PITA patients

[Aidey]

Your local LE agencies allow you to transport prisoners without LE escort? Fail.

I've done it twice, and in both cases the person was being released from PD custody. Once custody was being transferred to the local mental health authority, and the other time the guy was just being let go.

 

[FLEMTP]

maybe its just my area or maybe its like this everywhere, but the you call we haul policy seems to keep some of us in a job. unless its a really annoying pt, i really dont mind the bs calls, as long as my truck isnt tied up from something more important. gotta earn that paycheck somehow. lol.

The problem with your logic is that while you "still gotta earn that paycheck" this routine of calling 911 for things that are quite obviously not an emergency situation is contributing to the rising cost of health care, and the rising cost of health insurance. every time medicaid, medicare, or a private insurer pays a claim to an ems provider for a call that definitely did not need EMS, EVERYONES health insurance premium goes up, or in the case of a government insurance program (medicare/medicaid) the cost of these services go up.. and seeing as how they are governement (read: taxpayers) funded.. the cost continues to go up. YOU might get your paycheck.. but we ALL lose.

 

[Melclin]

and really they have no place to because their medical education was obtained via the "Google School of Medicine"

About 70% of my degree will be awarded to me by Google University. Or at least it should be.


The only call that has annoyed me in my short time was to a 60yo male who "fell yesterday". We get to his house and he answers the door with a small graze on his knee and remains standing the whole time we talk to him. He fell in the supermarket yesterday and grazed his knee, got straight back up, continued shopping and came home. He'd taken some ibuprofen for a mild dull ache and it had satisfactorily removed his pain. He'd woken the next day, went about his business and proceeded to call the ambulance at 3 in the afternoon.

Now I've been on plenty of calls before that didn't need an ambulance, I mean that's ambulance work isn't it, but the person has always thought they needed an ambulance. The thing that really got me about this guy was that he didn't want to go to hospital, he actually thought he was fine in the first place.

Lonely? Nope, he had three neighbours over who were good friends. He was lucid, no meds, no history of mental illness, nothing to suggest he was not of sound mind...I cannot for the life of me think why he called. I might add too that some 15,000 people were without ambulance cover while we were tending to his knee...imagine my surprise when the attending paramedic transported him. He told me later that the pt "seemed like the type to complain" and he didn't wanna put up with another complaint. Mystified.

 

[thatJeffguy]

flemtp i hear where ur coming from, we had a call for diff breather, we get on scene and this ones puttin on an almost convincing performance., she's faking syncope, and SOB., i really couldnt get a good bp because she was "fainting", and grabbing her L arm in the process., my partner gets behind to support her so i can finally get vitals., came out 132/100, pulse was in the 140's., as soon as she heard that she said its normally 70/?, oh and she doesn't take any meds., we cancel medics, get her on the stairchair and get her to the cot., we load n go, put her on O2., we get to the hospital of her choice, and try to get her to slide over to the bed(the performance is still goin), my partner finally raises her voice and the pt makes some progress and moves over without a problem., even worse was we had another call pending, it was a full moon, and we ended up getting 13 calls all back to back.

This is why paramedics go on to other careers.

 

[thatJeffguy]

About 70% of my degree will be awarded to me by Google University. Or at least it should be.


The only call that has annoyed me in my short time was to a 60yo male who "fell yesterday". We get to his house and he answers the door with a small graze on his knee and remains standing the whole time we talk to him. He fell in the supermarket yesterday and grazed his knee, got straight back up, continued shopping and came home. He'd taken some ibuprofen for a mild dull ache and it had satisfactorily removed his pain. He'd woken the next day, went about his business and proceeded to call the ambulance at 3 in the afternoon.

Now I've been on plenty of calls before that didn't need an ambulance, I mean that's ambulance work isn't it, but the person has always thought they needed an ambulance. The thing that really got me about this guy was that he didn't want to go to hospital, he actually thought he was fine in the first place.

Lonely? Nope, he had three neighbours over who were good friends. He was lucid, no meds, no history of mental illness, nothing to suggest he was not of sound mind...I cannot for the life of me think why he called. I might add too that some 15,000 people were without ambulance cover while we were tending to his knee...imagine my surprise when the attending paramedic transported him. He told me later that the pt "seemed like the type to complain" and he didn't wanna put up with another complaint. Mystified.

