May 18, 2012

EMS Tour 2011

I have always been of the belief that someone with enough time and knowledge could travel completely across the United States all by calling 911. Would this be illegal? Perhaps. Would this prove a point that abuse on our system is out of control? Absolutely. Is anyone actually going to attempt this? Probably not.

To pull off such a project would require some serious homework on the front-end but it could be done. You would have to plan a route based on hospital locations and ambulance service areas. For the most part, you could probably get where you needed by using the old “patient choice” routine and demanding that you be taken to the furthest possible hospital.

You might run into some problems once you hit rural areas with only 1 hospital. However I would imagine that you could pull the cardiac chest pain card to be transported to the closest cardiac facility. Hell this tactic could buy you nearly 100 miles a whack.

Here are some of the bigger hurdles that you probably face:

  • Crossing state lines.
  • Traveling across large areas with little to no population.
  • Leaving big cities.

I would imagine that you would have to plan your route carefully to avoid getting transported to a large metropolitan area. For example, if you made it to my town, you would be hard pressed to get an ambulance crew that would take you outside of our metro response area. It would violate transport protocols and take us out of our area. Now if you were in one of our rural communities that we serve, you could go pretty much any direction you wanted.

Crossing state lines could be hard but not impossible. I do know of several areas in California that transport to Nevada hospitals so I would imagine that it wouldn’t be too different in other areas.

I think the biggest problem would be hitting areas like Texas, Arizona or New Mexico where there are really long stretches of road without any sign of civilization outside of the interstate. This would require some carefully planned routing to avoid getting stuck in these areas. Then again, just hit your head on something and pretend that you had a loss of consciousness. I’m sure you could find some yahoo to launch a helicopter for you. I hear trauma centers have the best lunches.

By the time you reached your final destination, I would imagine that you would have real medical issues to be addressed. After all, spending months on ambulance gurneys would probably leave you in a wheelchair and eating all that hospital food would most likely cause kidney failure, GI issues or maybe even high blood pressure. If you did happen to survive the trip, you might as well just hop the next plane to Europe because you are never going to pay off all those medical bills. On second thought, nobody else pays them.

It would be interesting to see if this would actually work. Of course I don’t ever want to take an ambulance out of their area and possibly deny the service to someone in need, so I would never encourage anyone to attempt this. It would be a fun project to actually do the homework and plan the route. Leave the trip to everyones imagination.

I bet this would make a pretty cool movie.


Can you call a bluff?

Your ambulance is dispatched to a scene for a complaint of seizure activity. You are arrive on scene to find a young male in his 20′s shaking violently on the floor. Your initial reaction is to protect his head and place him on high flow oxygen. You instruct your partner to place him on the ECG monitor and get your narcotics. Your just about ready to start your IV when you glance at the ECG and see a rate of 60 beats per minute. “Wait a minute, 60?”.  You then tug at his arm and pull it towards you with little effort. He then pulls it back with a few second delay. Having a pretty good idea of what’s going on, you stand back and say out loud “well I can’t find a vein, looks like we have to give rectal valium!” Suddenly his “seizure” stops and he immediately starts talking.

Obviously the patient above was not having seizure. Luckily you were able to figure this out. Had you have just assumed he really was seizing, you would have administered a controlled substance for no reason. Sometimes knowing when a life-threatening illness is not present, is just as important as knowing when one is.

Emt and paramedic school is great at telling you what to do when a patient complains of chest pain or has a seizure. Unfortunately, nobody really tells you the reality of treating patients in a pre-hospital setting. The fact is, people lie. People want drugs and people want attention. I really think that we need some some emphysis on teaching paramedics to detect when someone is “faking”.

In my opinion, part of doing a thourough assessment is determing whether or not the patient’s complaint is ligitiment. I wouldn’t give atropine to a patient in SVT, and I wouldn’t give nitroglycerine to a patient that was hypotensive. So why would I want to give valium to someone that wasn’t having a seizure?

Any seasoned emt or paramedic knows when a complaint is real or not. But this comes from experience in the field, not from training. At some point, we all had to learn our lesson from the one guy that fooled us. Why can’t this be taught as part of our detailed assessments?

I really think that we need to start training our paramedics the reality of working in the field. We need to promote having an open mind and realizing that things aren’t always as they seem.