It’s a beautiful Tuesday morning, and your comm center is directing you to move someone from a skilled nursing facility to a private residence.
You’ve checked, cleaned and counted everything in and on your ambulance, from the roof antennas to the lug nuts. You’re ready for the Big One, and that’s a fact. You’re on your way to a standby for fire at a burn-down, you’ve just picked up some drinks, and you’ve been planning to shoot some photos. The last thing in the world you want to do right now is take somebody’s nana home from a SNiF.
You and your medic partner, Eammonn, roll your eyes and groan like a couple of kids trapped by oatmeal. After all, you guys have skills. In your minds, a taxi call is the most boring, least significant thing you can imagine doing with an ambulance. It’s clearly a waste of your training, your experience and a perfectly good set of equipment.
Q. Don’t you think these kinds of calls should be handled by the newest, least-experienced crews of all? I mean, why take a 9-1-1 crew out of service to transport somebody home?
A. I think there will always be some exciting days for us, and some days that are anything but. There’s a reason why we call this work. Namely, it’s work. Besides, going home from a nursing facility may not be exciting for you, but it can be a big deal for somebody who’s been kept away from their most familiar surroundings for weeks, months or years. Not only that, but in a very real sense, you’re this patient’s last line of defense against a very bad decision; and to provide that protection, you’ll need every bit of your experience.
Q. What do you mean, a bad decision?
A. Home is more than a place; it’s a situation. And the circumstances surrounding some situations can be deadly for some people. Everything from trip hazards, to the layout of a home, to the contents of the refrigerator, to the people who live there can make it unsafe or impossible for someone to live at home. And very often the observational powers of a neophyte are oblivious to those things.
Q. What are you talking about? Obviously, the best place for anybody is at home. Home is certainly better than life in any care facility.
A. You’d think so, but the fact is, we’re in the grip of the worst global recession in history. And one of the first things that gets cut in tough economic times is social services. Most people don’t need social services, so decision-makers tend not to address them. As a result, we’re being called on more and more to notice unlivable situations in people’s homes. The longer a person has been away from home, the more suspect the home is.
Q. Surely you don’t think it’s up to us to evaluate the destination of every patient we take home from a hospital or a nursing home? I never signed up for that. Some things are none of our business.
A. I know it’s not mentioned in any training program I ever attended, and I certainly haven’t seen it mentioned in any EMS texts. But there are many things in a home that need to match a resident’s physical and mental capabilities. In many homes, we tend to be the only outside visitors. I think we need to start worrying about the kinds of things we see that are likely to produce emergencies. And I think it’s those of us with the most experience who are most likely to notice them.
Q. I understand about trip hazards and grab rails in bathrooms. But can you be a little more specific about other things that should get our attention?
A. Sure. Walk yourself mentally through the things a person must be able to do daily, like getting in and out of bed, getting to and from the bathroom, bathing, getting up and down stairs, and preparing, eating and cleaning up after meals. They need access to fresh food, medications, and transportation to and from a physician’s office. And finally, they need the capacity to manage their trash, clean their environment, care for their animals, and pay their bills.
Is the person you transport likely to manage all of those challenges, given your assessment of their physical and mental capacities? If they’re not, and they don’t have daily access to a support person, I think we can anticipate emergencies.
And if we anticipate emergencies, I think we’re responsible for preventing them.
Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail firstname.lastname@example.org.