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.
