Some towns’ police departments call us to check out prisoners’ medical complaints, typically those suffering from jailitis. The cops get annoyed when we bring the stretcher in. He’s not going to the hospital, we just want you to check him out, they say.
If you want to make the cops happy, you finesse a refusal out of the prisoner. You say: “You look okay, sign here.”
But that is sort of against official EMS policy. In this state, we are required to offer treatment and transport three times before getting a refusal.
The issue of evaluations is murky. We cannot tell anyone they can’t go to the hospital if they think they are sick. You have a complaint, we transport. That’s the nature of the job. That’s how the system is set up.
So I ask the prisoner if he wants us to take him to the hospital and he says yes. When I tell this to the sergeant, he says, “Bull-!” He isn’t going to the hospital!”
I want to say, “Then why did you call us?”
It seems they want us to evaluate the prisoners so they can write in their report the patient was medically cleared, but we can’t clear people. It’s not in our scope of practice.
This has now been communicated again to the towns and for a little while now, we have stopped getting prisoner evaluation calls. But we do get other requests for evaluations.
We get called to evaluate the 2 year old who was locked in the car for ten minutes. We get called to evaluate the man punched in the nose. We get called to look at the scratches a woman got on her arm during a fight with another woman.
Your kid looks fine.
You got punched in the nose.
Yes, you have scratches on your arm.
The refusal form says “I am refusing treatment and/or transport against the recommendation of…”
But the thing of it is as a man of I hope some common sense I really don’t want to recommend to someone that they sit in a waiting room for five hours only to be told:
“Your kid looks fine — I mean he was only in the car for ten minutes.”
“Yes, you got punched in the nose. Medical science hasn’t yet figured out how to unpunch someone. Suck it up.”
“Yeah, those are scratches. Don’t lick them.”
Legally we have to recommend treatment and transport to everyone.
“While it appears you are fine and not hurt, legally I must recommend treatment and transport to you. It’s just something I have to do. It is standard policy.”
The other day we get called for a fall at a business. We find two women sitting on couches in the lobby. One tripped on the escalator, the other says she hurt her knee helping the other up. Two patients, one ambulance. I’m wondering if I need another ambulance. My first question is “What hospital do you want to go to?”
“I don’t want to go to the hospital,” says one.
“Me, neither,” says the other.
“I just want to be evaluated,” says the one.
“Me too. I just want an evaluation,” says the other.
What do I say:
1. “I have nothing available today, but I can try to fit you in at 10:30 tomorrow.”
2. “I can take you to the hospital and they can evaluate you there. In fact, I recommend (times 3) that you be treated and/or transported. If you refuse my recommendation (times 3), sign right here at the ‘X’ times one.”
3. “Evaluation! Get out of here! Just go on! Get! What are you doing? Calling an ambulance for an evaluation? Go on! Git!”
What did I do? I told them I could take them to the hospital where a doctor could evaluate them or they could go see their own doctor. They shrugged and got up and walked back to their offices.
Later the first responder told me the women had been joking while waiting for us (He had slowed us down to a non-priority response.) “Good thing we’re not bleeding to death.”
I guess I have no real problem with someone wanting to know my opinion. My problem is that I am not supposed to tell them what I really think. Or can I? I don’t think you need to go to the hospital, but you might want to go see a doctor or someone with more specialized training. I’m just a paramedic, and while I think I am good at my job, legally I can’t give you the medical opinion you seek. If you don’t want to go to the hospital with us, we just ask that you call us if you change your mind or your condition changes.
That’s what I say and it usually does the job.
I don’t know why I get so worked up about it.
Nature of the business, I guess.
As far as the cops go, if they don’t want the patient to go, I say, well, he may not be hurt or sick, and I’m not convinced he is, but if he wants to go and you don’t want him to, then I’m going to need you to sign my run form, clearing me from liability.