Ridiculous people = Ridiculous calls

[medic417]

Good lord, I agree with you!

The apocalpyse... The apocalypse is a'comin!

lol:blush:

 

[PapaBear434]

We do have to educate our patients but that should be happening on scene. People call us because they are scared that their problem is life threatening. When our primary concern is to avoid being sued and implementing protocols instead of treating patients, our care suffers. We will bring in that infant who's mother accidently cut her fingernails too short (actual call for me) and the broken/sprained wrist even though they could probably be seen in their doctor's office instead of the ER. Why? Because of the what if's and our own uncertainty.

Better understanding of body systems not only helps us find those hidden problems underlying the cc but also will give us the confidence to say "You should probably get that treated but you really don't need an ambulance" Someone can be sick and be non-emergent.

I had one similar over the weekend. A woman called because her 14 month old's nose wouldn't stop bleeding. Bright red, not coughing up, seemingly not draining back. We took a look at the little guy, who was cute as a button and had a lot of blood all over his sleeve. Bleeding seemingly controlled by the time we got there.

Shining a pen light up his nose showed two scabs on either side, right inside the nostrils. It was still leaking out a bit, and when he felt it, he wiped his nose on his sleeve. But the little guy did it so hard, that he tore his scabs open and he started bleeding again.

I asked if he just had a cold recently, and Mom said he's had a runny nose all weekend.

Well, we logically inferred since there was nothing else wrong with the little guy that he probably just had a runny nose, and with how hard he was jamming his nose he was probably making himself bleed. And when he felt THAT, he wiped even more, keeping the nose bleeding. We told Mom that if she was worried, we'd take him, but that he appeared to be completely fine/non-emergent and that he's probably fine. But if she was worried later on, that she could take to the emergency room herself or just call us back out.

On my way out, I taught the little guy how to give me a fist bump and a thumbs up, and bid them good afternoon.

I think if we got better educational standards and a standard licensure program, we could reform EMS into a potential treat-and-release operation as well as emergency transport/rescue. Think of paramedics like mobile nurse practitioners. It's not likely to happen, because no city or state government is going to want to pay for it. But I think it would greatly cut down on OVERALL health care costs, as needless transports and emergency room visits could be dramatically cut back on. Just have a medic come out, check someone out, give them what they need in a non-emergency situation (sometimes all they need is a professional opinion and reassurance), and send them on their way.

Yeah, we'd still have pointless calls (like another I had on Saturday for a woman complaining that her Potassium was a little high), but we wouldn't have to tie ourselves up transporting them and we wouldn't have to clog up the already overworked Emergency Department with people complaining of infected hangnails.

 

[Aidey]

I used to work as a stand by medic in an industrial setting, and one day the cook came into my office complaining that he had been experiencing an ear ache for the last 2 days. Vitals were all normal, I dig out the otoscope and take a look. His L ear looked fine, but the R ear had some blood evident behind the ear drum and copious amounts of ear wax. I called med control, got orders for antibiotics, and the doc recommended a couple of gentle warm water flushes to get the wax out.

So I pulled an 18g catheter off an IV, hooked it up to a 10cc syringe and went to work. Nothing. I had done this before and it had always worked really well, but for some reason none of the wax was coming out of this guys ear. I get the otoscope out again and take another peek and observe that the clump of ear wax has moved, but is still there. At this point I'm starting to think "wow, that clump looks pretty strange". I rinse again, and this time it starts to come out a little. Acting on a hunch I got out the tweezers and extracted the "clump" from the guys ear.

Turned out to be a toothpick. It had perferated the ear drum, causing the blood. The patient swore up and down he had no idea how it got there. I called the doc back and had a very hard time keeping a straight face while telling him about the new development in the case.

 

[jochi1543]

Yeah, we'd still have pointless calls (like another I had on Saturday for a woman complaining that her Potassium was a little high

How in the world does she know? Do they have home tests for it or something?

 

[PapaBear434]

How in the world does she know? Do they have home tests for it or something?

Guess I should explain a bit better.

