Medic 21 responds to a call for a fall victim. Dispatch updates with the information that an elderly man has fallen down a flight of stairs and is unconscious. Porter First Aid responds also with three volunteer EMTs.
When Medic 21 arrives, First Aid already has the patient in their ambulance. Terri, one of the EMTs, reports that the patient fell down a flight of stairs, was unconscious, then was carried upstairs and put to bed by his daughter, a nurse at Porter Community Hospital. She says the patient is confused but conscious.
Terri says the daughter has been adamant about the patient going to Porter. To confirm her words, the back of the ambulance flies open and the daughter yells, “Under no circumstances are you to take my father anywhere but Porter!”
What Terri and the medics know is that Porter is a community hospital, while just two miles farther is a Level I trauma center. The medics try to talk to the daughter, but she keeps yelling, “Let’s go, let’s go, what are you waiting for?” At this point, they have not yet examined the patient.
Mark, one of the medics, exits the ambulance to attempt reasoning with her, while the other medic, Dave, has a chance to do an assessment. Mark soon learns the woman is nearly hysterical and not listening to him. He remains patient and calm, but it is having no effect. He is trying to provide good service by explaining the situation, but she refuses to pay any attention.
Meanwhile, Dave has learned the patient remains confused, A/O X1 only, and has blood dripping out of his left ear. There is also an obvious separation stain on his shirt over his left shoulder. Terri says she tried to explain to the daughter the significance of these findings and the need for a trauma center, without avail. Terri and Dave doubt she really is a nurse.
The medics confer and agree they are going to the trauma center. They tell the daughter that they are sorry, but the patient must go there. Mark calls medical control and explains the situation. He also tells the ED to have the patient representative handy and that security will be needed.
After transferring the patient to the trauma team, they brief the patient representative, let security know what is going on, call the nursing supervisor and page the EMS supervisor.
The daughter, who tailgated the ambulance all the way to the hospital, was angry, upset and extremely agitated. It turned out she was not a nurse, but a secretary at Porter. She was also the niece of the CEO of that same hospital. She started making phone calls.
The patient was subsequently diagnosed with a basilar skull fracture and an acute subdural bleed over the frontal lobe. He was admitted to the ICU.
What do you think happened to the medics? Nothing. They provided excellent customer service. They recognized that the needs of their most important customer, the patient, superseded the wants of the daughter. Making that decision required confident knowledge in their local protocols. Unfortunately, the daughter refused to be served. They had notified all the other parties that were sure to be involved and they were in fact praised by the ED doctor for their judgment. No apology was ever received from the daughter.
Handling Difficult Situations
What do you do when you have been considerate and respectful and the customer simply will not listen? You owe it to yourself to do whatever possible to gain their understanding and cooperation, while documenting everything in case you need to complete an incident report following the call. You should always write an incident report whenever there is a significant conflict with anyone on a scene.
Doing something that the patient needs, but goes against what the patient or family wants, puts you in a difficult situation. Being confident that you are right is important. If you are unsure of yourself, get some help by contacting your medical control, your supervisor or even the patient’s doctor. Unfortunately, there will be several people
looking at your decisions and making their own judgments after the fact.
Was this customer right? No way! It is a fact that not all people can be pleased. Always remember, it will be hard to fault you if you are following your protocols and have your patient’s best interest in mind.
Paramedic and nurse Chris Hendricks has been in EMS since 1994 when he joined the Ortley Beach First Aid Squad. When he authored this article, he was a field instructor with Pridemark Paramedics Services in Boulder, CO. He now works as a paramedic and ER nurse, and serves with the Wyoming Air National Guard as a flight nurse. He will be receiving his Masters of Science in Nursing Education in summer 2011 and is a certified emergency nurse and a certified forensic nurse.