Officially and politically correctly: Liars.

mycrofft

mycrofft

Still crazy but elsewhere
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How are you expected to handle malingerers, liars, drug seekers, Munchausians...the lot?
(I am not talking about the obvious need to take care of actually sick gamers, but when you have ruled out a factitious complaint).
 
Interestingly enough, our medical director came out with a policy about this in the past month.

Basically, we're to do a full assessment and then contact medical control if we feel there is no reason for the patient to be transported by ambulance. The doc will make the final call on whether or not the patient gets the ride in.
 
I take them to the hospital and return to service asap.
 
re

Since VS can not always show a persons true pain level i would rather touch a drug seeker with a little MSO4 then not treat somebody that is truely in pain.
 
agreed... give them to the hospital... they're used to it.
 
DV_EMT said:
agreed... give them to the hospital... they're used to it.
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Nothing like taking a unit out of service for over two hours for somebody that does not need an ambulance at all.
 
ffemt8978 said:
Nothing like taking a unit out of service for over two hours for somebody that does not need an ambulance at all.
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Unfortunately, while we feel and see the symptoms and side effects from this system abuse, it seems (at least for me), there is little street EMTs/Medics can do to change it.

While it isnt an excuse for passivity, system abuse requires a system-level response, either in the change of protocols, addition of additional resources (whether it be more trucks on the road, nurses by phone, etc.)
 
emt.dan said:
Unfortunately, while we feel and see the symptoms and side effects from this system abuse, it seems (at least for me), there is little street EMTs/Medics can do to change it.

While it isnt an excuse for passivity, system abuse requires a system-level response, either in the change of protocols, addition of additional resources (whether it be more trucks on the road, nurses by phone, etc.)
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And that was the point of my post...our protocols have changed. No longer are we taking everyone to the hospital just because they want to go.
 
I am firmly of the opinion that I would rather take a patient to the hospital who didn't need to go than encourage a patient to refuse and have them code an hour later.

Everybody makes a mistake once in a while, and all it takes is one for us to miss a legitimate complaint while assuming that the patient is drug seeking or making it up for some other reason.

Always err on the side of life.
 
Are we qualified to reject a citizens call for help, even if we believe that they are (and the probably are) full of it and need a swift kick in the a**? How much trouble can we get into for even having this attitude toward a patient we are transporting? My personal (horrible) experience in this regard explains how I feel, although I see no other option but to treat and transport...

I had just been working ambulance for about a week. I was still with my EMT FTO and his Paramedic Partner (Both Burnouts). We get dispatched out to a person vs. train call; PD on scene. We get on scene w/ fire. 30ish y/o male was lying on the road where the train tracks crossed over. PD says that he was driving by when he saw the man dragging himself along the tracks to the road. Man (a transient) claims that he was walking along the road as the train was going by. Wanting to take a ride, he chased after it, attemted to jump on and missed. He claimed to hit the ground hard and felt a "Snap" in his leg/hip and was unable to walk. So he dragged himswelf back to the raod where the PD saw him. Good story, right. This was 4 years ago, so here is a basic run down on the assessment: Screaming his head off until asked a question, answered and then went back to screaming. Vitals normal except for pin point pupils. No meds; except for a heroin addiction (no fix in 2 days). No deformity or such to the leg. Pain on palpation inconsistant. Just everything screamed "faker seeking drugs". Paramedic and FTO spotted it immediately and classified it a B(L)S call. FF's help pivot him to the gurney (occaional inconsistant screams and crys of "it hurts so bad"). My FTO and I get him in the back of the rig and the Medic drives. FTO sits in the jump seat and has me run the show. Up until now, I has no patient contact. The Medic immediately begins driving off on what they viewed as a taxi ride to get this guy his fix. So I start from scratch, assesing, and started treating. I wanted to splin the leg (upper femur pain on palp w/ no other signs of injury) and to give this guy a little O2 (per county protocol). FTO waves off the O2 as not needed and tell me to use a pillow to prop up the leg in a position of comfort. The patient said the pain went down from a 10/10 to a 3/10 when the leg was inline. So I did as I was told becasue the 20 years of FTO experience told me to and I was just a newer EMT with little street experience. I prop the leg up and the guy sighs and closes his eyes. The FTO silently tells me to move the pillow out and let the leg fall. I do and the foot falls out of line. It took 10 seconds before the patient realized it, looked down, and then started screaming again. I prop it back up, continue talking got the patient, and get asked from him, "can you guys give me some morphine or something?" "No sir we are not allowed to." Hey, I'm just an EMT! Sounds fakerish right? Get to the hospital and handed him off to a skeptical nurse....