Her grandson took her to the doctor on Friday, as she was feeling a little tired. Doctor told her that her potassium was PROBABLY high. Told her to take her insulin regularly (as she wasn't) and she should be fine.

She called us the next day, as she didn't feel quite right and the Doctor didn't want to deal with her. So, we showed up, she was in her motorized wheelchair with only one leg amputated and the other paralyzed. She was barely five feet tall and weighed close to 220 lbs. She was in her coat, had her purse, and was ready for the taxi ride to the hospital while talking to her friend on the phone.

She didn't want us to take her sugar, either. Just kept telling us that it was fine, but wouldn't give us a number nor give us a finger to do it, even though she was extremely diabetic.

We just transported to the hospital, took some basic vitals and dropped her at the hospital like she wanted. Meanwhile, there was a stroke patient and a woman with an ectopic pregnancy in our first run area that had to be taken by other squads.

 

[rescuepoppy]

^^^^

I think alot of these "BS" calls could be resolved with a better dispatching system.

The only way I can think of to resolve the "BS" calls is if you have the right to refuse to send out an ambulance. I work part time as an EMD I am not going to put my certification on the line by telling someone they do not need an ambulance. In a dispatch setting where you use EMD protocols any call you can imagine is covered under the EMDPRS cards. When the caller can give no specific complaint or their complaints don't fall under a specific guidline you just go to the "sick call" protocol this still is a reason to send out an ambulance. About the best you can do is to prevent unneeded "hot" responses.

 

[flywnc]

The only way I can think of to resolve the "BS" calls is if you have the right to refuse to send out an ambulance. I work part time as an EMD I am not going to put my certification on the line by telling someone they do not need an ambulance.

The agency I work for has the ability to transfer a very low priority call to a 'Nurse Hotline' (pretty much just a ED nurse at a desk) and if the nurse, dispatcher, and caller agree, the EMS unit will be canceled off the call and caller can get family/public transportation or such to take them to an area Urgent Care instead of using an ALS unit to transport them to the ED with a chief complaint of 'foot pain x10 days'.

We've only recently started this, but so far we've had pretty good results, although you still have those who demand a ambulance transport.

 

[medic417]

The only way I can think of to resolve the "BS" calls is if you have the right to refuse to send out an ambulance. I work part time as an EMD I am not going to put my certification on the line by telling someone they do not need an ambulance. In a dispatch setting where you use EMD protocols any call you can imagine is covered under the EMDPRS cards. When the caller can give no specific complaint or their complaints don't fall under a specific guidline you just go to the "sick call" protocol this still is a reason to send out an ambulance. About the best you can do is to prevent unneeded "hot" responses.

I disagree with not sending the ambulance to. It is hard to get accurate info from caller and is impossible to do an exam without seeing and touching patient. Now once on scene and following an exam we should have the right to say no you do not need an ambulance, heres your bill. Have a nice day.

 

[flywnc]

I disagree with not sending the ambulance to. It is hard to get accurate info from caller and is impossible to do an exam without seeing and touching patient. Now once on scene and following an exam we should have the right to say no you do not need an ambulance, heres your bill. Have a nice day.

There is no charge for treatment here, only charged if transported, so we collect no money for that run unless the patient is transported. I work in a busy urban area and the less BS we have to deal with the better. The whole protocol is contentiously reviewed by the Medical Director and a board of other health care professionals.

They have been doing this in the U.K. for several years now with excellent results.
I don't know of any other way you could reduce the amount of unnecessary calls without a program like this.

EDIT:

A ALS unit is dispatched as soon as the call is received just like any other 911 call for service. We are only canceled if it has been resolved before we arrive on scene.

 

[rescuepoppy]

The agency I work for has the ability to transfer a very low priority call to a 'Nurse Hotline' (pretty much just a ED nurse at a desk) and if the nurse, dispatcher, and caller agree, the EMS unit will be canceled off the call and caller can get family/public transportation or such to take them to an area Urgent Care instead of using an ALS unit to transport them to the ED with a chief complaint of 'foot pain x10 days'.

We've only recently started this, but so far we've had pretty good results, although you still have those who demand a ambulance transport.

Sounds pretty good. Keep us up to date on how it works.