I'd rather err on the side of caution. If you call 911 and want to go to the hospital I'll gladly take you.

 

[FLEMTP]

I'd rather err on the side of caution. If you call 911 and want to go to the hospital I'll gladly take you.

There is a difference between "id rather err on the side of caution" and wasting resources. If there is no emergent situation AT ALL, and the complaint is something that is really more appropriate for a primary care physician, and there is very little likelyhood that the complaint will result in admission, the patient should be strongly encouraged to utilize other MORE APPROPRIATE resources, but only after a very thorough H&P by the paramedic.

Oh wait.. I just read what I said.. thorough H&P... and paramedic.. dont seem to fit into the same sentence anymore.

EMS is in a sad state of affairs these days <_<

 

[abckidsmom]

There is a difference between "id rather err on the side of caution" and wasting resources. If there is no emergent situation AT ALL, and the complaint is something that is really more appropriate for a primary care physician, and there is very little likelyhood that the complaint will result in admission, the patient should be strongly encouraged to utilize other MORE APPROPRIATE resources, but only after a very thorough H&P by the paramedic.

Oh wait.. I just read what I said.. thorough H&P... and paramedic.. dont seem to fit into the same sentence anymore.

EMS is in a sad state of affairs these days <_<

Right here in this thread though, we have an example of a provider blowing off a patient they reported had signs of hypoxia. I wish we could count on medics arriving on scenes and making decisions based on the welfare of the patient alone, but we can't.

Right here in this thread, we see plenty of providers making decisions based on potential availability for other calls.

And since when did you need to probably be admitted to merit a ride to the hospital? I've seen trauma alerts discharged home, anaphylactic reactions, flash pulmonary edema.

What I'm getting at is that there is such a wide range of possibilities with every story, every complaint, that it's not realistic to think that your standard community-college-educated paramedic has the resources to rule out or in an emergency. Especially in patients with complex histories who are more likely to have a subtle condition going on right alongside their PITA status.

I get the PITA thing. I just think that those PITA patients are the ones medics can tend to make poor decisions on.

 

[FLEMTP]

And since when did you need to probably be admitted to merit a ride to the hospital? I've seen trauma alerts discharged home, anaphylactic reactions, flash pulmonary edema.

If someone has a medical complaint that will result in an admission because of the complaint (not a pre-planned elective admission) then management of that complaint should begin with EMS, especially if they called EMS for the complaint. Until we are given better point of care testing, and EMS Education programs step up and begin to teach a true H&P to paramedic students, then paramedics only have previous experience to go on to make that judgement call, outside of calling and consulting with the ER doc, or the patient's primary care physician.

Speaking of which, I am not outside of contacting a patient's primary care physician (of course with the pt's permission) and speaking with them regarding the patient's condition and the need for transport vs follow up in the PCP's office. PCP's seem to very much appreciate that from EMS providers, and I feel that we as EMS providers need to involve the patient's PCP in transport decisions where there is not an urgent matter to be attended to and time is permitting. I also wont leave a diabetic with a hypoglycemic episode until I've made a follow up appointment with either their PCP or their endocrinologist.

Im a big believer that if we want to start being respected as medical professionals.. then we need to behave like a medical professional... not a blood hungry heathen...running from call to call looking for the "best" call of the night.

 

[abckidsmom]

If someone has a medical complaint that will result in an admission because of the complaint (not a pre-planned elective admission) then management of that complaint should begin with EMS, especially if they called EMS for the complaint. Until we are given better point of care testing, and EMS Education programs step up and begin to teach a true H&P to paramedic students, then paramedics only have previous experience to go on to make that judgement call, outside of calling and consulting with the ER doc, or the patient's primary care physician.

I think it's possible you misunderstood me. I was just saying that plenty of people NEED EMS who will never be admitted. The examples I gave were just 3 off the top of my head.

I took some time off of EMS to be a mom these past several years. During that time, I learned that people will call for just about anything *when they are not comfortable with the situation*. Sure, it's not a big deal to you or me because we've dealt with similar situations many times before. But to the patient, they are unable to cope with their problem.