6 months latter I get called into the supervisors office. "You are under investigation for a call you ran months ago. Please review the paperwork. You will need to be interviewed by County EMS and Corporate tomarrow." Turns out the patient had a hairline fracture to the femur!!! As a new hire with a FTO I was not considered the target of the investigation by County EMS. They wanted the medic and I was considered just a witness to the event. My paperwork was spotless and detailed the entire sequence of events. According to county protocol any fall from a height greater than 5 feet with femur/pelvic pain must be treated as an ALS call. According to protocl (based solely on the pateints c/c) he should have had an IV, Morphine, splinting (duh), and 15 lpm O2 via non rebreather. According to the county the Medic violated county protocol. The company chose to suspend him for 30 days to apease the county. Despite the fact that the county saw no fault in me (which they viewed as mearly a ride-along), the company put the magnifying glasses on me, which mad the next several months fun.

I learned a lot from that experience. PAPERWORK saves butts. Never listen to "superior medical burnouts"; trust your own training and follow your protocol regardless. And just because the patient seems to fit the "Liar/Faker" lable, CYA and treat/transport in accordance with protocl, no matter how stupid you think it is. They say they have pain... they have pain until the Hospital says "Get the hell out." Make it their malpractice investigation, not yours. Is it right? No. Is it cynical? Yes. Will it give you a longer career in EMS? YES.
 
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We can not agree on any education higher than a few hours for a certificate and yet some believe those in EMS are Psychiatrists who can diagnose Munchausian Syndrome in the field.

Who is going to bet their career that the drug seeker claiming chest pain is a liar?

How many of "these patients" have you actually followed up with to see if they were admitted to the hospital or some facility to get more treatment if not for a medical condition but for their addiction?

How many work for services that have a referral system which tracks these patients? If yes, how many use it to see these patients are placed in the system for followup? If no, why continue to complain and want others to do what you and/or your service could do with a few proper and appropriate connections?
 
VentMedic said:
We can not agree on any education higher than a few hours for a certificate and yet some believe those in EMS are Psychiatrists who can diagnose Munchausian Syndrome in the field.

Who is going to bet their career that the drug seeker claiming chest pain is a liar?

How many of "these patients" have you actually followed up with to see if they were admitted to the hospital or some facility to get more treatment if not for a medical condition but for their addiction?

How many work for services that have a referral system which tracks these patients? If yes, how many use it to see these patients are placed in the system for followup? If no, why continue to complain and want others to do what you and/or your service could do with a few proper and appropriate connections?
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Amen, Reverand Vent!!!
 
Take em out to the rural area and shoot em.



Just kidding of course :)
 
ffemt8978 said:
And that was the point of my post...our protocols have changed. No longer are we taking everyone to the hospital just because they want to go.
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You must work for a very progressive system. Shame there are not more like it.

