emergency response.

I can not speak for every ambulance service and especially the OP's. However, the one exodus is with is closest to what I am attempting to explain.

 

[EMSLaw]

Scoop Stretchers

It is required equipment in NJ to be a OEMS licensed ambulance. Of course, the First Aid Council thinks otherwise

It's technically optional equipment under NJSFAC standards, yes, but I don't know of anyone who runs an 911 ambulance without one. Such squads might exist, of course, but even then, a reeves /is/ required equipment, and there is also the aforementioned sheet drag possibility.

 

[Aidey]

I know that technically a "delusional" patient can't always refuse care because they don't meet the threshold. However, sometimes allowing the pt to refuse is a heck of a lot safer than arguing with them. Is it really good care to physically restrain a patient to get a BP?

 

[njff/emt]

I just want to clarify things

I fully understand that the emergency itself was not BS, sorry if it sounded like that., I meant that the circumstances about the call such as switching out rigs, etc. was BS., With the stretcher situation the reason we got that was because I believe it was requested by the facility., It wasn't until we made PC that we got the surprise that the Pt. wasn't the 300lbs that it said on the text., I think that our dispatchers forgot to ask afew key questions, and/or whoever called for the transport messed up., When the staff member met us at the door they didn't even ask why we had a big stretcher., With the scoop stretcher, we have them on our BLS rigs and I hope the CC trucks., But the CC we picked up was kinda old and did not have one., WIth the CODE3 situation, I now its ridiculous, and the base we went to just recently opened up and only has a handfull of rigs and crews., I think the crews were most likely in PA., I honestly doubt we were the closest crew, but we were probably the only available crew(which I also doubt)., Like I said before I think if it was that much of an emergency they could have just called 911 and request the local squad., Granted we have a contract with them but I don't think in this situation it doesn't matter whether we have the contract or not., About the head/toe lift, the room was small and the bed was horizontal against the wall, so we really had no other choice., About the delusional part, the nurse told us that and when my partner was about to get vitals, the Pt. refused., I didn't know much about the past Hx cause my partner had all the paperwork, so I don't know the full deal on that., I was just going by what the nurses told me(which, I know, I know, I shouldn't always rely on what the nurses tell me). In all and I've noticed that lack of communication is a huge problem and I think that this call should've gone better than it did.

 

[njff/emt]

In regards to the CC, I was driving and my partner was teching., I do have experience driving the TypeIII's., He didn't have any and asked if I wouldn't mind driving, which I didn't mind at all., I actually kinda enjoy driving those.