Across the board, the people I've gotten to know outside of EMS really believe that EVERY paramedic knows the right answer to the situation, and they will go along with what you say, even if it doesn't seem right to them, or if they still aren't comfortable with the situation or whatever. So if you (general you) suggest that maybe they don't need to go to the hospital, it's more than just a suggestion. They take it as a recommendation.

I'm going to put it in all caps, for emphasis: OUR WORDS CARRY MUCH MORE WEIGHT THAN WE KNOW. These people are in a crisis, and our words, whether positively or negatively recieved, are greatly magnified to the patient/family.

Speaking of which, I am not outside of contacting a patient's primary care physician (of course with the pt's permission) and speaking with them regarding the patient's condition and the need for transport vs follow up in the PCP's office. PCP's seem to very much appreciate that from EMS providers, and I feel that we as EMS providers need to involve the patient's PCP in transport decisions where there is not an urgent matter to be attended to and time is permitting. I also wont leave a diabetic with a hypoglycemic episode until I've made a follow up appointment with either their PCP or their endocrinologist.

Im a big believer that if we want to start being respected as medical professionals.. then we need to behave like a medical professional... not a blood hungry heathen...running from call to call looking for the "best" call of the night.

I like your ideas, but they run right along the edge of safe practice. I like talking to the PCP too, but again, I have to stress, our words carry much more weight than we think. If you start to downplay the patient's condition in any way, the doctor will listen to you and believe that. It's absolutely imperative to paint the most conservative picture possible for the patient's safety, if this is the way you want to operate.

Standard behavior among paramedics is to transport diabetics with hypoglycemic episodes to the hospital. I could argue that people in the first hour after a hypoglycemic episode are NOT competent. Have you ever felt that sensation? Try reaching for a thought, through the mud that is your brain, when the medic is saying, OK, let me get you a sandwich and we'll just go on back to the station. Sign here.

It's not always possible for a person to articulate whatever nagging doubts they have about the situation. I had an insulinoma in the placenta during one of my pregnancies. The blood glucose lows were LOW, down to 8-12, frequent, and very annoying. We had to call an ambulance several times before we got the diagnosis. Each time, we (two very competent medics) refused transport, and the medics totally agreed. THAT WAS SO STUPID. What I needed was an ER. But the culture was such that, well, the emergency's over...what do we need to be here for? Right. They needed to be there for the repeat drop in BG, and the seizure that accompanied it, in the car on the way to the hospital. That's what.

Sorry to be preaching. It's not just at you, believe me. This is a soap box I really believe is overlooked in the busy, slightly burnt-out, maybe a little bored, undereducated medics that I encounter in every single type of system out there. Except, ironically enough given the climate on this forum, the well-paid fire-based EMS system I'm familiar with.

 

[katgrl2003]

Each time, we (two very competent medics) refused transport, and the medics totally agreed. THAT WAS SO STUPID. What I needed was an ER. But the culture was such that, well, the emergency's over...what do we need to be here for? Right. They needed to be there for the repeat drop in BG, and the seizure that accompanied it, in the car on the way to the hospital. That's what.

However, you as the patient, refused transport. If they had put you on the cot and taken you to the hospital, it would have been kidnapping. Yeah, in a perfect world all patients will go to the hospital that need to go, but we can't force them too. If you knew your BG was going to drop again and you needed to go to the ER, why didn't you agree to go by ambulance? We can't blame "stupid medics" for everything. Sometimes, no matter what we do, the patient will not agree with anything we suggest. And if the patient refuses transport, what else can we do?

 

[abckidsmom]

However, you as the patient, refused transport. If they had put you on the cot and taken you to the hospital, it would have been kidnapping. Yeah, in a perfect world all patients will go to the hospital that need to go, but we can't force them too. If you knew your BG was going to drop again and you needed to go to the ER, why didn't you agree to go by ambulance? We can't blame "stupid medics" for everything. Sometimes, no matter what we do, the patient will not agree with anything we suggest. And if the patient refuses transport, what else can we do?

It's true, we can't blame stupid medics for everything. The best we can do is BELIEVE they need to go, and work off of that belief. There's nothing definitive about the care or evaluation you recieve from a medic.

