On another site I keep a daily journal. I record evey call I do in a day along with some observations. It is from this journal that I draw most of the material for this blog. Here I try to write simple stories that I have given some thought too. There I just write whatever I think of when I get home. Some days its pretty boring, some its repetitive. Because of the nature of confidentiality, I don't use my name on that site because it identifies the calls as date specific, and even though I may change many of the details, I just prefer to leave it more anynomous. Reviewing what I have written over the last year, shows too many days when all I am writing about is a broken EMS system. Here is part of a recent entry(I did rewrite it some. I can't help myself).
A 97 year-old-man whith a poor gait falls twice in his apartment in a residential community. He is not hurt, but according to the nurse he is not as spry as he used to be(like when he was 96) and hasn't been eating as much and, fall once, you get a free pass, fall twice, it's a trip to the hospital. We go to a distant hospital because that's where his doctor is based, not that his doctor is going to come in and see him on a Sunday.
A nursing home calls a commercial service to transport a patient not as responsive as usual, which usually isn't much. The commercial call-taker hears the word "unresponsive" and passes(as directed by state mandate) the call to us -- the local 911 provider. Because it is now a 911 call, our police dispatcher sends two police cars lights and sirens, in addition to us, who are coming from the distant hospital. The cops skid into the curb, run inside and find no nurses or aides. They find a patient "not breathing" and put her on oxygen and she immediately starts breathing. They finally find a nurse and what develops is a heated arguement about elder abuse, complete with "I want your name" and "I want your name."
That's when we come in. Now I have often been to this nursing home and found patients in dire straights with no nurses anywhere to be found to give me a report, and the nurse who is here today is one of the worst offenders, but when I enter the room, the patient seems fine. She does have periods of apnea, but I have taken her in before and that is normal for her. Sometimes she just isn't as perky in her semi-responsive way as she is on better days. The patient has every diagnosis possible: CVA, Dementia, diaylsis, MI, CHF, NIDDM, Alzheimers, HTN, Seizure, etc. And of course she is a full code. I guess the officers came in during one of the apnea periods. They thought she wasn't breathing, they put her on an 02 mask and whalla, she started breathing.
The officers should never have been sent in the first place. It was after all just a nursing home "emergifer(emergency transfer/unscheduled transfer)." And of course they were never told it was an commercial pass. They thought they were responding to a life and death emergency. They found a patient "not breathing" unattended by a nurse or even a nurse's aide. From where they are coming from, they were rightly upset. But to the nurse it was just a transfer and she had other patients to attend to because the truth is nursing homes are notoriously understaffed.
I love being a medic and like working on the regional EMS committees. But somedays I wish I was in charge of the whole shebang with unlimited power, then I could fix some of these things. Fix the apnea in the system.
