What would you do with this patient?

[P_Instructor]

But should we just let it go after the proper people are notified? Don't we have a moral obigiation to follow up and see if they got the help they needed? In all honesty our system sucks it really does will this little man be one of the one's that falls through the cracks and is lost?

Dependant of what your laws state, here it is a manditory reportable case. We do not investigate, just report to the proper authorities. It is their job to investigate and then make recommendations, etc.

Dependant of what your laws state, here it is a manditory reportable case. We do not investigate, just report to the proper authorities. It is their job to investigate and then make recommendations, etc.

Yes you are correct, and it does suck.....many of these patients do 'fall through the cracks'.

[VentMedic]

But should we just let it go after the proper people are notified? Don't we have a moral obigiation to follow up and see if they got the help they needed? In all honesty our system sucks it really does will this little man be one of the one's that falls through the cracks and is lost?

You initate a paper trail and get the names/numbers of all involved. You can then followup with the Case Manager or Social Services or have you supervisor do so. It would be nice to have a system in place like Washington D.C. is attempting (although I believe that is just a media distraction from the real problems in taht department) or have a social services plan of care/action such as Lee County, FL has. You might email Nifty911 and see if he can send you his EMS system's protocols.

A few EMS systems have in the past tried to expand their roles in Public Health and also do welfare checks but often those working in EMS view these the same as they do nursing home transports. Lee County used to take a more active role and at one time several agencies were looking to them as role models for the future. At least they still have some contact with the Social Services agencies to provide some followup.

[WolfmanHarris]

But should we just let it go after the proper people are notified? Don't we have a moral obigiation to follow up and see if they got the help they needed? In all honesty our system sucks it really does will this little man be one of the one's that falls through the cracks and is lost?

And to be clear, under CREMS we don't just call and say "come see this guy." The expectation is that we discuss the case with CCAC in detail. They are provided with the run number and we document that interaction and it's details on the ACR. Not perfect, but short of medics actually then acting as worker for CCAC, I don't know what else can be done yet.

There is some very promising work being done in the Long and Briars Islands in Nova Scotia that are very much worth looking into. A far more proactive approach that may be a good direction for EMS in the future. Here we'll be running flu shot clinics in conjunction with public health.

This is where we enter a difficult issue, atleast under Ontario's PHIPPA laws. When my contact with the pt. ends, I leave the "circle of care" I no longer have access to their confidential information. Therefore it would be inappropriate and a breach to make formal contact after the call. Sure a crew could check in on a patient at the hospital or as they drive by, but it is a difficult gray area to stay in.

Part of it though depends on how much faith you have in your local system. CCAC has an obligation to make a home visit after a referral and I have no reason to doubt that they will do that and provide options for the patient. But that is the whole purpose of CREMS, was to ensure that we could get a patient access to the care they need and not leave it to the hospital (who never sees their homelife), to the patient at our suggestion, the family or chance.

Now if I feel there is abuse or neglect, regardless of the care or the referral, I will still make a call to PD and/or protective services to investigate further.

Edited October 10, 2009 by docharris

[VentMedic]

A good link for Elder Abuse laws throughout the U.S. and advocacy:

National Center for Elder Abuse

http://www.ncea.aoa.gov/NCEAroot/Main_Site/Library/Laws/InfoAboutLaws_08_08.aspx

Now if I feel there is abuse or neglect, regardless of the care or the referral, I will still make a call to PD and/or protective services to investigate further.

If the patient was in immediate danger and was not capable of making any decisions then the PD might need to get involved. However, there is nothing sadder than seeing an elderly person being forcibly removed from their HOME. I have had the displeasure of doing this when working as a Paramedic on ground EMS and you often wonder who the real criminals are. If another solution can be found through Social Services and Home Health to where the patient can maintain some dignity and independence, at least in their own minds, that would be a better situation.

Other health care professionals do actively participate in the advocacy for home health and Social Services issues. RT, Nursing, PT, SLPs, OTs, NPs and PAs all have a vested interest in advocating for legislation to protect the patients and provide more services. Unfortunately EMS has not gotten a large voice in this area or they are too focused on their own agendas.

[AnthonyM83]

Depends on how bad the place looks.

What you described is very very common in much of my service area?

It'd ba subjective decision. If the patient wanted to stay, I'm not going to intervene and make problems every time I saw that environment (I'd be doing it daily.)

*BUT* if I thought it was just absolutely disgusting and thought elder abuse of some kind might be going on, I'd report it after the call, unless it seemed immediately life-threatening. In which case, we might have to call a social worker then and there (if patient wanted to stay and it was life threatening almost).