You, your partner and an intern from a local community college are sitting around the dayroom table at the beginning of your shift. You're engaged with the other crews in a free flow of jocular sarcasm about your system's patient from hell-a frequent flyer the offgoing shift just transported to a nearby ED.
Marie Elbert is a 40-year-old, 500-lb. hypochondriac who talks explicitly about your roles in her sexual fantasies, pees in her bed for no particular reason and generally lives like a pig. Her landlord informed her yesterday she is being evicted. Last night, she got into a screaming match with her psychotic nephew over her welfare funds and claimed that provoked an asthma attack. When the crew arrived, they found her faking apnea and unconsciousness. Of course, she lives upstairs, and the closest elevator is in Kansas.
Crews have tried everything to get Marie to move there (to Kansas), actually. They've involved social services, cajoled, lectured and called the cops. She seems bound to this subsocial lifestyle, and she likes living in your district.
Q. Isn't there some way to eliminate some of these stupid calls?
A. I get ridiculed for this, but I really think we label too many calls stupid. There are plenty of calls that don't make sense to us at the time of service, but there's always a reason why people do what they do. What makes a call seem stupid too often boils down to stuff we don't know. You can laugh and say "Thom's on drugs," but if you stay in this biz, you'll see it happen over and over again.
Q. OK, tell me this isn't an example of a stupid call.
A. I can't disagree; it sure seems that way. In fact, you could probably use some calls to define the term stupid. Some patients' needs just don't fit the designs of 9-1-1 systems. There's overlap built into every system, and every once in a while somebody like Marie figures out how to use it. But "stupid call" is a term you should probably watch for in your vocabulary-like a vital sign. If you find yourself saying it a lot, maybe the communications center is not doing its job. Or maybe you're becoming cynical.
Q. There must be a way to screen patients like this out of our emergency responses. She clearly and flagrantly abuses emergency services, and ours in particular.
A. We're the Every Time people. We always respond. The last person you would ever want to screen out of a 9-1-1 system is one who has everything to gain from a lawsuit and nothing to lose. As things are, she's an offender. Don't let her trap you into making her a victim. Sure enough, the one time you blow her off will be the time when something goes really wrong. Let's face it: She's about one cookie away from the big one. You make one faulty assumption about somebody like that, and they win. Next morning, your mom gets to read all about you in the local paper.
Q. So, what? Do we just keep on responding until she dies or moves out of our district?
A. Depends on your documentation. Plenty of EMS crews, cops and social workers have been grappling with this very issue for years, and so far nothing works better than good documentation (eventually, at least). Make sure that every time you see this lady you consistently provide the social services people at your local ED with plenty of usable documentation about her ability or inability to care for herself. Usable means detailed, but always objective. I have been told repeatedly by social workers that prehospital charts should be as clear of adjectives and as full of details as possible. Adjectives express opinions and are subject to other people's interpretation of what you mean. Details are unembellished observations, like what you personally see, hear and smell.
Actually, it turns out that's a good way to write any medical document.
Thom Dick has been involved in EMS for 37 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 EMS Magazine's editorial advisory board. Reach him at email@example.com.
Thom Dick is a featured speaker at EMS EXPO, October 11-13, in Orlando, FL. For more information, visit www.emsexpo2007.com.