Cab-ulance

I've been credited with initiating several partners with this term. I'm not quite sure how or where, since I don't recall first using it, but there you are. And I do tend to forget what I've said when I'm transporting a patient at 3am. Heck, one partner even said I used it over the radio when calling into County that we were enroute. Again, not something I recall.

At any rate, it's no secret around my dept that I have a deep and utter loathing for people who use the ambulance for their own personal taxi. Granted, there are exceptions to this, and I'm ok with that, and I've been told that other EMT's admire me for my 'outward' politeness to these system abusers (though my partners know full well what is going through my head at the time). I know many other EMT's and medics feel this way, and in fact, had an instructor in my EMT-I class who has been in trouble for taking a 'patient' (and I use the term lightly) to the hospital by telling the person to get in the back, and then getting back into the front seat himself, and dropping the person at the doors to the waiting room.

NOTE: I DO NOT condone this action. I did find it funny as hell when he related it to the class, and I wish to hell I had the cojones to do it, but I fear for my certification.

Here are some instances in which I have had the urge to tell the person calling an EMERGENCY VEHICLE for taxi-transport to F**K OFF!!!!

-the guy who has a history of kidney stones, thinks he's getting it again, and has abdominal pain of 3/10. Lives on a road that barely exists and is full of potholes. Has the energy to pack a suitcase, and wait for us at the end of the driveway, and then walk back up the driveway to the house to call 911 back and complain we aren't there yet, because we are lost. Upon putting his keys into his suitcase, I notice 2 car keys on the ring, and saw at least one car in the driveway when I was playing bellhop and loading up his suitcase into the ambo. Total time: 20 minutes getting to his house. 5 minute drive (no flashy lights or sirens because it's 2am) to the hospital, 15 minutes to put guy in triage and wait to give report to the nurse because the ED is full, 15 minutes back to the station.

-the mother who called 911 because her (old enough to know better) son was jumping on the bed and when the mattress slipped off, he cut his foot on the springs. Granted, the slice was deep, and probably painful, though the kid was remarkably calm, and definately needed stitches. Call comes in around 6pm, just as dinner is getting on the table. Upon arrival to the scene, there were so many cars in the driveway (and on the grass, and in the road) that we had to park one house away and walk everything in. Upon being told by the Lt riding charge that Jr needs stitches and a tetanus shot, but mom (or any one of the 15 adults standing around) can take him herself once we bandage the foot up (because arriving on the big white box with lights that aren't flashing doesn't mean you have to be seen immediately), mom states (and I quote) "Oh that's ok. Jr has never ridden in an ambulance, and thinks it would be neat, so we'll let you take him. I'll have someone follow in a car." Because clearly it is a priveledge for us to take your old-enough-to-know-better son and yourself to the hospital, just to take you to the waiting room (because both the adult ED and the peds ED are full) and listen to you complain that the wait will be too long.

-the 20-something year old woman who was complaining of lower back and flank pain on one side. Had no desire to go to the hospital, just wanted to know if she had a kidney infection. I almost hugged my Lt when he told her (with a straight face) that the ambulance's portable x-ray machine was broken and she would have to either go to the hospital or to her PCP. She didn't get it.

-if you cut yourself, and pass out at the sight of your own blood, and then call 911, don't get mad at me when I ask where the cut it. If I can't see it, it probably doesn't warrent a trip to the ED. Now, while I am not made sick at the sight of blood (my own, or anyone else's), I can understand that cutting yourself with a sharp knife is very painful and that some people have that reaction. I really am trying to be understanding and put your mind at ease. Your vitals are all fine, and the headache you feel is probably left over from the adrenaline rush which caused you to get all weak and wobbly anyway, and most likely is NOT from bumping your head on the cabinet as you slid to the floor. Oh, and having your wife constantly question me isn't helping...Man up, dude.

-Note to nursing home staff. I know it's hard to work in a nursing home, and I know the pay is crap. I know you have to pass a ridiculous amount of tests and audits and that you get treated like criminals every time a patient dies. Trust me, I've worked there....I know. But here's a few things I'd like you to think about....Just because the doc told you to ship the patient out to the ED because you woke him up at 2am because patient A has a cough doesn't mean you have to call 911. There are transport services around that can do the same job. The only difference between them and me is that I come in 5 minutes, after putting my own and other's lives in danger by running hot, and I don't charge a fee, unlike the transport service, that, depending on call volume, may get there in an hour or so, and will charge you.

Also, calling for the 'unconscious person' because you checked on them at 8 when you cleaned up their dinner tray and then didn't check on them again until midnight shift change won't go over well with me OR the medics when it turns out the patient was merely sleeping, and took out their hearing aides. Looking at me wide-eyed with astonishment when I was able to magically wake them up won't win you any points either. Obviously the patient is stone-deaf, and can't hear you whispering for them to wake up at the doorway.

As I said before, I've worked in nursing homes and such. I know the nurse to CNA ratio is low, and patient to carer ratio is extremely high. However, I made it a point to know my patients (and I was in a rehab place, so it was quick turn-around) so that if 911 did have to be called, I would know what was going on with them. Calling me for anything and having the CNA meet me, and tell me they don't know what's wrong with the patient is not helping you, me and most of all the patient. This is especially true for when you call me for a fall. If the patient falls, and you suspect something is wrong, PLEASE do not pick them up and put them back in bed, and then wait till the next shift comes in so that they have to call. Make them comfy on the floor and call and wait. I hate hearing the patient ask me not to hurt them again when I have to move them. It breaks my heart, and since it's been hypothesized that I don't have much a heart anyway, that is no mean feat.

And while I have several other beefs (especially with nursing homes), my last one is this. Many people go to a nursing home because they cannot be cared for at home. The vast majority of the time, these people are just waiting to die. Sorry to be blunt, but that's how it is. If I am old and sick, the LAST thing I want is to be moved from my bed and my belongings and sent to a cold, impersonal hospital to die. I have a DNR-B for a reason, and that reason is that I WANT TO DIE PEACEFULLY!!! I don't want to die with the sounds of a hospital ED being the last things I hear. So calling an ambulance for the 99 year old person with end-stage lung cancer and Alzhiemer's Disease who has a DNR-B, and at midnight shift change had a blood pressure of 50/10, a heart rate of 20, and a respiratory rate of 4-6 (and it's now 0130 because you HAD to finish shift change rounds) is probably not the best practice. Yes, I know you get investigated by the state every time a patient dies on grounds, but really? And yes, the doc told you to ship them out, (which I hate, because the patient is NOT a package to be 'shipped') but when you wake a doctor up at 1am and tell him the patient's vitals and not much else, what else do you think he's going to say? I really dislike transporting what is essentially a corpse to the hospital because you don't feel like doing the paperwork.

Being named the 'Angel of Death' by the ED nurses because 6 out of 10 patients I transported over a 2 day period (all of them nursing home patients with a DNR-B) took their last breath as I moved them over to the hospital bed doesn't make me much happier with you, by the way.

Perhaps this nursing home rant should be it's own post. I think it will be. But the next post I think will be one in which I discuss the times I don't mind being a cab-ulance. Those times include little old ladies or anyone who can't drive themselves for something that they otherwise would have.