I, as the patient, refused transport, but if the medics, as the medics, STRONGLY recommended that I go, I might have changed my mind. Instead, they shrugged, said "what can you do?" and went on. Medics' strong recommendations carry much weight.

 

[46Young]

PITA pts for me have been the ones who call EMS from outside the ED, after having been waiting for too long.

We need more programs that educate pts as to alternatives to the ED, or at least alternatives to 911 txp. On the one hand, the "U call we haul" crowd say that we get revenue for the txps. Realize, however, that the vast majority of PITA toe pain callers tend to be from the poorer areas. These callers will typically be underinsured via medicaid, or have no insurance whatsoever (this is my aunt from XXXXX country and she's visiting for a couple of weeks. She doesn't have insurance). So, you have the 'caid paying pennies on the dollar of what the txp actually costs, and then your 100% uncompensated txps. As the population continues to rise, so will these calls. That requires more units on the road, new hires, more stations, etc. That also requires a tax increase. When does it end?

It's a PITA to know that I'm being woken up a 0 dark 30 to run a call for toe pain or hurt feelings, knowing that my partner and I are basically paying for the txp through our taxes and insurance premiums. Same thing for All-State-itis MVA's.

Having said that, it's wrong to talk pts into refusing without having clear guidelines for doing so from the medical director. This would be intended for pts that don't truly need 911 prehospital txp, of course, after having had a full and proper assessment.

Another PITA pt is one that calls, then needs to pack all their bags, use the bathroom, call five seperate family members, get dressed (even though we put our pts in gowns typically), three family members also want to travel in the ambulance when there are several cars in the driveway (hint) etc.

It also gives me head pain to see the family following by POV when we're txp'ing the non acute pt.

 

[MrBrown]

We have been leaving people at home since 1972, it works well, perhaps once your Ambulance Officers recieve adequate education then you too can leave people at home.

 

[abckidsmom]

We have been leaving people at home since 1972, it works well, perhaps once your Ambulance Officers recieve adequate education then you too can leave people at home.

I've heard you say this several times. Can you explain how it works?

 

[njff/emt]

I had a pt today(IFT) that was sorta a PITA, the thing about him that annoyed my partner and i was he constantly was yelling we were trying to kill him(in the ER mind you), and a whole bunch of other stuff., When i talked to their friend(he was a hospice) they told me he wasn't fully there cause of all the pain meds(there were ALOT of meds)., Does anyone know of afew pain meds that can cause someone to get a little loopy cause i really cant figure out which ones.

 

[jjesusfreak01]

Here we have advanced practice paramedics (APPs) that can do redirects. Any medic here can leave people at home if they don't need to go and they don't want to.

 

[WVEmt]

We have been leaving people at home since 1972, it works well, perhaps once your Ambulance Officers recieve adequate education then you too can leave people at home.

does the nremt cert carry one over there? lol.

 

[46Young]

PITA pt: a (usually drunk) pt that's all bloody, that climbs up into your ambulance, then touches everything possible along the way - the door handles, the bench seat, the captain's chair, the O2 tank, the monitor, your uniform, the cabinets, every strap within arms reach, etc. Bonus points for spraying blood while they talk or cough, before you can get a mask on them.

 

[MrBrown]

I've heard you say this several times. Can you explain how it works?

Sure.

If the Ambulance Officers attending to the patient think they do not need to be seen by a doctor or require further monitoring then they can decline to transport even if the patient requests it. Once any significant intervention (defined as a drug or IV fluid) has been administered then the crew must transport. Exceptions to this are hypo's and seizures who have recovered normally.

does the nremt cert carry one over there? lol.

Short answer is no.

 

[Melclin]

We have a similar system of not transporting to NZ.

American EMS types seem to get the collywobbles about not transporting. People don't magically get better because they get taken to ED (although, it does shift the blame when the lawyers come a runin' :wacko: ). Besides, I hate this "Even if there is the remotest of possibility of there being something wrong, we should transport" idea. There is ALWAYS the possibility that something might be wrong. But we cant put every cough and tickle in the Royal Melbourne's medical ICU now can we. The health care system needs to make educated guesses if it wants to function. Paramedics are part of that healthcare system.

How much does a visit to the GP cost in America anyway?