Too Busy

Writing about the daily life of EMS always creates a tension for me. On one hand I want to write about the nobler aspects of the job, on the other, much of the job is so frustrating you just want to scream. I try to avoid whining so most of the time I ignore it. I just came back from the EMS EXPO — all fired up as always to go out and do great calls — and as always happens instead of coming back to use your new skills in airway management or cardiac arrests, you get crapped on.

Yesterday was abuse EMS day. Most of the time when we think about EMS abusers it is the poor people who call for an ambulance because they have no primary care doctor and no ride to the hospital. Yesterday was two different, but in my opinion, worse offenders.

Call number one was for “high blood pressure.” An ambulatory, working patient with mental retardation, who takes his blood pressure twice a day with one of those drug store home automatic BP cuffs, had a pressure of 150/100 while at his job. Since this exceeds his parameters — 140/90, his case worker’s “protocol” is to have him transported to the ED, and of course that means calling 911. She said to my partner, the ambulance and the hospital seem to always get upset when she calls, but “I’m are just following our protocol.” My partner said maybe your need a new protocol.

The other call ticked me off even more. A doctor’s office calls 911 for “heart failure.” The patient at the office for a scheduled stress test has been gaining fluid in recent days. Her respiratory rate is 20, her SAT on room air is 95%, her end tidal is 35, her heart rate is 60, her pressure is 150/90. She is a direct admit to one of the floors. The office says they will fax her info to the floor and they get upset when I ask for a report. Why do I need her information when I am just taking her to a floor where they have already talked to the people who will be taking care of her? I ask them why they called 911 for a direct admit, they said when they call the commercial ambulance it takes an hour and they are “too bust to wait that long” at their office. It takes an hour of course because for direct admits the ambulance company has to get the patient’s insurance company to approve the transport since it is not an “emergency.” I am supposed to call the commercial ambulance to come and take the direct admits because as the town 911 ambulance, we don’t do direct admits, which often take a great deal of time because the hospital is not ready for the patient – we only go to the ER. What I end up doing is taking the patient to the ER anyway, and then telling the triage nurse the patient may be a direct admit, and if the room is ready, then I take them up to the floor. If the room isn’t ready, I leave the patient in the ER. That way, my run form shows I took them to the ER, which means their insurance will likely pay for the ride, instead of jobbing them with a $300 plus unapproved bill. I just resent the attitude we’re too busy to wait for a commercial ambulance. We get better service with 911. On the one hand, you want to say to the office, we’re not taking her. You’re going to have to call the commercial. On the other hand, you have an innocent old woman sitting there and you don’t want to put her in the middle.

And we also did a bunch of fender bender MVAs my neck hurts.

The only good thing about the day was we had an unresponsive diabetic at a nursing home. I brought her around with some D50, had them call her doctor back. The patient had been given insulin that morning, but had not eaten and the home’s glucometer was off. They had a reading of 78. Ours was less than 20. The doctor canceled the transport.

3 Comments

  • Anonymous says:

    I do some part time work for a commercial service with similar work to that which you described in your posts over the past year. We get treated the same way. We have a contract with a government agency to be the sole provider of services for their transports to and fro. One instance with them the other day consisted of us getting called to transport a trauma patient to a trauma center since, “We’re a medical facility, and this guy is a trauma patient.” He was 48 hours post car accident and looking like a got ran thorough the wringer.He’d come into the facility because he knew there wouldn’t be a charge since he’s in the client population served by this facility and they listened to him say that he’d been in a car accident. Nuff said. They threw a c-collar on him, did some x-rays of the back, and had him sit in a chair. When we arrived, nobody had any history on him, no meds, no info, no IV. We ended up starting an IV, running a bit of fluids, and doing a head to toe — in the hospital.It took 40 minutes to find out whether his x-rays were cleared. On arrival to the trauma center, I gave report and when I described my findings, a stat CT was ordered. Nobody at the hospital seemed too interested in getting a good history.In another case, we went to a hospital in town to pick up a patient of theirs for transport. The nurse walked in the room when I arrived, said, “He’s got all these bags” pointing to four black garbage bags of stuff, and walked out. No report, no history, no nothing. Just sort of a, “Screw you, and screw this patient” attitude.Sometimes people have to wait because we’re busy waiting for radiologists to call down with results, or waiting to get insurance information, or waiting to get a room number for the direct admit. We won’t transport without payment arranged in advance. I have personally been handed checks for thousands of dollars, or called in credit card numbers. I don’t like doing it, but I also respect that the company can’t get stiffed on a 4 hour transfer.In one case recently, we had to wait 2 hours for hospital staff to show up to actually tell us where the patient was. Nobody was scheduled in this wing until 6 am. We arrived at 4 am. Then they cancelled the call. We could have taken another call in the time it took to wait. I felt like nobody even cares about the service we offer or that our time is important too. It really bothers me because in the case of long distance transfers, I spend more 1:1 time with a patient than just about anyone else.What a terrible deal. Somebody, and I don’t know who, got a bill for that one.

  • PC says:

    Thanks for the interesting comment.

  • denvermedic says:

    ooooh, don’t even get me started about those first two (the htn and the direct admit ones) – i feel my blood pressure rising with both of those. i remember a call we had (of course it was emergent) to a health fair where nurses were doing bp checks. a rather large woman had her bp checked by the only cuff they had, and of course it was too small and it was electronic. came up with some crazy high number. i got a large cuff and auscultated a bp that was borderline htn – something to talk to your doctor about, nothing to go to a hospital about. the patient didn’t want to go to the hospital and nurses were nooooot happy – they thought i should make her go.those direct admits kill me every time, especially when the facility just hands you the paperwork and gets mad when you want a report. then they really don’t like it when you calmly explain that you are the 911 system, not a private ambulance service, and this patient will have to go to the emergency department as that is the only place we take patients to.for what it’s worth, this is me being brief. i could spend hours (and probably only make myself mad) about the ridiculousness of it all.

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