Part of the problem I have seen is not so much that we find ourselves in a position of transporting obvious BS calls, but none of us seem to have the balls to suggest that, given the lack of abnormal findings in the physical exam, there are other transport means available to them (their own car, family, neighbor, friend, taxi, bus, subway, walk, unicycle etc). This is really where we fail. Of course for those who cannot deny transport for the "nothing calls", this has to be done tactfully..."OK, we will gladly take you down to the hospital today, but please be aware that we are only one of x amount of emergency ambulances on the road at this time, and we are always grateful when our non-critical patients can travel by other means, to optimize our emergency response...so that we will have a better chance of being there when we are really needed"...something like that. Throwing in an example of a pediatric arrest call, always gets them to sit up and listen, and puts their "sore thumb" into perspective. Of course you will still get the family following right behind in their car. :deadhorse:

Many of these patients only do it in order to "jump the line at the ED", many of them will freely admit it - others, just don't know how the system works so cannot be faulted. Either way, we shouldn't feel bad about educating our patients in how to best utilize the emergency services whether we transport them or not.
 
My services protocols are we transport them. At most we are out of service for these type of calls half an hour.
 
We transport everyone. Period. Unless they say they do not want to go. We are strongly discouraged from talking a patient out of transport, mostly I think because we are a private service and we are currently in a recession.
 
Aidey said:
We transport everyone. Period. Unless they say they do not want to go. We are strongly discouraged from talking a patient out of transport, mostly I think because we are a private service and we are currently in a recession.
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Probably what most of us do unfortunately. Even my volly dept, who stand to gain nothing monetarily by transporting, as we don't bill. There are differences though between giving out patient education on EMS resources, and trying to persuade them not to go to the hospital.

But it is part of the problem with trying to break away from the taxi service we are, and have always been.
 
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It is really tough where I'm at, I would say something close to 75% of our non inter-facility transfer calls could be handled at either an urgent care clinic or by a primary care appointment. I know we end up taking people a number of times because they don't have a car or can't drive themselves for whatever reason (how they get home from the ED I'm really not sure).

It's such a double edged sword too. Someone who has been told "I'm sorry, you don't need to go to the hospital via ambulance." one time may not call the next time when they are actually having an emergent issue.
 
Scott33 said:
Many of these patients only do it in order to "jump the line at the ED", many of them will freely admit it - others, just don't know how the system works so cannot be faulted. Either way, we shouldn't feel bad about educating our patients in how to best utilize the emergency services whether we transport them or not.
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I'm pretty sure where I come from (not a paramedic [yet]), unless you are in a life threatening emergency, even if you are transported via ambulance you are triaged and placed into a line with people who came to the ER via their own means.
 
VentMedic said:
We can not agree on any education higher than a few hours for a certificate and yet some believe those in EMS are Psychiatrists who can diagnose Munchausian Syndrome in the field.

Who is going to bet their career that the drug seeker claiming chest pain is a liar?

How many of "these patients" have you actually followed up with to see if they were admitted to the hospital or some facility to get more treatment if not for a medical condition but for their addiction?

How many work for services that have a referral system which tracks these patients? If yes, how many use it to see these patients are placed in the system for followup? If no, why continue to complain and want others to do what you and/or your service could do with a few proper and appropriate connections?
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I throw the bullshiiitt card on this one.

Münchhausen syndrome, are you kidding me.

The Er's I transport have about 30 psychiatrists in them. Are these people falling through the cracks, everyone is mis diagnosing them? Admitted? Yeah they get admitted, the majority of the time to a padded room with a box of crayons with their name on it, or a timeout in the local drug program, which they weasel their way out of with a prescription of soboxin that they can sell to get something with a kick. They dont want treatment, they want to be high.

I may only have a couple hundred our of training however I am no dummy, drug seekers dont call 911 with chest pain, they wont get pain meds for that, they know the protocols better then we do. When you walk up the stairs and their already telling the fire department there allergic to Tylenol, Ibuprofen, and aspirin and asking if its an ALS truck coming. I transport 20 people a shift, when 5 of them is one guy searching for the new medic or shift change at the ER, well you know what if it walks like a duck, talks like a duck, its usually a duck.

Referral system? This people are connivers, liars and cheats. They have worked their way through every drug program in a hundred mile radius, they rob the system of countless man hours, they our responsible for making truly sick or injured people wait, they dont want to get clean they want to get high. Refferal? Sure to a jail cell. They dont want to get clean, force them to, they will dry up quick in the clink.
 
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