Wednesday, December 2, 2009

I am NOT 911

So it’s about 3 am on a ‘work night’, meaning I have to get up for the regular job in about 3 hours. This is the worst time for me because it is right in the middle of my deep sleep period, assuming it is one of the rare nights when I can sleep normally. It’s hard to wake up and become alert at this hour.
The phone rings with it’s little ‘TWITTLY-DITTLY-BEEP” which at that hour and in my state of sleep, can sound an awful lot like my pager which sits right next to it on the shelf. I sat up getting ready to grab my socks and hear the call and location while I dressed. ‘TWITTLY-DITTLY-BEEP” it goes again and I realize through my stupor that it is the PHONE and not the pager. I pick it up expecting the usual wrong number. As I grunt out a “Hello?” a very grumbly low voice on the other end grunts out “I think she’s having a heart attack!”. The voice was excited and I am still not awake, I asked for a repeat: “I think she’s having a heart attack!” Now I’ve got it and I’m waking up. “Who is this?” I ask. “It’s Mary and I think Susie is having a heart attack!”. “OK, Mary, listen carefully, I want you to hang up the phone and call ‘911’, OK? I am on my way.” “OK” she says, “But hurry, PLEASE”.
So now I am awake enough to function and dressing quickly. It’s not my ‘on duty’ night but I always run on cardiac calls especially ones where I might make a difference. It is one of the true emergencies, and certainly worthy of ‘all hands on deck’. I know that the elderly woman who called lives in a retirement trailer just down the road from me and I can be there in quick order. I am halfway there when the page goes out for a patient with ‘severe chest pain, possible cardiac emergency at 119 WINDING MOUNTAIN RD.’ HUH? That’s 3 miles from here?! Well, what do I know? So I change gears and head to the new address, sliding up the hill and arriving at a mostly dark trailer home. We had to use mild force to gain entry because the patient was in too much distress to move. The dog barking, the patient yelling to us, firefighters and EMT’s walking around the premises looking for an entry point made the scene a little confusing as the snow fell to complete the effect.
As it turned out, the patient was experiencing crippling arthritic pain because she was non-compliant with her pain meds (“they make me all wobbly in the head”). We worked with ALS to do an assessment, get her packaged and out the door. Routine call, except for how it started.
I talked to Mary a couple of days later and found out that her best friend Susie had called her in the middle of the night to ask for advice about her pain. You know the rest. I told Mary that the next time something like this happens, please call 911 first, and then she is welcome to call me if she feels the need.
You would THINK this is a rare situation, but it happens a lot. Some folks mistakenly think I am their solution to all problems medical. Some folks think they can evade intrusive treatment if they just call me. I get calls for ‘lifting assistance’ and find a broken hip. I always tell them the same thing, “hang up, call 911, I’m on the way”.
I don’t mind helping, that’s why I’m here. I am happy to stop by and do a B/P on a patient to help them monitor their ongoing care or look up medication sheets and explain to patients what they say and mean. Things that others in the healthcare system SHOULD have done, but failed. But it’s hard to explain to people that when it’s an emergency, they need to call 911 and get the system in motion. It is equally hard to explain that if you can walk, and have transportation to take you to definitive care, it MAY not be an EMERGENCY. There is nothing more frustrating than being called to a residence at oh-dark-thirty for a belly ache. You assess the patient, they say they can walk fine, but want to go to the hospital. You walk them to the ambulance and the spouse/father/mother/boyfriend/girlfriend says “OK Honey, I’ll follow you to the hospital”. So I’m thinking “OK, so you called 911 and snatched 3 people out of bed (the BLS Crew, and of course you awakened many more that that when all those pagers went off), 3 people who have to go to work in a few hours, got an ALS crew on the road from Big City based on your chief complaint, PD rolled on the call because he knew we would have trouble finding your house (you never bothered to replace the numbers that fell of the tree at the end of your 200 foot driveway), and all the time, you have a perfectly good car in the driveway, complete with driver, and you want to walk to the ambulance anyway. Did it ever occur to you that if you had just gotten in the car, you would have seen a Doctor about 20 minutes sooner?” I’m a firm believer in EMS 2.0, and I would love to be able to make ‘house calls’ within the parameters of the system. Unfortunately, the system is not designed to always do what is best for the patient. Protocols are protocols and we need to follow the protocols. You call, we come, you get a free ride, even if you already have one in the driveway.

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